Author Topic: How much will non-vaxxing by GOP reduce the population of voting age republicans  (Read 86612 times)

Metalcat

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Thanks Abe.

NaN

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As much as the comparison to AIDS infuriates me - @Abe I think there are plenty of differences - I would 100% agree that there is no short term chance that hospitals do anything other than provide the best care for unvaccinated COVID patients.

Long term, I think the biggest change will first be in the US health insurance industry. Companies with high vaccination rates may be offered plans with lower premiums. Hospitals can start passing on more charges. As much as I hate the health care system in th US I expect those to show up before changes in hospital care priorities.

former player

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Just to say, I wasn't proposing "don't treat unvaccinated covid patients in the ICU because they are bad people for not getting vaccinated", I was saying "don't treat unvaccinated patients in the ICU if with their co-morbidities heroic efforts are 99.9% likely to be futile and several other people's lives and qualities of lives could be saved instead during the several weeks they will spend unconscious and dying".   If a hospital has all the ICU beds, and staff, that it needs to treat everyone for as long as there is brain stem activity, by all means torture 99.9% of them to death slowly just in case 0.1% of them might survive with lifelong disabilities.  But if a hospital doesn't have all the ICU beds and staff it needs to treat everyone then the QALY (Quality Adjusted Life Year) comes into play, and the covid patient with co-morbidities who would need ICU care and perhaps be unconscious on ventilation for weeks and still be 99.9% likely to die because they didn't get the vaccine and their body can't cope with the results shouldn't crowd out the cancer patient or the trauma patient or the patient needing a transplant who will have better chances of surviving for years with a recognisable quality of life.

Survival statistics for vaccinated patients needing hospital and ICU treatment are very significantly better than for unvaccinated patients.  The same issue could arise for vaccinated patients with co-morbidities, but probably not in the numbers where vaccinated patients having ICU treatment are crowding others needing care out of the ICU.  Which is why the "unvaccinated" bit matters: it is the decision on rationing care that arises because they are unvaccinated, and the consequences of making that decision would be the same for both vaccinated and unvaccinated - except that if people are vaccinated the decision either never has to be made or can be made on the basis that the vaccinated person has the better chance of survival with a better quality of life.
« Last Edit: September 30, 2021, 06:07:55 AM by former player »

LennStar

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Thanks Abe for you well thought post.
The whole topic is a very hard one and anger or fear are never good advisors, especially here.

It is also hard to put an end at a specific point except the start (not judgement at all) - it's a very, very slippery slope. One where you end with euthanasia for people who are uncurably sick, like with the sickness of homosexuality.

As Terry Pratchett put it in regards to assisted suicide: Spain does not have it because of too much religion, and Germany does not have it - very emphatically does not have it - because of too much history.

I lived most of my life a mile away from a psycological facility where insane people were gassed in Nazi times. I stood there in the gas chamber.
The people doing the gassing where simply doing their job, helping good Germans survive by cutting off "unworthy life" (lebensunwertes Leben) from the German society. They weren't murderers, right? Or wrong? What is the difference between in insane (or comatose) taking up care capabilities and a non vaccinated person? Their decision? If you kill people because they made a stupid decision, nobody would surive long enoug to get into school.

I am very interested in Japan. There are several types of yokai (monster) that are based on children that have been killed by their parents in times of e.g. starvation. Kill one to safe the rest. Is that moral?
The Zashiki warashi is one of them and it is said that this yokai, that can sometimes be seen as a small child, is protecting the houses of their killer/parents and sneaking into their beds.

Does that sound like the people involved thought the killing was a moral thing to do? I don't think so.


As much as the comparison to AIDS infuriates me - @Abe I think there are plenty of differences
You might say that. Many people (the vast majority) 50 years ago did not. In both cases: AIDS and Covid (because of not vaccinated) were the result of the patient's moral failings.
So if saying we should let non-vaccinated die because of their decision is okay with you, but letting people with AIDS (or even at the beginning: homosexuals (which were thought to be the only ones who got it)) die is making you angry: Are you sure you are making a unbiased decision?

partgypsy

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Thanks Abe for you well thought post.
The whole topic is a very hard one and anger or fear are never good advisors, especially here.

It is also hard to put an end at a specific point except the start (not judgement at all) - it's a very, very slippery slope. One where you end with euthanasia for people who are uncurably sick, like with the sickness of homosexuality.

As Terry Pratchett put it in regards to assisted suicide: Spain does not have it because of too much religion, and Germany does not have it - very emphatically does not have it - because of too much history.

I lived most of my life a mile away from a psycological facility where insane people were gassed in Nazi times. I stood there in the gas chamber.
The people doing the gassing where simply doing their job, helping good Germans survive by cutting off "unworthy life" (lebensunwertes Leben) from the German society. They weren't murderers, right? Or wrong? What is the difference between in insane (or comatose) taking up care capabilities and a non vaccinated person? Their decision? If you kill people because they made a stupid decision, nobody would surive long enoug to get into school.

I am very interested in Japan. There are several types of yokai (monster) that are based on children that have been killed by their parents in times of e.g. starvation. Kill one to safe the rest. Is that moral?
The Zashiki warashi is one of them and it is said that this yokai, that can sometimes be seen as a small child, is protecting the houses of their killer/parents and sneaking into their beds.

Does that sound like the people involved thought the killing was a moral thing to do? I don't think so.


As much as the comparison to AIDS infuriates me - @Abe I think there are plenty of differences
You might say that. Many people (the vast majority) 50 years ago did not. In both cases: AIDS and Covid (because of not vaccinated) were the result of the patient's moral failings.
So if saying we should let non-vaccinated die because of their decision is okay with you, but letting people with AIDS (or even at the beginning: homosexuals (which were thought to be the only ones who got it)) die is making you angry: Are you sure you are making a unbiased decision?

What? Is this what you really intended to say? If not please rephrase because I find this offensive

GuitarStv

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Thanks Abe for you well thought post.
The whole topic is a very hard one and anger or fear are never good advisors, especially here.

It is also hard to put an end at a specific point except the start (not judgement at all) - it's a very, very slippery slope. One where you end with euthanasia for people who are uncurably sick, like with the sickness of homosexuality.

As Terry Pratchett put it in regards to assisted suicide: Spain does not have it because of too much religion, and Germany does not have it - very emphatically does not have it - because of too much history.

I lived most of my life a mile away from a psycological facility where insane people were gassed in Nazi times. I stood there in the gas chamber.
The people doing the gassing where simply doing their job, helping good Germans survive by cutting off "unworthy life" (lebensunwertes Leben) from the German society. They weren't murderers, right? Or wrong? What is the difference between in insane (or comatose) taking up care capabilities and a non vaccinated person? Their decision? If you kill people because they made a stupid decision, nobody would surive long enoug to get into school.

I am very interested in Japan. There are several types of yokai (monster) that are based on children that have been killed by their parents in times of e.g. starvation. Kill one to safe the rest. Is that moral?
The Zashiki warashi is one of them and it is said that this yokai, that can sometimes be seen as a small child, is protecting the houses of their killer/parents and sneaking into their beds.

Does that sound like the people involved thought the killing was a moral thing to do? I don't think so.


As much as the comparison to AIDS infuriates me - @Abe I think there are plenty of differences
You might say that. Many people (the vast majority) 50 years ago did not. In both cases: AIDS and Covid (because of not vaccinated) were the result of the patient's moral failings.
So if saying we should let non-vaccinated die because of their decision is okay with you, but letting people with AIDS (or even at the beginning: homosexuals (which were thought to be the only ones who got it)) die is making you angry: Are you sure you are making a unbiased decision?

What? Is this what you really intended to say? If not please rephrase because I find this offensive

Due to the patients moral failings, the sickness of bigotry has proven to be largely incurable among followers of certain religious sects.

Metalcat

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What? Is this what you really intended to say? If not please rephrase because I find this offensive

I read it to mean that AIDS at the time was considered a product of moral failing. I think the point was that what is considered moral can change over time, so just because some people today might find poorer care for unvaxxed covid patients to be morally acceptable due to the circumstances, they may end up judged harshly by history if the sense of that morality changes.

At least, that's what I thought was being said.

LennStar

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What? Is this what you really intended to say? If not please rephrase because I find this offensive

I read it to mean that AIDS at the time was considered a product of moral failing. I think the point was that what is considered moral can change over time, so just because some people today might find poorer care for unvaxxed covid patients to be morally acceptable due to the circumstances, they may end up judged harshly by history if the sense of that morality changes.

At least, that's what I thought was being said.
Basically yes.
Just without thinking about the judging part and instead pointing to the fact that, if looked at their frame of reference (hence the old Japan point), the people were doing the appropriate thing (even if it was evil - a necessary evil maybe, but still the correct thing to do. Like in slavery where slaves naturally thought about buying slaves for themselves if they ever got rich.)

And of course you can exchange "moral failing" with "will of God", that has been done a lot.
« Last Edit: September 30, 2021, 08:05:02 AM by LennStar »

FIPurpose

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What? Is this what you really intended to say? If not please rephrase because I find this offensive

I read it to mean that AIDS at the time was considered a product of moral failing. I think the point was that what is considered moral can change over time, so just because some people today might find poorer care for unvaxxed covid patients to be morally acceptable due to the circumstances, they may end up judged harshly by history if the sense of that morality changes.

At least, that's what I thought was being said.

I would agree with the sentiment except the analogy is tenuous to me at best.

AIDS being a curse of the "homosexual lifestyle" or however it was said back then did not cause the bigotry against gay people. A large number of Americans have been bigoted against gay people for a long time. Blaming AIDS on gay people's moral failings was simply mixing together ignorance and an already existing bigotry.

Today, we were not blaming anyone for getting the disease before the vaccine. Even though it appeared in larger concentrations in certain populations, there was not a widespread belief about Covid being a sign from God about his displeasure with New York or New Orleans. Society at large saw it as avoidable, but generally felt compassion for anyone that caught it, no matter the circumstances (except for maybe attending a giant 15,000 person wedding during lockdowns or something like that.)

Today we have LOADS of science showing that the vaccine prevent death and hospitalization, that it's safe, and that the quickest way to end this is by a large number of people getting vaxed. (And we also tell positive stories to our children in school about how our country came together and ended Polio with vaccines (not evenly that well tested!), so, the morality about country-wide vaccine campaigns has been quite consistent for decades)

It comes to moralizing now because there are a significant number of people who don't trust doctors to take a vaccine, but have no problem at all trusting them when they have covid potentially filling a critical bed for weeks. And we now have stories of hundreds of people who have had heart attacks and other issues that can usually be solved with a visit to the ER and a short stay in the ICU dying.

Covid is NOT the same as AIDS. The moralizing is not being driven from a pre-existing bigotry against a sub-group. (If anything, anti-vax people are being driven by their own bigotry against "the libs") The moralizing is being driven from the very real world where a large group of people who have had 6 months to be vaccinated and prevent their hospitalization/death are actually killing people with treatable problems. No one is acting or even speaking in a bigoted way against unvaccinated people.

This is simply a Trolley Problem where you either save hundreds of people tied down to the track or the 1000's of people simply standing on the track out of their own free will with a highly visible, slow moving train.

Anyways, that's why I find the comparison between the 2 unfounded.
« Last Edit: September 30, 2021, 08:15:12 AM by FIPurpose »

FIRE Artist

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Just to say, I wasn't proposing "don't treat unvaccinated covid patients in the ICU because they are bad people for not getting vaccinated", I was saying "don't treat unvaccinated patients in the ICU if with their co-morbidities heroic efforts are 99.9% likely to be futile and several other people's lives and qualities of lives could be saved instead during the several weeks they will spend unconscious and dying".   If a hospital has all the ICU beds, and staff, that it needs to treat everyone for as long as there is brain stem activity, by all means torture 99.9% of them to death slowly just in case 0.1% of them might survive with lifelong disabilities.  But if a hospital doesn't have all the ICU beds and staff it needs to treat everyone then the QALY (Quality Adjusted Life Year) comes into play, and the covid patient with co-morbidities who would need ICU care and perhaps be unconscious on ventilation for weeks and still be 99.9% likely to die because they didn't get the vaccine and their body can't cope with the results shouldn't crowd out the cancer patient or the trauma patient or the patient needing a transplant who will have better chances of surviving for years with a recognisable quality of life.

Survival statistics for vaccinated patients needing hospital and ICU treatment are very significantly better than for unvaccinated patients.  The same issue could arise for vaccinated patients with co-morbidities, but probably not in the numbers where vaccinated patients having ICU treatment are crowding others needing care out of the ICU.  Which is why the "unvaccinated" bit matters: it is the decision on rationing care that arises because they are unvaccinated, and the consequences of making that decision would be the same for both vaccinated and unvaccinated - except that if people are vaccinated the decision either never has to be made or can be made on the basis that the vaccinated person has the better chance of survival with a better quality of life.

That certainly wasn’t my intent either, and where I live our triage protocol has been made public and it is very clear to everyone that vaccination status is not going to be a factor, it is going to be based on likelihood of survival to 1 year as the first criteria and then it goes from there.  I fully support their plans.

What I am questioning is the draining of the entire medical system before we consider starting this ICU resource triage, that is what I can’t wrap my head around, like the examples we have of transplant programs being shut down, biopsies not getting done etc.  I am questioning if we have gotten the balance right on this, as there seems to be no real balance at all and it seems to be all in on the ICUs, everything else be damned.  Our province has implemented enough surge beds to double normal ICU capacity, and currently we are around 175% normal capacity, but this was done by moving to only life or limb surgeries, and increasing patient load for nurses across the entire system and ICU nursing no longer means 1:1, it is not even clear to me what it is going to be cut to open up this remaining capacity they claim to have. 

SunnyDays

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Following this discussion with interest.

I imagine it's worse in the US because of the large numbers of unvaccinated (although perhaps mitigated by the private health care system) than here in Canada.  However, in Alberta, where hospitals are on a knife's edge of buckling under the strain, doctors are already warning of imminently having to decide who gets a ventilator (or is removed from one) and who doesn't.  Once that begins, I wonder if it will have an impact on those who have not yet been vaccinated?

In my province, where health care workers must be vaccinated, there are reports of many leaving the profession due to this, compounding the problem of limited resources.  We also have a public system, which is more limited to begin with than a private one.

There is also growing anger about those with other medical issues being unable to receive the needed treatment.  To the point where it has been suggested that, because the unvaccinated here are 20% of the population, that only 20% of resources be allocated to them.  A separate triage system, where, once the resources are used up, you have to wait, regardless of critical need.  There is little chance of this being adopted, but I can understand the frustration behind it.

There is a region not far from me where the unvaccinated are the vast majority.  It also happens to house a large, modern medical facility.  It has not yet been overrun, but in a matter of time, it might be.  Several of the doctors are considering leaving the area because of their frustration with the situation.  Which will then leave the people with fewer options for regular medical care, and having to be moved for critical care to an area where a larger percentage are vaccinated.  Which makes them angry.  Nobody wins.

NaN

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I need to explain my infuriation with the comparison with HIV/AIDS epidemic. There are so many differences that make it unfounded, as @FIPurpose says, too. I'm glad someone else thinks so. Here are the main differences:

1. The HIV/AIDS epidemic was most severe in major cities like NY, SF, etc.
2. Catching severe HIV at that time was largely a death sentence. Hospital systems were particularly very vulnerable. Fear in medical care facilities, completely reasonable given #1, were only compounded with the societal constructs at the time. 
3. There is no vaccine for HIV/AIDS, yet. Those in at-risk communities, and in health care systems, would have taken a vaccine in a heartbeat back during peak epidemic time.
4. Major cities created special AIDS care centers because hospital systems were overrun. These helped improve and focused care and educate at-risk communities in preventative measures and encouraged testing. But it took a long time for people to even feel comfortable wanting to know if they were HIV positive, which further promoted the spread.
5. It took decades of education, research, and new drugs to make it not a death sentence and a manageable condition.

On the other hand:
1. SARS-CoV-2 is widespread across the globe and now spreading rampantly through rural areas due its airborne transmission.
2. Being COVID positive is not largely a death sentence.
3. There is a vaccine - actually many different vaccines. Hospital systems are requiring staff to be vaccinated.
4. Testing and care for COVID patients has been universally very positive across the country for the year and half the pandemic has ravaged the U.S. (and Canada). I think we generally, as a society, addressed a lot of the positive test fears very early. We have learned from past epidemics.
5. There will be nothing major coming down the lines in terms of advancements in preventing death from COVID since the vaccine exists and are very effective.

I could go on. I think any comparison of care in the hospital of an unvaccinated person to that of one with HIV during the peak epidemic is very short-sighted, too simple, and not the right comparison. I think anti-vaxxers want people to make these arguments because it helps bolster their case that there is no penalty for them not getting the vaccine, and further targets a liberal base. And if you think penalties for being unvaccinated are unwarranted, well, the cat is out of the bag. People are being fired from their job for not being vaccinated. That is a huge penalty.

What those penalties are in the care system are still TBD, but I think they will come early 2022 if cases still flood hospitals. Someone dying from a condition manageable pre-pandemic because the hospital system is overrun with unvaccinated vaccine-eligible COVID patients will be unacceptable. Even the unvaccinated will have conditions requiring what used to be routine medical care. This is the first wave with dominantly unvaccinated COVID patients. I do not think the second one will be very kind.
« Last Edit: September 30, 2021, 02:07:00 PM by NaN »

talltexan

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Part of the mishandling of the HIV/AIDS epidemic had to do with Christian conservatives gaining power and moralizing against gay people.

mm1970

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Thanks Abe.

That post makes me think about my own family history.

My grandmother died of a heart attack.  She was being kept alive, and several days later the family decided to let her go, and she moved. So they waited.  And she died a day or two later.

My father had an aneurysm in his aorta burst.  He was a couple of months shy of 82.  Living alone.  Lord only knows how he managed to dial 911 and get Life flighted to the big city hospital a 2 hours drive away.  But the surgeon told my sister before the surgery, that he really would have had <50% chance of survival if he'd been in his 60s.  In his 80s?  Way less.  So...why do the surgery?  He died during surgery.


Abe

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I am using the AIDS comparison purposefully because from a physician perspective there were many physicians who blamed the people who had AIDS and thus treated them poorly. This is well documented. Thus from a physician's perspective, then as now, it is unjust for me to consider treatment based on my perceptions of that patients' decisions. I personally agree that the specifics of the epidemics are significantly different in many regards. The end result, however is the same: one person has power over another person's life. They cannot ethically use their opinion on the patient's behavior to guide treatment.

Regarding your specific points, you do highlight major societal and epidemiological differences between the two pandemics (which I generally agree with), but I am overall unclear to why this makes the above ethical stance invalid or infuriating.

1. The HIV/AIDS epidemic was most severe in major cities like NY, SF, etc. - yes, but irrelevant on the ethics of healthcare. 

2. Catching severe HIV at that time was largely a death sentence.

- I don't believe there's a difference in severity of HIV (especially without anti-retrovirals). I guess you are talking about AIDS vs. non-AIDS infection (though almost all people with HIV who don't have treatment will develop and die of AIDS). At any rate, Severe COVID is not necessarily a death sentence but has a very high rate of mortality.

Hospital systems were particularly very vulnerable. Fear in medical care facilities, completely reasonable given #1, were only compounded with the societal constructs at the time. 
- yes. Hospital staff are still vulnerable to COVID given the method of transmission (much more likely to be transmitted than HIV), risk of breakthrough infection and new variants developing that may be vaccine-resistant. Not sure why this is relevant to the ethics argument.

3. There is no vaccine for HIV/AIDS, yet. Those in at-risk communities, and in health care systems, would have taken a vaccine in a heartbeat back during peak epidemic time.
- yes, but again my point is we cannot ethically use patients' choices to guide treatment decisions. Anti-gay physicians used the fact that men who have sex with men were more likely to be infected with HIV as a reason to give poor care (implicit or explicit).
 

4. Major cities created special AIDS care centers because hospital systems were overrun. These helped improve and focused care and educate at-risk communities in preventative measures and encouraged testing. But it took a long time for people to even feel comfortable wanting to know if they were HIV positive, which further promoted the spread.
- again unrelated to the ethics of treating critically ill patients.

5. It took decades of education, research, and new drugs to make it not a death sentence and a manageable condition.
- again unrelated to the ethics of treating critically ill patients.

On the other hand:
1. SARS-CoV-2 is widespread across the globe and now spreading rampantly through rural areas due its airborne transmission.
- yes. Rural people are people too. Unclear about what your point here is.

2. Being COVID positive is not largely a death sentence.
- Severe COVID is (see above), and we are discussing denying care to patients with severe COVID.

3. There is a vaccine - actually many different vaccines. Hospital systems are requiring staff to be vaccinated.
- ok. Unclear again what the point here is regarding treating or not treating patients.

4. Testing and care for COVID patients has been universally very positive across the country for the year and half the pandemic has ravaged the U.S. (and Canada). I think we generally, as a society, addressed a lot of the positive test fears very early. We have learned from past epidemics.
- and cannot let that cloud our judgement of the people who refuse testing/vaccination's right to treatment.

5. There will be nothing major coming down the lines in terms of advancements in preventing death from COVID since the vaccine exists and are very effective.
- yes.

I can see this is an emotional issue for you, and the treatment of people with HIV was and often remains inappropriately poor. But this is my point exactly: emotions should not drive clinical decisions by healthcare workers, and especially not triage decisions.
« Last Edit: September 30, 2021, 06:09:22 PM by Abe »

Abe

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Specifically regarding ethical triage, there are a few models that were considered during the start of the pandemic

1) time-based: whoever arrives first in the ICU is treated. Additional people are treated until there is no more capacity. At that point, the people who have been longest in the ICU are terminally extubated. This is based on the idea that time one is critically ill is predictive of survival and is related to the physiology of sepsis and cardiopulmonary function. I won't bore you all with the details, but basically increased comorbidities cause people to crash early in their ICU care (especially in resource-poor settings). It is a natural selection process.

Issues with this approach are several:
- allocation is dependent on one having medical knowledge to seek care early and the resources to do so. This becomes a socio-economic triage system and thus is unethical due to lack of justice.
- Even in a fully equal society, there are issues. Patients have the right to treatment if there is a reasonable chance of recovery. We know that time is the major determinant after the dust settles. Missing from that equation is the difficulty of predicting long-term survival in the short-term while fixing whatever caused someone to be critically ill. Survival from a heart attack is very variable and depends on many technical factors that may not be known in the few hours after someone arrives in the ER (but needs a ventilator). Similar for stroke, and similar for acute respiratory failure from COVID. Would it be ethical to take someone who has a reasonable chance of recovery for someone who might have a better chance, but also equally may have a worse chance once the dust settles? That lack of clarity in the short term makes this judgement difficult and quite often inaccurate.

Because of this, another framework was more often adopted for emergency situations: co-morbidity based. There are several well-validated scores for predicting survival in critical illness. The worse your score is, the lower you are in the queue for critical care. This doesn't fully resolve the time-to-seeking care issue but works for sorting people in a given time interval. If __ people arrive within ___ minutes of each other, the one with the best score gets the ventilator, and so on from there.

Issues with this approach:
- comorbidities are strongly linked to several external socioeconomic factors outside of the control of the patient (especially in that timeframe). Thus we are in a way judging people for their past actions.
- many scoring systems look at physiologic derangement to predict success at treatment. However they often require extensive laboratory testing and knowledge of the person's pre-existing conditions to use effectively. They are thus subject to a wide range of errors and pre-COVID were not considered suitable for a triage situation.
- comorbidities do not vary as much in a given population as one would think. Thus in practice this stratification is usually not very stratifying. Then we are now splitting hairs, which again is subject to significant error.

These issues were never successfully resolved, hence they were for the most part abandoned in favor of increasing the resources available (which is obviously more just). This leads to our current situation where some hospitals have relatively few cases and others have too many. Equitable distribution of cases (of all types) across hospitals is necessary but for the most part has not been done effectively. This is due to the fact that many states most affected by COVID lack leadership that takes it seriously. An ideal system would have a state-wide or region-wide (or even nation-wide) central triage desk that would route critically ill patients to the closest available facility.

This is what the EMS systems do to direct ambulances, but many critically ill people come in through the front door of the ER. The deaths that result in the time period that requires stabilization were likely not survivable anyway and not the fault of the ICU patients in that hospital.

I think it is also important to clarify a few things regarding hospital capacity and what that means. In Houston, the medical center is at 140% of ICU capacity (thus using non-ICU physical spaces to provide ICU-level care). This was accommodated not by denying care to non-COVID critically ill people, but delaying:

1) elective operations with minimal long-term risk to health (hernia repair, joint replacement, spine surgery for chronic back pain, plastic surgery, weight-loss surgery). If people really want these, they can go to an area that isn't at capacity or wait until the surge resolves. It would be unethical (and un-necessary) to deny care to people with an acute illness for these operations.
- at any given time, elective surgery stays make up 25-40% of hospital bed use in non-trauma hospitals.

2) outpatient operations (ones that don't require a hospital stay). This preserves ventilators, trained staff and other resources for the surge. Exceptions are outpatient cancer-related operations (these were delayed briefly last year but not since then).

3) elective organ transplants. Patients do not require kidney or pancreas transplants (the more common ones) to survive. It sucks to lose a useful organ, but it can be diverted to other states for use.
- heart, liver and lung transplants can sometimes be life-saving with a need to be performed urgently. These situations are very rare and are accommodated.

What we do keep available are:
1) operating rooms and cardiac cath labs for emergencies
2) emergency room triage systems: people who are sicker will get to the head of the line. The long delays in the ER are for non-critically-ill people.
3) airlift capabilities: if someone is critically ill but cannot be accommodated upon arrival in the ER, they are airlifted to another hospital. Again, people needing this level of care immediately are often unlikely to survive regardless of location.

In this scenario, the main issues we see are under-treated chronic medical conditions (which are not dependent on hospitals but are delayed because of staff diversion or people's fear of going to clinics). This will likely lead to a bump in preventable deaths over the next few years. Again, it would be unethical to deny acute life-saving care to someone for these reasons.

The only places to use triage as described above were the NY/NJ area in the very initial surge, and now Idaho and West Virginia. Again, these are preventable if patients are triaged out to other states once stabilized (thanks Seattle and Pittsburgh!). The issue is that transporting very critically ill people is often difficult (or not possible) and they need to be moved while stable in the ICU. Coordinating this is exceedingly difficult in the US for beauracratic reasons mostly.

 
« Last Edit: September 30, 2021, 07:01:06 PM by Abe »

NaN

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Not worth correcting you @Abe. The comparison of care for COVID patients now to that of one during the AIDS/HIV epidemic is still unfounded and way more complex than you want to believe. I can't stop you from narrowly focusing your responses. Ethics in many, but not all, situations is never black and white.

I'm sad the ethical consideration of those who will unnecessarily die from either a) afraid to go the hospital, b) routine non-urgent care that would catch urgent matters, and c)  worse care due to burned out medical staff is not enough to convince those who are unvaccinated to get the vaccine.

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maybe a better comparison would be organ transplant or hepatitis treatment for those patients who drink (or smoke). those kind of treatments are largely denied in alcoholics because not only did they do it to themselves, more importantly their drinking status makes it that much more likely that treatment will fail. In the same way someone who refuses to mask up and get vaccinated, is more likely to get the virus AGAIN.

Abe

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maybe a better comparison would be organ transplant or hepatitis treatment for those patients who drink (or smoke). those kind of treatments are largely denied in alcoholics because not only did they do it to themselves, more importantly their drinking status makes it that much more likely that treatment will fail. In the same way someone who refuses to mask up and get vaccinated, is more likely to get the virus AGAIN.

I’m going to push back on that. Liver Transplant allocation is not affected by prior actions. A person who has a history of alcohol abuse/dependency can be transplanted if they are able to abstain from alcohol use during the time they are first evaluated for transplant until after transplant. Alcohol is directly toxic to the liver, and outcomes are poor if someone who was alcohol dependent relapses after transplant.

History of smoking has no bearing on transplant allocation. Active smoking is discouraged but is not a contraindication except for lung transplant (for same reasons as above for alcohol and liver).

I want to make it very clear: Someone who is acutely dying of organ failure and needs an urgent transplant (probably the best analogy in this weak construct) will not be denied a life-saving transplantation regardless of their current drinking or smoking status. Those decisions are made solely on clinical status and certain lab tests.


Non-transplantation Hepatitis treatment is not denied based on current or former alcohol, smoking or drug history.
« Last Edit: October 02, 2021, 11:25:18 AM by Abe »

Abe

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Not worth correcting you @Abe. The comparison of care for COVID patients now to that of one during the AIDS/HIV epidemic is still unfounded and way more complex than you want to believe. I can't stop you from narrowly focusing your responses. Ethics in many, but not all, situations is never black and white.

I'm sad the ethical consideration of those who will unnecessarily die from either a) afraid to go the hospital, b) routine non-urgent care that would catch urgent matters, and c)  worse care due to burned out medical staff is not enough to convince those who are unvaccinated to get the vaccine.

My analogy was solely centered around care based on prior actions and the ethics around that. You wanted to expand it into some moral judgement of covid infected people vs. the aids crisis. I agree the care is obviously quite different now and then, for both epidemiological and technological reasons as you’ve pointed out. In no way do I believe the aids crisis and the covid crisis are similar outside of the risk of denying care to people based on actions (as many have advocated) and the ethical dilemmas of that. Hence my narrow focus. I think we’re talking at cross-points and do not have to discuss further if you don’t want.

I do agree with your second paragraph fully. I will not compromise my moral and ethical stands because of it, though. As I said before, we do not want a repeat of the moral failings from the last quarter century.
« Last Edit: October 02, 2021, 11:24:36 AM by Abe »

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My 61-year old anti-vax father-in-law just tested positive.

Hopefully it’s mild, but we’ll see where this goes.

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Oh no, I’m so sorry. Sending positive thoughts for an uneventful course of illness.

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Thanks for your posts @Abe It's great to see such clear and well articulated thoughts from someone with actual experience in having to make these sorts of ethical decisions.

It's sad to see how many are seemingly ok with the provision of medical care being based on the providers moral judgement regarding the worthiness or otherwise of the actions of patients.

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It's sad to see how many are seemingly ok with the provision of medical care being based on the providers moral judgement regarding the worthiness or otherwise of the actions of patients.

It is sad to see so many refuse a vaccine that would potentially save not just their life, but others' lives as well. The HIV epidemic did not have this problem.

By in large, I will contend most physicians and nurses during the HIV epidemic treated HIV positive or potential positive patients without hesitation. It seems to be even more the case today with unvaccinated COVID patients. I am not worried we are going to 'repeat any moral failings' here.

In regards to ethics, I first would start with empathy: I don't fault someone for choosing in the trolley problem to save their single loved one than saving five strangers, so neither would I fault someone for wishing the hospital cared for their loved one who died with a savable condition instead of the large number of unvaccinated COVID patients at their local hospital. I haven't experienced this, but it has happened more than it should have during this pandemic.

It is not to my goal to convince someone like @Abe that he should start convincing himself or others in his profession that they should judge treatment based on their opinion of the patient. No way.

However, the dilemma hospital systems (points of treatment of COVID) are in is new, and real, as doctors are still figuring out what is considered 'elective' and what is really not. This reads that a lot doctors want to do it differently this time. And in that article linked, the Vanderbilt hospital was already spending more time on helping those waiting on 'elective' operations. Is it a moral failing for that hospital system to have this person spend time on this case by case examination each morning instead of putting them on an effort to help with the overhead of COVID patients? If we examine 'best care' being the 'all hands on deck' approach during last winter than is anything less than that now a failure? I guess what I am saying is someone is drawing the line on where to divert resources. And that line exists in the gray zone between the black and white we talk about in patient care. It won't happen at the door of the ER, but it happens within the system.
« Last Edit: October 03, 2021, 09:46:35 AM by NaN »

sui generis

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Thanks for your posts @Abe It's great to see such clear and well articulated thoughts from someone with actual experience in having to make these sorts of ethical decisions.

It's sad to see how many are seemingly ok with the provision of medical care being based on the providers moral judgement regarding the worthiness or otherwise of the actions of patients.

I'm not sure anyone has said that. I know it's not what I'm suggesting. I would want overall triage protocols to change to take it out of the hands of individual providers and make it easier for them. The current system of triage would be modified to deprioritize people who haven't been vaccinated, among all the other factors that are included in triage decisions that are ethical quandaries, but that we've set up an a priori objective system vs. evaluating on a patient by patient basis by individual providers at the point of care. By not making this change, we are also making implicit ethical judgments that we should question our comfort with. Sins of omission are no better, at least in my mind, than those of commission.

Davnasty

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Thanks for your posts @Abe It's great to see such clear and well articulated thoughts from someone with actual experience in having to make these sorts of ethical decisions.

It's sad to see how many are seemingly ok with the provision of medical care being based on the providers moral judgement regarding the worthiness or otherwise of the actions of patients.

I'm not sure anyone has said that. I know it's not what I'm suggesting. I would want overall triage protocols to change to take it out of the hands of individual providers and make it easier for them. The current system of triage would be modified to deprioritize people who haven't been vaccinated, among all the other factors that are included in triage decisions that are ethical quandaries, but that we've set up an a priori objective system vs. evaluating on a patient by patient basis by individual providers at the point of care. By not making this change, we are also making implicit ethical judgments that we should question our comfort with. Sins of omission are no better, at least in my mind, than those of commission.

I'll second this. I really appreciate Abe's post and I've learned a lot from them. They've helped me to see this situation in ways that I wouldn't have considered on my own.

At the same time I've been thinking that these decisions don't need to depend on any individuals morals, can't the decisions can be made at a system-wide level?

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As a recently deceased conservative radio host frequently said, "AIDS is the most preventative disease there is. Just don't have unprotected sex with multiple partners."

From that line of reasoning, I can see the parallel in the line of thought comparing the AIDS epidemic to covid. I can also say that I don't particularly care.

I'm all for a hospital administrator saying that they will not provide care to people that refuse the vaccine. I've had enough with the anti-vaxxers.


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Thanks for your posts @Abe It's great to see such clear and well articulated thoughts from someone with actual experience in having to make these sorts of ethical decisions.

It's sad to see how many are seemingly ok with the provision of medical care being based on the providers moral judgement regarding the worthiness or otherwise of the actions of patients.

I'm not sure anyone has said that. I know it's not what I'm suggesting. I would want overall triage protocols to change to take it out of the hands of individual providers and make it easier for them. The current system of triage would be modified to deprioritize people who haven't been vaccinated, among all the other factors that are included in triage decisions that are ethical quandaries, but that we've set up an a priori objective system vs. evaluating on a patient by patient basis by individual providers at the point of care. By not making this change, we are also making implicit ethical judgments that we should question our comfort with. Sins of omission are no better, at least in my mind, than those of commission.

I'll second this. I really appreciate Abe's post and I've learned a lot from them. They've helped me to see this situation in ways that I wouldn't have considered on my own.

At the same time I've been thinking that these decisions don't need to depend on any individuals morals, can't the decisions can be made at a system-wide level?

Anyone else see the irony in the fact that the very group of deplorables who decried "death panels" are now the ones who have created a crisis that requires them?

Abe

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Thanks for your posts @Abe It's great to see such clear and well articulated thoughts from someone with actual experience in having to make these sorts of ethical decisions.

It's sad to see how many are seemingly ok with the provision of medical care being based on the providers moral judgement regarding the worthiness or otherwise of the actions of patients.

I'm not sure anyone has said that. I know it's not what I'm suggesting. I would want overall triage protocols to change to take it out of the hands of individual providers and make it easier for them. The current system of triage would be modified to deprioritize people who haven't been vaccinated, among all the other factors that are included in triage decisions that are ethical quandaries, but that we've set up an a priori objective system vs. evaluating on a patient by patient basis by individual providers at the point of care. By not making this change, we are also making implicit ethical judgments that we should question our comfort with. Sins of omission are no better, at least in my mind, than those of commission.

I'll second this. I really appreciate Abe's post and I've learned a lot from them. They've helped me to see this situation in ways that I wouldn't have considered on my own.

At the same time I've been thinking that these decisions don't need to depend on any individuals morals, can't the decisions can be made at a system-wide level?

It could be, but in most cases the same system that would be making these decisions (state governments) are over-run by people who think wearing a cloth mask is too much suffering to impose on people.

And I don't think that would get around the essential ethical question - are we as a society OK with denying life-saving care to people based on their behavior? I don't think we, in general, are. This would be a hugely unprecedented step. I cannot emphasize this enough.

There are many more options before the "nuclear" option. Here is a short list that don't require any triage decisions (and are mentioned tangentially in The NY Times article NaN linked):

1. Better triage and transfer of non-critically-ill patients. The US system as a whole has not collapsed, and it seems that in general this will now be a regional crisis rolling through various states at a time. Though intra-state transfers are common, inter-state transfers (except in the Mountain West & Alaska) are unusual. Alaska, Montana and Idaho are special cases because they have limited ICU capabilities and many of the critically ill are transferred to Seattle even in normal times. There are some legal and insurance billing issues that would need to be sorted for this to work, but would resolve 99% of our triage problems outside of these very isolated areas.

2. For the special cases above, we do need to increased ICU capabilities. This is somewhat a failure on the states' part to prepare and coordinate with others on supply and personnel transfer agreements (the whole stick-your-head-in-the-sand attitude commonplace in these more conservative areas regarding COVID). This COVID pandemic isn't a surprise! We do not have a shortage of ventilators or dialysis machines in this country. We do have a shortage of sedatives and narcotics, but that's everywhere.

2. Delaying non-urgent operations in a given area until the crisis passes. On average the duration of elective shut-down is about 2-3 months. Again, in almost all cases urgent operations are continuing ahead in most areas. The places being most strongly affected by triage decisions are also the areas that are most anti-vaccine (hence the problem!). I don't think it is ethical for us outsiders to tell them how to run their healthcare systems since we have limited standing other than moral outrage. I also don't think there is a scenario where states would allow such an unpopular mandate to be enforced at a state level, especially if solution #1 hasn't been attempted.

3. Deploying National Guard, Army physicians and Army medics to provide coverage of ICU units. Though the Armed Forces cannot be deployed in a military capacity within the US, they can be deployed by request of the states for disaster relief. They are well qualified to provide basic life support in a civilian setting.

So there are several solutions to this problem beyond the obvious, punitory one. Extremely rural areas again are a special case, but we run into ethical considerations of autonomy and paternalism if we try to tell them how to triage.

While to us the answer may seem obvious, in reality it is not. There are downstream consequences to every action. I do agree with Sui generis that there is an error of omission, but lay that at the hands of the legislatures who repeatedly and intentionally ignore healthcare experts advising them on the above measures.

On another point worth considering in the examples from the article, here are some questions to mull over (modeled after similar questions from my medical ethics classes):

1a) What if the person who needed emergency surgery in that article was also not vaccinated and was anti-vaccine? It isn't mentioned in the article. Does the lack of knowledge on this subject affect our decision on triage? If not, why not? If so, why?

1b) How confident are we that the COVID-infected patient was not vaccinated? What if they had one dose? How much punishment should be assigned to being late to vaccination, even if one's intentions were good (they were planning to get a second dose eventually?).

1c) Are anti-vaccine people to be de-prioritized if they have a COVID-induced critical condition, for some critical conditions, or for all critical conditions? 

2a) The patient in the ER had a better chance of surviving than the patient in the rural area. Thus a decision was made to save the one in the ER. How much should a patient with COVID who is not vaccinated be de-prioritized? If the surgical emergency patient had a 1% chance of surviving and the COVID patient a 40%, how should that be calculated?

2b) How confident are we that the person in the ER was not vaccinated? If they cannot answer for themselves, how much do we trust their proxy? What proof is required of vaccination?

2c) Why was the person not vaccinated? Discuss these situations:
1- they were not aware of the vaccines' efficacy and had no trusted healthcare resource to discuss with
2- did not think it would work because they were somewhat immunocompromised (a common misconception)
3- thought the vaccine had a Gates microchip in it that would turn them into a Biden slave
4- lived 350 miles from the nearest clinic and lacked resources to obtain the vaccine. Which of these are and are not acceptable to spare them from triage? How would we verify which one it is?

3a) Is it ethical to deny care to people who do not comply with a voluntary medical request in their jurisdiction? If so, which ones? How does the temporal relationship between lack of compliance and illness affect decision-making? Is a lifetime of non-compliance with medical advice leading to an exacerbation of a chronic condition acceptable? Why or why not?
- If an exception is made specifically for COVID, detail why it is different than all other stressors on the healthcare system.

3b) Is it ethical to punish members of society for the failings of their legislatures to prepare for an expected outcome?

I don't have a good answer to these (but many not-so-good ones), and am interested in others' comments. Feel free to add other hypothetical situations. This is an important part of ethics - to chance to discuss theoretical situations and understand how the nuances affect our thinking. That is why an absolute judgement, in my mind, is very difficult (regardless of who decides it).

« Last Edit: October 03, 2021, 08:43:41 PM by Abe »

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I'll give these a go.
On another point worth considering in the examples from the article, here are some questions to mull over (modeled after similar questions from my medical ethics classes):

1a) What if the person who needed emergency surgery in that article was also not vaccinated and was anti-vaccine? It isn't mentioned in the article. Does the lack of knowledge on this subject affect our decision on triage? If not, why not? If so, why? Irrelevant if they're not in for covid.  Maybe they can't get the vaccine for medical reasons and have been sheltering from covid for the last 18 months.

1b) How confident are we that the COVID-infected patient was not vaccinated? What if they had one dose? How much punishment should be assigned to being late to vaccination, even if one's intentions were good (they were planning to get a second dose eventually?). I would have thought this is important knowledge for deciding on treatment given that one dose or none changes outcomes.  Should be a record somewhere (see 2(b)).

1c) Are anti-vaccine people to be de-prioritized if they have a COVID-induced critical condition, for some critical conditions, or for all critical conditions? Unvaccinated (doesn't matter why) are prioritised for care, including ICU and ventilators, according to their chances of surviving as against other patients requiring the same care at the same time: the ones most likely to survive, or survive with more QALYs, get the care.

2a) The patient in the ER had a better chance of surviving than the patient in the rural area. Thus a decision was made to save the one in the ER. How much should a patient with COVID who is not vaccinated be de-prioritized? If the surgical emergency patient had a 1% chance of surviving and the COVID patient a 40%, how should that be calculated? The patient with the better chance gets the care.  If the rural patient's chances are less just because they are rural, and they would have better chances than the covid patient once they get to the hospital then they get the care.

2b) How confident are we that the person in the ER was not vaccinated? If they cannot answer for themselves, how much do we trust their proxy? What proof is required of vaccination? This question does not compute, as the NHS has the vaccination records of everyone in my country.  If someone came in without ID from the street they are probably vaccinated.

2c) Why was the person not vaccinated? Discuss these situations:
1- they were not aware of the vaccines' efficacy and had no trusted healthcare resource to discuss with
2- did not think it would work because they were somewhat immunocompromised (a common misconception)
3- thought the vaccine had a Gates microchip in it that would turn them into a Biden slave
4- lived 350 miles from the nearest clinic and lacked resources to obtain the vaccine. Which of these are and are not acceptable to spare them from triage? How would we verify which one it is?
All questions and answers are irrelevant to deciding on the appropriate medical treatment.

3a) Is it ethical to deny care to people who do not comply with a voluntary medical request in their jurisdiction? If so, which ones? How does the temporal relationship between lack of compliance and illness affect decision-making? Is a lifetime of non-compliance with medical advice leading to an exacerbation of a chronic condition acceptable? Why or why not?
- If an exception is made specifically for COVID, detail why it is different than all other stressors on the healthcare system.
All questions irrelevant to deciding on appropriate medical treatment for covid.  The issue of non-compliance with medical (rather than governmental) advice may be relevant for some other treatments such as transplants, joint replacements, etc. because non-compliance means a low/lower chance of success.  The existence of co-morbidities may make treatment for covid less likely to be successful, in which case it's part of the decision as to who has the better chance of being successfully treated.

3b) Is it ethical to punish members of society for the failings of their legislatures to prepare for an expected outcome?
Question relevant to existence of resources (vote the bastards out of office!) but irrelevant to deciding on appropriate medical treatment using those available resources.

I don't have a good answer to these (but many not-so-good ones), and am interested in others' comments. Feel free to add other hypothetical situations. This is an important part of ethics - to chance to discuss theoretical situations and understand how the nuances affect our thinking. That is why an absolute judgement, in my mind, is very difficult (regardless of who decides it).

One point to make is that not giving someone an ICU bed and all the bells and whistles doesn't mean turning them out to die in the street, it means they get a bed and comfort care/hospice-type care - which they might survive or might not.

Another point to make is that excess death rates are a lot higher than covid death rates.  That means that there are a lot of people dying "out in the community" who could have had a better chance of survival if they had seen a doctor and been treated but never even got that far.  While the unvaccinated covid patient with co-morbidities and a small chance of surviving is taking weeks to die in the ICU there are going to be other people who never even get the chance for a doctor to see them and make the choice to treat them instead, because that doctor is too busy giving futile care to someone else.

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Anyone else see the irony in the fact that the very group of deplorables who decried "death panels" are now the ones who have created a crisis that requires them?

I see it too.

One level above that irony is the issue of medical ethics apparently becoming a mission to make the world safe for those who trust social media influencers over doctors and scientists. Compassion fatigue and frustration are suddenly becoming a contributor to the death toll, and we're seeing that in public policy (e.g. no lockdowns or restrictions around the delta wave). When the history is written, none of us will look very good.

Just Joe

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My 61-year old anti-vax father-in-law just tested positive.

Hopefully it’s mild, but we’ll see where this goes.

I hope his recovery is speedy and easy!

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Thanks, @Abe, I appreciate the points and the questions. A few general points:

-I definitely agree that increased efficiency and techniques / use of resources should be leveraged to minimize the bad outcomes we are seeing.  Reading a story recently about a daughter calling hospitals in many surrounding states for her dad when the providers themselves had given up was pretty depressing, but I realize is just one of about a half dozen anecdotes I've read.  I hope some of those measures will be implemented swiftly.

-It's a good point that that same systems that are overwhelmed are not likely to put any revised triage procedures into place.  I mean, I think it's pretty unlikely anywhere (and so this conversation is mostly a thought experiment), but the likelihood is lower in places where people largely think vaccination is mind control or will prevent them being able to have children, etc. which is exactly where intervention is needed.  I'm not usually one to wave my hand and think those backwards people should be consigned to the fate they've invited upon themselves, though, not least because there are ALSO people there that aren't a part of it and yet have to suffer the consequences.  And so, it may be none of my business or appear paternalistic, but I still have a hard time just being satisfied with not intervening on those people's behalf.

-I'm not so sure about the lack of education here being a big ethical issue.  There's a lack of education for everything to some degree and, perhaps it's just as a lawyer I've gotten comfortable with the fact that ignorance of a law is not an excuse or justification for violating it.  In this case, I think ignorance is harder to come by than for a lot of things.  I traveled to a remote town in Alaska (a very red state, I'm sure I don't need to point out) this summer - permanent year-round population about 20, but definitely higher in the summer.  And they were advertising a vaccine clinic that was coming.  So I don't want to pretend like everyone has had someone show up at their door at a convenient time with balloons and a lollipop to give along with the vaccine, but I'm a lot more comfortable with this than with....like most other things ever regarding access and knowledge.  And on that note, my next point then applies:

-Some of the questions you pose are not so much ethical questions as practical ones with an ethical prod.  For instance, how to be sure the patient truly is or is not vaccinated.  That's a practical question about systems and procedures, simply with a reminder that it's important that we establish thoughtful and careful systems and procedures around verification because we don't want to create perverse incentives or leave giant loopholes.  If we let every question about not being sure our systems were perfect, and how unethical that could be, stop us we'd all of us be permanently paralyzed and couldn't even feed ourselves without paroxysms of conscience and self-doubt.  It's important to keep in mind *why* we wrestle with establishing rigorous systems, but not that we let those questions stop us from doing so efficiently and promptly.

-Finally, I take a bit of issue with some of the use of your word "punish" or other implications of being punitive.  This isn't about punishing people in the retributive sense, which is how it feels like you are using it.  It's about making fair decisions about use of resources. Fair decisions are often detrimental to one party or stakeholder.  That doesn't mean retirbution is being taken on them for any actions.  In many cases, the affected party may not have any control whatsoever for the negative impacts they will suffer.  And at least that's not the case here.  In this case, to the extent any decisions are made that could have negative impacts (or feel like they are "punitive" in a retirbutive sense) to an unvaccinated person, they have a choice to change that.  I think it's a pretty good deal.

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I've had enough with the anti-vaxxers.

Crazy week: anti-vax coworker quarantines because anti-vax friend they spent a bunch of time with came down with COVID. This is after a close call at an with friends who are COVID positive within the next day or two.

Almost time to come back to work. Coworker's family member gets it, is hospitalized, outcome remains uncertain. Coworker quarantine extended. Then coworker's spouse gets COVID. Coworker still tests negative. When I spoke to them recently, I asked them to follow HR's protocol and stay home. I don't want it. I have my shots but I work closely with this person. Coworker thinks they are immune. Maybe they had a mild case in the past coworker suggests. I'd go get my shots a week ago if I was coworker.

Meanwhile in my family: elderly relative falls. Ambulance can't find a bed until 5th or 6th hospital. Relative spends two weeks in hospital and dies. Another elderly relative needs surgery for heart condition. Is put off for several weeks until this week. Surgery okay. Recovering. And third elderly relative has developed an un-diagnosed condition where they just pass out and then recover in ~5 mins with no awareness of anything happening - if they were sitting down. This led to a nasty fall this weekend. Again - hospitals are overwhelmed with unvaxxed COVID patients. Took all day to find hospital and then transfer out of the ER to a room. No cause found for this condition, recovering from the fall.

So my family spent weekend to help wrap up departed relative's affairs.

First relative was not in great shape before the fall but was certainly worse off due to life under COVID restrictions - more isolation, less opportunity to get out of their apartment.

A tale of two families. I don't have words strong enough to express my frustration with people like coworker and their social circle who reject the vaccine b/c of religious reasons.  And to think some of their church friends are protesting outside the local hospital b/c of the visitation policies and the fact that the hospital won't treat patients with alternative medicines like Ivermectin. Local ICU is over-whelmed and some of these people think they ought to be able to visit their relatives in person. Really?

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Sorry Joe, my annoyance is small compared to what your family is experiencing.

Because my FIL tested positive, MIL can't watch my child while I work, so I'm doing what I can work-wise while keeping a toddler entertained.

FIL was also at a funeral (not covid-related) with a lot of other family members and unmasked. Daughter of the deceased is furious with him right now. Of course, because it's TN, I'm willing to bet that at least half of the people at the funeral weren't vaccinated.

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That sounds about right... I've heard more than one story of anti-vax folks that won't even quarantine if the virus doesn't force them into bed. Or they are out and about until they can't.

DW and I are so over this thing...

One more head shaker - they are coming fast these past weeks. Found out that another relative that works in health industry is now declared anti-vax and they are recently recovered from COVID. I guess it is easy to disregard COVID when you are young and immortal. How a person can value healthcare science, healthcare employment and reject some vaccines while accepting the others is nuts.

Sorry about the odd wording. Trying to share the anecdotes without revealing too much about who or where. I don't bully people IRL, I try to get along with the people around us - especially family of course - but I unload here in the forums. My apologies. ;)

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CNN: Lindsey Graham gets booed by his own supporters because he suggested that they "think about" getting vaccinated.

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CNN: Lindsey Graham gets booed by his own supporters because he suggested that they "think about" getting vaccinated.

The old guard cynics like Graham and McConnell are now reaping what they have sown since their party has been taken over by the True Believers. Those assholes are responsible for this, because they knew better.

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It's not like the Republican establishment wanted Trump in office prior to 2016. They did as much (if not more) to fight his nomination as the DNC did to fight Bernie's. Granted, they were a bit more open about it.

They got caught up in the tidal wave of idiocy and felt like they needed to go along with it.

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It's not like the Republican establishment wanted Trump in office prior to 2016. They did as much (if not more) to fight his nomination as the DNC did to fight Bernie's. Granted, they were a bit more open about it.

They got caught up in the tidal wave of idiocy and felt like they needed to go along with it.

Yeah. Cowardice. And I think they are paying for it now.

Unfortunately, so are the rest of us.

PDXTabs

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CNN: Lindsey Graham gets booed by his own supporters because he suggested that they "think about" getting vaccinated.

The old guard cynics like Graham and McConnell are now reaping what they have sown since their party has been taken over by the True Believers. Those assholes are responsible for this, because they knew better.

I agree 100%. In fact I'm gullible so I thought that McConnell would see this coming and impeach Trump a long time ago.

Travis

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CNN: Lindsey Graham gets booed by his own supporters because he suggested that they "think about" getting vaccinated.

The old guard cynics like Graham and McConnell are now reaping what they have sown since their party has been taken over by the True Believers. Those assholes are responsible for this, because they knew better.

Trump himself got boo'd for suggesting vaccination a couple months ago. He backed off that one real quick.  Right now Hannity would make you think vaccination was the worst idea ever, conveniently forgetting he wanted us all to bow down and praise Trump last year for funding vaccination research.

Seems like yesterday when McConnell was literally crying on the floor of the Senate saying how terrible it was that Congress was attacked. Changed his tune as soon as the investigation started to ask who in Congress knew it was coming.
« Last Edit: October 07, 2021, 06:33:10 AM by Travis »

Sibley

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I saw this: https://www.washingtonpost.com/health/2021/10/05/uchealth-transplant-unvaccinated/

At least one hospital system is requiring COVID vaccination for transplants. It makes sense. There aren't enough organs available for donations to start with, why would you risk giving one to an anti-vaxxer?

MudPuppy

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Even if the organ would never go to anyone else but that person, insurance and Medicare reimbursements are often tied to outcomes. If there was a problem that could have been prevented by the hospital/staff’s actions and they failed to take those precautions, there’s a high likelihood that they would have to eat certain costs related to this.

LennStar

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CNN: Lindsey Graham gets booed by his own supporters because he suggested that they "think about" getting vaccinated.

The old guard cynics like Graham and McConnell are now reaping what they have sown since their party has been taken over by the True Believers. Those assholes are responsible for this, because they knew better.
You know, at this point I sometimes fantasize about spreading rumors that their leading idiots have secretly vaccinated themselves, just to see them go at each other even more.

nereo

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CNN: Lindsey Graham gets booed by his own supporters because he suggested that they "think about" getting vaccinated.

The old guard cynics like Graham and McConnell are now reaping what they have sown since their party has been taken over by the True Believers. Those assholes are responsible for this, because they knew better.
You know, at this point I sometimes fantasize about spreading rumors that their leading idiots have secretly vaccinated themselves, just to see them go at each other even more.

They have been vaccinated and were pretty public about it. Graham was the first vaccinated senator to then test positive for Covid. Trump and McConnell were among the first in the nation to get the jab. All US Governors (Dema and Rep) have been vaccinated, and the senate had a vaccination rate of 92% back in May (can’t find updated figures to see the the last 8 holdouts have since been vaccinated).


DadJokes

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Southwest Airlines had to cancel over a quarter of their flights yesterday.

While they initially said it was due to weather, the apparent reason was employees walking out over vaccine mandates.

We have a flight on Southwest soon. I really hope the cancellations don't continue.

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