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  • Reverend James Squire

Bioethics and Vaccine Distribution

Updated: Jan 23, 2021

My first opportunity to do bioethics at an institution was when I was invited to join others to vet the controversial Body World Exhibit that was coming to the Franklin Institute in Philadelphia. We were to offer recommendations after thoroughly going over the exhibit. The exhibit was touring the United States. The creators of it used the process of plastination to show the inner workings of the human body. You could see the nervous system and other systems that were difficult to see as a whole. The medical schools in the Philadelphia area took their anatomy classes there. They could see first-hand the systems in the human body.

Our recommendations included having the exhibit of the fetuses that was part of the exhibit placed in a room off the central pathway through the exhibit to be sensitive to the Roman Catholic population and other pro-life groups who would be attending the exhibit. They could choose not to view that part of the exhibit. We made sure that there was tracing for the consent that must be given to all the people who donated their bodies to this exhibit. We also asked that the gift shop not contain plastic kidney key chains and other items of that nature. The Institute and Administration of the Body World exhibit accepted all of our recommendations with the exception of what would be sold in the gift shop. Vicki and I attended an opening night gala and reception for the Body World Exhibit at the Franklin Institute. I was criticized by several people who attended for approving the exhibit in the first place. This bioethics vetting was easy compared to who should get the vaccine and when.

Bioethical thinking is a lot like law school. You follow precedents for your decision making. There were no precedents for this Pandemic. You couldn’t even look at how the Spanish Flu Epidemic was handled because of the different historical context.

Let me touch on some themes that have made vaccine distribution very difficult in terms of who should have priority to receive it. There is no national recommended policy on who should get the vaccine and when. States are making those decisions. There is an overarching reality that has produced part of the vaccine controversy. Vaccine distribution is a zero-sum game meaning one person’s gain getting the vaccine is another person’s loss.

There is the Mickey Mantle Factor in bioethics. Mickey Mantle, a famous baseball player, was an alcoholic who received a liver transplant after a short waiting period over people who were just as needy. That event created a formula for how you get a transplant. In essence fame shouldn’t matter. The same is true for the order of who should get the vaccine. Sports teams have been criticized because they can get testing on a daily basis when others can’t. The ethical principle here is “what you do for one you should do for all”.

The vaccine priorities that seem to be a part of most conversations are smokers and obese people are higher up the list as they have a choice to change their lifestyle. The bioethical debate is the question, “Are they life choices or underlying conditions?” My vote would be for life choices.

Nursing home patients are at the top of the list because 40% of the deaths in our nation are found in nursing homes. The argument against vaccinations for the elderly is that they don’t prevent the spread of the disease. My vote would still be for giving them the vaccine because it feels fair and right. Our elders should be honored.

I have saved the most controversial to last. Should prisoners be given the vaccine before others do? This gets the blood boiling. States like Colorado are totally against this. The argument for giving the vaccine to prisoners is that you are putting the prisoners in harm’s way. The idea in the Hippocratic Oath has been used here where “you should first do no harm”. The argument against is the zero-sum game that other people need it more. One of the categories of bioethics is justice vs. mercy. I would vote for mercy here for the prisoners. The gray area is determining how to relate to poor communities where people have to live in close quarters as well. This has still not been addressed. Ranking people is ultimately about access to the vaccine. For example, in Texas most of the vaccination sites are in the white affluent areas, but more than half of the fatalities in Texas are found in the Hispanic community and almost 10% have been in the Black community. These areas are not affluent. This is racist!

Remember the first ethical statement that we human beings say. “It’s not fair!” This too is the subjective guideline for a discipline that has to operate frequently in the gray area. The people who are responsible for the ranking are taking this into consideration. They are also looking at the driving force of the theory of the Utilitarian view of the “greatest good for the greatest number in a particular group.”

I mentioned in an earlier post that England is getting all of their vaccine out because of the significant fast transmission of the disease. They are risking that the second shot will not be available but their formula is for short term gain over long term consequences which makes perfect sense to them in their situation. They have used cost/risk/benefit analysis which is a decision-making process that we will be seeing more of in the days to come in the US as well.

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