Why stop there?
In 2013, my emergency management counterpart at Johns Hopkins Hospital in collaboration with other system colleagues, as well as UPMC and Carnegie Mellon, piloted a study (“The community speaks: understanding ethical values in allocation of scarce lifesaving resources during disasters”) which sought to understand community members perception of allocating scarce medical resources — ventilators — during a pandemic (too many patients, too few resources). Researchers proposed to participants six models for allocating scarce resources to patients during a pandemic, including, first-come, first-served; lottery; prioritizing those most likely to survive; prioritizing those with the most years left; life cycle or fair innings principle; or value to others.
Interestingly, none of the proposed models involved withholding medical care based upon a patient’s vaccination status during a pandemic, yet today some members of the public health and medical community, as well as some in the media, suggest denying medical care according to one’s COVID-19 vaccination status. This proposition stems from the claim that the unvaccinated are a greater burden (both on physical resources and financially, which go hand-in-hand) to our nation’s health care infrastructure than the vaccinated. Speaking of burdens to our nation’s health and medical sector, then, perhaps we need to examine rationing care in other areas to alleviate resource and financial strain within healthcare.
Perhaps we deny care to the obese? According to Cawley, et al., writing in Direct medical costs of obesity in the United States and the most populous states, “the aggregate medical cost due to obesity among adults in the United States was $260.6 billion” in 2016. Is it fair that the obese impose such a financial burden on our nation’s medical systems?
What about cigarette smokers? A mountain of evidence, since we are told to trust the science, tells us that, “Tobacco use is the single most preventable cause of disease, disability, and death in the United States,” according to the CDC’s Tobacco Control Interventions webpage.
While we are at it, should those who willfully engage in substance abuse be denied care due to the financial and resource burden they knowingly place on our health care infrastructure? For the first time ever, our nation surpassed 100,000 annual overdose deaths, a sad testament to the availability of illicit drugs and the abuse of prescribed drugs.
Of course, I am being facetious by suggesting we should ever limit or deny care to any patient regardless of their health condition. The argument that care should be withheld to anyone regardless of their personal health decisions, whether we agree or not, or medical conditions is unethical and unprofessional. If we are to ration or deny care for those who might burden our healthcare infrastructure, then, how do we define burden, who becomes a burden, and where is that line drawn?
DAVID E. BJORKMAN
Submitted by Virtual Newsroom