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  • Reverend James Squire

You Broke it, You bought it

The pandemic has brought home some uncomfortable tensions between a failure to get vaccinated and the real world that is covered by guidelines regarding who can receive an organ transplant. It is also a tension between entitlement and reality for the cost now facing our health system.

The case in the recent news is about a person who is in need of a heart transplant. The family of the individual wants the rules thrown out in their situation. Simply put immunizations are required in order to be in line for a transplant including vaccination for Covid, a flu shot and a vaccine for Hepatitis B. The person wanting the transplant has not received a Covid vaccine.

It is important to know why these guidelines are in place. It falls under the heading of the short term vs. long-term paradigm as well as justice vs mercy. The guidelines for receiving a transplant are specific and grow out of a history of bioethics legal action.

In an article in the January 27th Inquirer by Philip Marcelo and Rodrique Ngowi (Associated Press) is titled Hospital Defends Refusing Transplant to Unvaxxed patient, “There are currently more than 100,000 candidates on waitlists for organ transplantation and a shortage of available organs – around half of people on the waiting lists will not receive an organ within five years.”

You have a choice of not getting vaccinated, but that rubs up against the reality that any hospital wants to make sure that you will have long term survival given the scarcity of organs. Hospitals are operating in the short term and long-term paradigm.

Guidelines for who gets transplanted are universal. For the most part you can’t shop around for a state to honor your request to receive an organ. This is because of the “Mickey Mantle Factor.” He is the great baseball player who was an alcoholic who needed a liver transplant. He was bumped up the list because of his popularity while others were still waiting in line. This led to the inclusion of a “justice” piece to be part of the guidelines. But there is also a guideline that is the most difficult in my experience waiting with people who needed a transplant who didn’t live long enough to get one. You have to be healthy enough to survive long term but not be too sick to benefit from the new organ. It is a life and death issue.

There are many other parts to the guidelines. My mentor, Dr. Art Caplan, now at New York University raises the question, “Should sin count? There are many diseases that have a personal responsibility component. People may bring harm to themselves from drinking, smoking, and having sex with many partners without a condom. If we said, ‘let’s not let people who’ve sinned get access to expensive medical treatment,’ the hospitals would be empty.”

You can argue both sides of the question if the unvaccinated should be able to get an organ, but guidelines that require all to be treated in the same way seems to me to be the most important factor. Caplan also feels that if you had money and an advocate in the past, you were treated differently than others.

I feel that this case about the person who wants a heart but not a vaccine (unless you can guarantee I won’t have symptoms after the shot) needs more attention to bring people to the “costs” of not getting the vaccine. It cost approximately $1,382,400 for a heart transplant.

Since I mentioned money, let me share with you a recommendation regarding unvaccinated people who are hospitalized. It is a proposal, by an Illinois legislator Jonathan Carrol, made to increase personal accountability. He is working on a law where people who are unvaccinated should pay for their hospital bill. People have forgotten how the cost of the unvaccinated is a threat to our national health system. His proposal would conflict with federal Obamacare protections for people with pre-existing conditions, but he is open to seeing this as a starting point. Here is the question that has not been raised enough. Who do you think is going to pay higher insurance premiums to keep the hospital systems on sound footing? You and me!!!!

This could be a game changer because of the choices cited in David Callahan’s, The Cheating Culture. His research documented that when choosing between money and integrity, people will come down on the side of money.

We are threatening sanctions against Russia. Why not have sanctions against people who have not been personally responsible regarding vaccines?” After being against science, they quickly embrace it when they are hospitalized for Covid. I literally have family members and friends who have had their “normal hospital” treatments postponed because currently “there is no room for them in the Inn.”

Because of Trump we are acting under the cultural guideline that if you don’t like the rules, just change the rules to meet your personal needs. We need to jack up the price of irresponsibility for our unvaccinated neighbors so that the burden of cost is carried by them. It’s the ethical way to go forward as it fits the model of utilitarian ethic which is the “greatest good for the greatest number.”

A case in point is Novak Djokovic, the number one player in the world of tennis, who was forbidden from entering Australia because he falsified his immigration documents regarding his vaccine status. It cost him a lot of money and prestige, and other countries have indicated that the same will hold true for them. He will be forbidden to play. Watch how fast he gets the jab in his arm when a lot of money is on the line.

Don’t get me started on Aaron Rodgers who lied as well about his vaccinated status. He was slapped on the wrist. It cost him nothing. Such a weak response. Time to learn from Australia!!!

There is a need to have billboards all over the country as well as in the press with these words. Unvaccinated, you are costing me a lot of money. You have exhausted our medical people. You should pay the price for your convictions. It is the right thing to do. Your wrong actions should cost you and not the rest of us for your irresponsibility. That’s the ethical way forward.

Remember that sign in antique stores. You broke it (our health system), you bought it! What a great ethical maxim!

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