As I mentioned in an earlier post, triage is the assignment of degrees of urgency to illnesses to decide the order of treatment of a large number of patients. When you are dealing with large numbers of patients, you need criteria for treatment where the medical staff has to decide who would be treated first. During Katrina Memorial Hospital decided that those who had the most likely chance of survival would be treated first as they couldn’t treat all.
Medical professionals are fearing that we will be possibly entering a fourth wave of the pandemic. The pandemic is focused in red states with those who chose to not get the vaccine. The Yankees game against the Boston Red Sox was cancelled earlier this week. Recently Aaron Nola contracted Covid. He still has no plan to get the vaccine. He said that, “it’s personal.”
There are those that want to require the vaccine. We know that the Republicans would protest that we were taking away the personal freedom of people to decide.
Let’s look at triage, choice, and personal freedom from an ethical perspective in vaccine hesitancy. We have an assumption in place that if I get Covid, I will be guaranteed treatment at a hospital no matter how sick I get. That is a tacit understanding of the American people. But where is the medical staff treated to having the number of people that they can reasonably treat? The responsibility is on the medical teams and not on those who chose not to get the vaccine for “personal reasons.”
Personal freedom is a tricky issue. Let’s take a look at the founder of Natural Law, John Locke, and his point of view. Locke made the case that your body is important for that constitutes our primary property. We usually don’t think of that in regular discourse. Only you should make decisions that affect you. Part of Natural Law can justify abortion for the same reason. Locke also said that communities are like a pie that you cut and give to guests. You make the cuts equal in nature to be fair. Let’s say that someone wants to have a piece twice as big as the others. The community would rebel.
It is an ethical mandate that your personal freedom stops where my personal freedom starts. You can’t take a bigger slice. The bigger slice of the surge is the unvaccinated. We have a responsibility to the medical community as well. Do they have to treat everyone who has a choice and doesn’t get vaccinated when the medical community is exhausted and fearful of bringing the virus home? This is like sending an army back to the fighting at the front for the 4th time. We would never do that. Covid is a once in a lifetime illness so we can’t use the usual bioethics guidelines in the same way that Katrina, a devastating storm, created havoc at Memorial hospital.
There are two considerations that are the pillars of bioethics. One is autonomy which emphasizes the importance of individual decision-making. The other pillar is beneficence which means that your actions must benefit others.
Change the assumption from the fact that I will be treated if I get sick to only those who can show that they have had at least one vaccine shot will be admitted. Guaranteeing treatment is a hidden unrecognizable factor in vaccine hesitancy. It is a tacit, hidden, understanding by many. It has been underestimated.
The unvaccinated remind me of people with character disorders. When you have them in counseling, they do not respond to insight. That is why the current approach isn’t working. People with character disorders respond to cause and effect. “You do this, and I will do that.” Character disorders fill our prisons. When I have someone with a character disorder in counseling, I do not emphasize insight. I help the individual see the consequences of his actions for his family or general public.
When people say that their decision is personal and can’t explain why, it usually is because they don’t know why. They are not insight driven.
For example, I know a leader whose workers couldn’t stand him. Finally, they brought in a team to mediate a meeting between the leader and representatives from his workforce. The feedback that they gave him would drive most of us into a depression. No punches were pulled.
The mediating team had lunch with the leader. They asked how he was feeling. He responded, “I feel fine.” The team’s response was, “That is the problem. You shouldn’t feel fine after all that feedback.” There was no insight.
We will be in a never-ending cycle with Covid for many years if we don’t change direction. The professionals are concerned that this pandemic will spill over particularly to children where vaccines have not been tested. Make no mistake that it will be the children who don’t have any possibility or autonomy to get the vaccine who will die. Make an announcement that only people that have a card indicating that they were vaccinated will be able to be treated in a hospital. It is the only way to protect our children. It will also protect our medical community from being forced to go to the Covid front to do battle again and again. They can’t continue doing this. We will preserve the balance of autonomy and beneficence.
In bioethics we are always looking for precedents or the nearest situation that is the same as the one that is challenging us. I remember taking the polio vaccine which was infused in a sugar cube in elementary school. I didn’t have a choice because I might infect others. Require vaccination for Covid or use the above formula for triage. Your shot is your entrance card to a hospital. Our children’s lives depend on it. Desperate times require desperate measures. Giving those who are unvaccinated accurate information and requests from others has proven not to work. There is no insight. I will bet that this approach would get a quick turn-around. It is the only way to protect the children.
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