In rural Colorado, a vaccinated man suffering from gastric disease and rheumatoid arthritis is losing mobility and is barely able to feed. The doctor warned that he cannot schedule a visit to the nearest hospital because the beds are all filled with unvaccinated Covid patients.
Cases multiply in American states with low rate of immunization. Elective surgeries are canceled and cancer treatments are delayed. Unless the patient has an emergency such as a heart attack or stroke, exhausted staff in overcrowded hospitals cannot provide care.
In the Bronx, New York’s poorest neighborhood, infamous for having some of the worst public health rates in the country, a family doctor has found that the decision to switch hospitals doesn’t spare her the horrors she witnessed at the start of the pandemic .
She resigned from a prestigious Manhattan private hospital with burnout and depression after more than a year treating the infected in the emergency room. In the Bronx for six months, he is now facing not only the routine epidemic of chronic diseases such as asthma and diabetes among neighborhood families, but also ignorance and resistance to vaccines.
On Monday (13), the US Supreme Court rejected an action by doctors, nurses and other health workers in New York who wanted religious exemption to refuse the vaccine. The state government retains the right to impose the immunizing requirement, making a rare exception for cases of patients who had an allergic reaction to a previous dose.
The explosion of delta variant cases in the second half of this year, when most Americans already had extensive access to vaccines, sparked the ethical debate: Does a doctor have the right to deny assistance to those who refuse the vaccine?
The American Medical Association (AMA) responds that a patient’s vaccination status alone does not justify denying care. However, it lists situations in which the decision must be at the discretion of the physicians, without violating the code of ethics.
It is necessary to take into account whether the patient faces an emergency situation and whether, despite the easy access to the immunizing agent, he is risking the health of other vulnerable patients, a risk that increases according to the medical specialty of the place of care.
Ethical assessment enters a grayer area when considering the health of doctors and nurses. Features such as personal protective equipment or areas set aside for the unvaccinated vary across hospitals and offices.
The spread of the omicron variant in the winter months of the Northern Hemisphere should stir up the moral debate, not only among health professionals, but also among vaccinated people forced to work together with vaccine deniers. Not all choices will have to be officially announced.
Medical triage is a reality in situations of mass victims, such as soldiers at war. We know of individual cases, such as a Texas medical group that considered using vaccine status as a criterion for admission to ICUs.
Refusing care because of a patient’s anger is, of course, an ethical violation. But two years into the pandemic, workers in Covid’s trenches no longer hide their outrage. It is difficult to feel compassion for those who choose to become infected and risk the lives of others. The only effective protection at the moment are court rulings like the Supreme Court’s on mandatory vaccine in New York.
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