WTG's article posted yesterday highlighted tragically the horrific problem facing medical practitioners in ICU beds these days.

(To refresh, the story was about a veteran who died of a highly treatable ailment, entirely because he was unable to obtain an ICU bed. All in his Texas vicinity were full.

I guess you know Texas is one of the areas currently hardest hit by Covid patients (now hospitalized in ICU), most of whom are among the voluntarily unvaccinated.

When nightmare scenarios like this arise, can you see any moral and legal rationale for withholding a margin of ICU beds from unvaccinated Covid patients who elected not to be vaccinated? As we all know, the DELTA variant is both more transmissible and more virulent - its victims far more apt to be hospitalized and even to die.

Despite there being arguments to excuse such hold-outs (for instance, that they were so heavily propagandized against vaccines they were unduly motivated to avoid them.)

However, despite the claim that individuals have the right to decline vaccinations on whatever grounds (personal liberty, disbelief in the reality of the virus, dangers of the vaccine, etc.) the fact remains that their decision affects far more than just themselves. Such unvaccinated can transmit the infection to others - including "breakthrough infections" among the those who were vaccinated. Meanwhile, a critical population pushing the numbers beyond the acceptable maximum, are among those voluntarily unvaccinated.

This can and does, result in denying ICU care to "innocent" patients, Covid or otherwise.

I believe that such sick Covid patients (unvaccinated) should be relegated to a different level of care in heavily afflicted areas where necessary intensive care can and is denied to patients in need resulting in their suffering and possible (probable) death. These patients unable to obtain needed care may be vaccinated "breakthrough" patients and those suffering from other grave illnesses or injuries.

Without getting involved in relative responsibility for patients' severe problems (e.g., poor self-care in heart attack patients, speeding in a car crash, whatever), I still believe that this class of Covid patients however sick and/or pathetic in their number of dependents, should be put into that non-preferred category of care when beds, care and equipment are limited.

Also that these triage criteria be widely publicized to the general public.

What do you all think?

(To refresh our memory of wtg's article, here's the link:
https://www.cbsnews.com/news/c...s-treatable-illness/ )

I've already stated my position on this.

quote:

Originally posted by QuirtEvans:
I've already stated my position on this.

Oh, foo! Looks like I missed it. Could you please link it?

Well, triage is a fact of life so I don't see why this should be different.

Then again, I think COVID vaccinations should be mandated in the first place.

Triage is not a choice. It is an imperative when the system is overloaded.

As I've stated in another thread (can't remember which), what is the triage protocol for a patient who's already been admitted and is declining? I am assuming that COVID patients who've already been admitted will be given priority for an ICU bed over someone who hasn't been admitted. They're already in the system. Where the issue occurs is for unexpected emergency care (car crashes, drug overdoses, etc.). I honestly don't know what the protocol is there. I am assuming (only) that hospitals don't stop treating people, even moving them into ICU, for "just in case" situations. I guess my question is, do they keep a certain number of "just in case" ICU beds available for the unexpected emergencies, as above?

But once we start layering morality issues on top of triage, I get nervous. Making a judgment that an unvaccinated person is undeserving of an ICU bed seems to open the door to all sorts of stuff. For example, what is to keep someone from determining that a gay person who has AIDS is undeserving of the ICU bed? Or a lifelong smoker with emphysema? etc., etc. Today's COVID issue just opens the door for other judgments that we might not agree with.

The issue of necessary but non-life threatening delays is a real one as well. The whole thing stinks.

Yes, one of the difficulties about such a triage is the "first come first serve" angle.

I hear that the main difference between ICU beds and others is the level of specialized care that accompanies the placement.

It's certainly complicated in terms of personal responsibility.

How about having "invitations"/pressure for vaccinations to be obligatorily accompanied by a signed waiver on the part of "refusenik" patients. A waiver whereby they acknowledge their understanding that refusing the vaccine comes with their ineligibility for ICU level care if otherwise indicated.

This would serve a dual purpose in that it would vastly encourage hold-outs to take more seriously their turning down the vaccine - for one, reconsidering the cause and effect connection between the vaccine's protective effect (hitherto denied) and the resultant safety/unsafety of other needy patients. Perhaps for the first time, it would hit home that their "free choice" costs others a non-free consequence in their safety.

This ought to greatly increase the rate of vaccination and thereby prevent the number of transmitted cases, especially those grave enough to warrant hospitalization - ICU level care.

It would demonstrate that their refusals are more causally related, to personal consequences not only for them but for others who were not given such a choice. It might also be linked to more widespread advertising campaigns, "starring" interviews with regretful covid patients and their families. Likewise, interviews with might also include post facto interviews That with families who not only regret their vaccine refusals, but also urge others in their position to be vaccinated.

It would likewise be helpful to also include telling the stories of remorseful unvaccinated patients (and their families) who've become aware of non-covid patients who perished because of being unable to access an ICU bed .

I see this as a win-win approach.

No, this doesn't cover the issue of already admitted unvaccinated covid patients but at least it would deal with the moral issues related to such patients. Ones who welcome the opportunity to help persuade others turning down the vaccine, to make amends for their now-regretted decision - a decision they now realize has cost someone else their lives.

"According to state records, you have not taken any of the approved Covid-19 vaccines. Please sign here, or click to be placed on the do not vaccinate list. This also acts as your DNR for any Covid infection"...

Absolutely not. What a horrible precedent that would be. Healthcare shouldn’t be rationed based on moral judgements of those who happen to be in power.

Triage based on survival probability, for which vaccination status would be an important factor but one of many.

What Jon said.

I'm with Nina, jon, and jodi.

I don't like it, but if push comes to shove and we do not have enough beds, some standard has to be implemented. If not this, then what?

I liked the way jon put it:

quote:

Triage based on survival probability, for which vaccination status would be an important factor but one of many.

But yes, it's gonna get ugly. People who are used to basically unfettered access to health care aren't going to be happy.

Kind of related:

https://www.statnews.com/2021/...-better-alternative/