Dr. Parker argues for a contingency care requirement that focuses on emergency life-support, regardless of vaccination status, in order to save the most lives. “Simply declining the use of vaccination in prioritization of medical resources without analysis disregards the really genuine tradeoffs at play during a pandemic. The discomfort and suffering of the vaccinated from deferred medical care need a much deeper defense of caring for the unvaccinated.”
One example of this concept is providing vaccinated people access to sporting or home entertainment events that are off limitations to the unvaccinated (even if the unvaccinated test unfavorable for COVID-19). Proportionality is the principle that “payback” ought to be proportional to the magnitude of the act.
Priorities for looking after patients no matter vaccination status. Credit: ATS
A brand-new viewpoint piece published online in the Annals of the American Thoracic Society provides an extensive examination of the principles of using healthcare facility resources on unvaccinated-by-choice COVID-19 pneumonia patients, versus patients with other severe diseases whose diseases are not progressing as rapidly.
In “Caring for the Unvaccinated,” William F. Parker, MD, PhD, assistant teacher of lung and important care medication and assistant director, MacLean Center for Clinical Medical Ethics, Pritzker School of Medicine, University of Chicago, took a look at cases in which health centers delayed medically needed and time-sensitive procedures for vaccinated adults when they were overwhelmed with unvaccinated patients who had serious, dangerous COVID-19 pneumonia and suggested an ethical structure for triaging these clients.
” These vaccinated clients are directly harmed when hospitals utilize all their resources to care for the numerous unvaccinated patients with COVID-19,” he writes. “For example, delaying breast cancer surgery by simply 4 weeks increases the relative risk of death from the illness by 8 percent.”
Dr. Parker argues for a contingency care standard that prioritizes emergency situation life-support, no matter vaccination status, in order to save the most lives. “Simply declining using vaccination in prioritization of medical resources without analysis disregards the extremely real tradeoffs at play during a pandemic. The pain and suffering of the vaccinated from deferred medical care require a deeper defense of taking care of the unvaccinated.”
Removing the Double Standard That Harms Patients in Vulnerable Communities
He specifies, “Even though the huge bulk of patients who establish lethal COVID pneumonia are unvaccinated, hospitals still have ethical commitments to expand capability and focus operations on caring for them– even if it suggests making vaccinated clients wait for crucial however less urgent care like cancer and heart surgeries.”
” If tertiary care centers turn inward and stop taking transfers of COVID-19 clients from overwhelmed community healthcare facilities, this will result in de facto triage in favor of lower advantage care and trigger systematic harm to both the immunized and unvaccinated in vulnerable communities,” he adds. “Hospitals must validate their not-for-profit status by accepting transfers and prioritizing life-saving care throughout a pandemic rise.”
He points to Los Angeles County during the winter rise, in which the general public health department needed to issue an order forcing elite health centers to stop doing financially profitable elective treatments and accept patient transfers from community healthcare facilities that did not have capacity to manage all of the COVID-19 patients who needed extensive care.
Reciprocity and Proportionality
When 2 patients have comparable survival advantage from a limited health care resource, the principle of reciprocity supports a possible tiebreaker function for vaccination status. A universal exclusion of the unvaccinated from life assistance throughout a pandemic surge fails the test of proportionality for reciprocity, according to Dr. Parker.
One example of this principle is offering immunized individuals access to sporting or entertainment occasions that are off limitations to the unvaccinated (even if the unvaccinated test negative for COVID-19). Proportionality is the principle that “repayment” need to be proportional to the magnitude of the act.
Dr. Parker mentions that while the 8 percent increased relative risk of death from delaying breast cancer surgical treatment is awful, the outright boost in risk is just one per 100, and perhaps just one per 200 for a two-week deferral.
” After the rise is over, the medical facility can capture up on deferred optional surgeries,” he writes. “The damage from a coronary artery bypass or cancer surgery delayed 2 weeks is real, however small in contrast to specific death from denying life assistance for breathing failure.”
He concludes, “There is a defensible function for vaccination status in triage as a minimal tiebreaker, not as a categorical exemption, but only in the context of a well-defined and transparent triage algorithm. Regardless of the huge financial pressure to do otherwise, elite scholastic centers are obligated to prioritize life assistance for emergency situation conditions to conserve as numerous lives as possible during COVID-19 rises.”
Recommendation: “Caring for the Unvaccinated” by William F Parker, 19 November 2021, Annals of the American Thoracic Society.DOI: 10.1513/ AnnalsATS.202109-1039IP.