Medical Triage: Hospitals face the ethical dilemma of deprioritizing care for eligible unvaccinated people

“To say what should be obvious, getting vaccinated and wearing a mask in public spaces aren’t ‘personal choices.’ When you reject your shots or refuse to mask up, you’re increasing my risk of catching a potentially deadly or disabling disease, and also helping to perpetuate the social and economic costs of the pandemic. In a very real sense, the irresponsible minority is depriving the rest of us of life, liberty and the pursuit of happiness. Furthermore, to say something that should also be obvious, those claiming that their opposition to public health measures is about protecting ‘freedom’ aren’t being honest.” – Paul Krugman, The Quiet Rage of the Responsible

The Hippocratic oath requires doctors to treat all patients equally, but what happens when you run out of doctors? This is not the first time medical staff and hospital beds were in short supply during the pandemic. There is, however, something notably different this time.

In the early stages of COVID-19, patients overflowed hospitals at alarming rates. This forced physicians to make tough decisions, some likening it to conducting triage during war. Patients with the best chance of survival got the bed. The rest did not. It was a death sentence few health care providers wanted to write, but that the virus necessitated.

A year and a half later, it is happening again — hospitals are overflowing and medical staff are in short supply. Unlike when the pandemic started, this isn’t necessary. There are now several remarkably safe and effective vaccines that could all but eliminate hospitalizations and deaths. Regrettably, many Americans are simply refusing to use them.

When there was no vaccine, medical triage was straightforward. But now, the situation is changing. It is not a level playing field — many of the sick needing care have turned down a vaccine that could have prevented them from needing hospital care. This raises an uncomfortable ethical question: Should eligible, unvaccinated people be medically triaged at the same priority level as the vaccinated?

If medical capacities weren’t being reached, it’d be simple. In medicine, everyone receives equal access to treatment regardless of personal choices — even a convicted murderer on death row will be given a life-saving surgery the night before lethal injection. The same is true for decisions that knowingly shorten lifespan or create disease. It’s all part of the job.

But it’s not so simple anymore. It feels different when hospital resources become so scarce that the decision not to vaccinate against medical recommendation can kill someone else. For example, if someone makes the choice not to get vaccinated, and that choice results in occupying a bed that someone else who got vaccinated needs, and without it they could die, is that ethically fair?

This hypothetical situation is already happening in real life. In Arkansas, only 37.6% of the population is fully vaccinated. Due to the influx of patients infected with the delta variant, there are now only eight intensive care unit beds available statewide. This means that anyone — including the vaccinated — in need of urgent critical care have essentially nowhere to go in this region without expensive and medically risky out-of-state transfers.

Meanwhile, an eligible, unvaccinated person is receiving ICU care. Is this right? Is it fair? What if two people enter a hospital at once. One was eligible for the vaccine but denied it and now needs treatment for severe COVID. At the same time, another vaccinated individual is in heart failure. If there’s only one bed left, who gets it? What’s fair?

It is not only adults. The delta variant is now infecting children at significantly higher rates. According to projections by the state’s health department, the children’s hospitals in Tennessee will be filled by the end of this week. Other children’s hospitals are also seeing rapid increases as schools reopen, and thousands of children have already tested positive and been quarantined.

Is this fair? Predictably, these regions now expect assistance from other states that, due to higher vaccination rates, do not have hospitals overflowing. This means low-vaccinated states are offloading patients to more highly vaccinated regions, all while requesting that medical personnel come in and assist them. This puts a massive dent in the hospital capacities of the vaccinated regions — and some governors of unvaccinated states have even requested that vaccinated regions postpone elective procedures to accommodate.

Is this fair? There is no doubt that access to health care should be a human right. There’s also no doubt that we need to reevaluate our health care system in the future. However, today’s reality is that hospitals are nearing capacities due to people refusing to get vaccinated, and we must decide what is fair now.

As controversial as it may be, we should deprioritize the eligible unvaccinated patients during medical triage. It is a free country, and you can absolutely choose not to get the vaccine. But choices have consequences, and the willingly unvaccinated have made this consequence necessary.