I’m sure the HCWs fighting with anti-vaxx patients in emergency rooms and courts filling with cases where patients (or their families) sue to force HCWs to give them treatment with unproven, dangerous “remedies” wish that was true!
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As per Cory Doctorow, I would like to remind that when you have a The Cold Equations situation, it’s never actually created by the math.
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That’s very true…
And the solution to this? The “pushing unvaxxed patients to the back of the line” , or whatever method is used to triage people into these definitely collapsing medical institutions? Those too won’t be made fairly. Those will be a contrivance as well, and the “common man” will not get preferential treatment.
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I’m going to say it again: this is a terrible, terrible idea.
Who does the triage, separating the vaxxed from the unvaxxed? Who puts their life on the line and tells Jim Bob that his daddy’s gonna die because he didn’t get the shot? Are they armed? Because the unvaxxed surely are, as are their families. Hell, doctors and nurses are getting beat up today because they aren’t giving out horse paste!
Which health care worker gets to violate their oath and deny life-saving treatment? Who goes home and says “don’t talk to me, I had a rough day, I yanked the plugs on a bunch of unvaxxed people and watched them die to make room for some other people in the ICU”?
Who keeps the list of differentiators? Politicians? Who gets to decide which self-inflicted problems put you at the back of the line? Today it’s unvaxxed COVID patients; tomorrow it’s suicide patients with self-inflicted injuries; the day after it’s fat people with heart attacks. Then it gets worse: “illegal” aliens? Felons? People with drug convictions? (That last one is on FCC forms today; to apply for a radio license you must certify you haven’t been convicted of drug charges!)
And that’s just the practical reasons. There are also the ethics of the decision; which today is the equivalent of saying “I wish those stupid republicans would just die.”
Nope. Treatment has to be for all.
The one thing I might support would be for doctors to prescribe vaccines to be administered to all the immediate family members and housemates of COVID patients. “You brought him in? Roll up your sleeve, I’ll take care of this right now, no charge.”
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“Fair” and “appropriate” are not functional in this situation. And organ transplant is a bad analogy, because there is a protocol set up, and the level of urgency is much less. In the scenarios being put forth here, it is literally an instantaneous decision, and the only ones in a position to make it is the doc at bedside. Absolutely no one in my profession is going to willingly assume that responsibility. If you recall, back at the beginning, there were many plans for ventilating multiple patients with a single ventilator, because we will take any, even completely ridiculous, option over condemning a patient to death. I spent several years as an PICU doctor, I can speak to this with some authority. And no, we will not play that game.
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One of the most disturbing, nightmare inducing short stories I have ever read. Never thought I would be in a position where someone thought it was a good idea to go there.
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Cory’s article on it was an interesting read into it.
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That’s ignoring the rate at which those buildings collapse on and kill/maim the very people you go on to say we have an insufficient supply of: doctors and nurses.
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No, it was very much a “first come, first served” kind of situation. The closest thing to triage that was being done was focusing care on people most likely to survive once hospitals were already over-capacity and also denying care to disabled people.
Anecdotally, I hear stories that suggest the anti-vaxxers require more care as they make more (unreasonable) demands, as do their families (insisting on coming into the hospital without masks, demanding quack treatments) on top of a high incidence of physically attacking medical staff.
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Its basic triage, and completely ethical. The vaccinated patient has a better chance of surviving should receive resources first - and will likely consume less resources getting well, which means more people can get well. Sinking resources into a no-vax case means others who might otherwise survive may die because they could not get the resources that would otherwise ensure their survival.
We can’t hesitate to cut them loose. They’ve had a chance to get vaccinated, there was a chance for everybody to do so. WE begged them to. It was their choice.
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Thanks to the free market, non-socialist healthcare system they have fought tooth-and-nail for.
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It’s really weird that you responded to @Mindysan33 with this, but it was actually @docosc, a happy mutants medical doctor, who wrote to your suggestion that it would be putting medical professionals into the role of judge, jury and executioner.
But aside from whatever that was about, it’s easy to apply these philosophical ideas from our safe offices or wherever we are. I cannot imagine the stress of actually making life and death decisions for people who are at their most vulnerable, no matter what my feelings about how they’ve lived their lives prior to that moment.
Thank you to all our HCWs: We appreciate and need you. 
Sorry things are so shitty.
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I’m not sure about your hospital but here we have emergency plans for what happens when capacity is strained. As you noted, tough decisions on care rationing can’t be in the providers hands it has to be a set of pre-established rules.
This pandemic is wearing everyone in the hospitals thin. Even though sympathy burn out is real care has to be provided to those who will have the highest likelihood of survival adding any decision layer to that, as you mentioned, will just reduce the workforce even more than burnout and omicron (which is bad enough right now).
(mainly replying to person you are replying to in agreement with you)
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We can’t go there. Dehumanizing people is 100% always a bad idea, that inevitably metastasizes. With that said, I don’t have an answer. Other than I am very tired, and I am not in the ICU anymore. Those guys are crawling. Seriously, we cannot throw more burdens on a broken and bleeding medical staff. But we can’t provide care as we should. And trust me, we know it. Painfully.
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I’m reminded of The Good Place where as part of an ethical thought experiment made real, Chidi has to decide whether it would be ethical for him to kill his healthy friend to use her organs to save five patients that need them.
“I-I won’t do it. As a doctor, I’ve taken the Hippocratic Oath to do no harm, and although five people will die, I cannot harm one innocent person to save them and forsake my oath. It’s unethical.”
“Okay. Tell their families.”
“What?”
“Doctor Chidi? My daddy needed a heart transplant. Did you save his life? He was working, then a really bad man ran him over with a trolley.”
“Oh, come on!”
There can be a big gap between ethical and won’t mess you up for life. It’s very easy to say other people they need to harden their hearts but maybe it’s worth noting what reaction the actual practicing doctor here is having to this idea.
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Cool, you can stand there and tell them they get to die. Good luck with that.
I’ve seen way too many people die right in front of me to wish it on anyone or choose one over another to their face but you do you.
Sure, that opens the door to somebody else choosing you as the one to die due to their arbitrary rules set but you’re cool with that, right?
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And you’re not alone. Thanks for being patient with humanity this year, Doc.
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Have the HMO ‘experts’ make the decision; they happily deny advanced care to everyone they can, regardless of color.
It’s already metastasized in the GQP to the point where cult members stand up in public and ask when they can start shooting “the others”.
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That doesn’t mean it’s okay for us to do it too.
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