No surprise, then, to see the backlash, including the Alabama doctor who announced that he would not treat patients who refused to get vaccinated, after Gov. Kay Ivey (R) said “it’s time to start blaming the unvaccinated folks” for the jump in cases. Social media hosts the bloodless celebration of celebrities who wind up in the ICU or the morgue, such as Tennessee radio host Phil Valentine, who once made a song mocking vaccines, and whose death from covid inspired responses along the lines of “#COVIDiots thanks for playing the natural selection game.” The less and less “silent majority” from business leaders to health-care workers to much of Blue America, leans toward making the unvaccinated pay for holding everyone else hostage.
But even as the culture wars rage over masks and mandates, access to health care adds a new dimension. ICU beds are a finite resource; so is time, and this is a zero-sum game. Hallways, conference rooms and cafeterias are being turned into covid wards, but what happens when the ambulance pulls up with a stroke victim, the clock is ticking and there’s no space left? “We’re going to have to choose who gets care and who doesn’t get care,” says New Mexico Health and Human Services Secretary David Scrase of the state’s looming crisis, “and we don’t want to get to that point.”
“Triage” comes from the French word to choose or select. Hospitals have scoring systems for prioritizing patients based on multiple factors, such as the seriousness of their condition and chance of recovery. The question now is whether someone who refuses to get a lifesaving vaccine approved by the Food and Drug Administration has the same claim to scarce health-care resources as those who were vaccinated.
One group of Texas doctors explored the idea in a private memo obtained by the Dallas Morning News: They noted that because a patient’s prognosis is part of the equation and vaccination reduces the chances of severe infection and death, “vaccine status therefore may be considered when making triage decisions as part of the physician’s assessment of each individual’s likelihood of survival.”
There was plenty of pushback when that memo leaked, including among doctors, and the Texas team characterized it merely as a thought experiment. As an oncologist friend explained to me, he does not shame lung cancer patients if they smoked for 30 years; nor does the emergency-room doc turn away from the drunk driver with lacerations or the gang member with the gunshot wound. We only ever have incomplete facts, and if caregivers shift from weighing who needs care most to who deserves it, the slope gets very slippery.
And yet. Something still feels different about the debate over treating the unvaccinated. Health-care workers recount the trauma of too many shifts, too many deaths, too many avoidable tragedies. It’s soul-crushing to watch people die because they made bad choices. Partly it’s the maddening hypocrisy — the patients who proudly dismiss science right up until the moment their lives depend on it. Partly it’s the sanctimony, the assertion of personal freedom over any sense of public good.
The tension strikes close to home: I had cancer surgery at the end of May, and had I been living in one of many states with exploding caseloads, my procedure might have been postponed. Doctors are being forced to delay all kinds of treatments that feel anything but “elective” in the face of overcrowding. Studies have shown that even a 30-to-40-day delay in colon cancer surgeries or chemotherapy, for example, was linked with worse survival odds. When does a quietly metastasizing tumor or occluded artery become sufficiently life threatening to qualify you for a gurney?
Imagine if some private hospital corporation, or even a state legislature, ruled that when you arrive at the emergency room, you need either proof of vaccination or proof that you were medically unable to be vaccinated, to have an absolute right to care; otherwise, care is conditioned on whether there is room. Would that count as legitimate protection of the public good? Or one more step in the penetration of politics into demilitarized zones?
Vax Americana wants to hold the unvaccinated accountable for the public toll of their private choices. But, once through the hospital doors, that’s a dangerous piece of road. We depend on health-care providers to save us from the cumulative costs of our luck, imperfections and weaknesses. And we are, none of us, perfect. Trust between doctors and patients depends on the exercise of medical, not moral, judgment, and we all benefit from their dispassion.
So, yes, cheer the colleges, restaurants and corporations that are mandating vaccines. Keep working hard to persuade your unvaccinated cousin to step up. But praise the caregiver who might one day save that cousin’s life if he doesn’t.