In one of my healthcare policy courses, a beloved professor passionately argued that unvaccinated individuals should be turned away from medical care. No one dared to disagree in the awkward silence following his call to battle, “anyone disagree?” A doctor made the media buzz with his sign declining care to the unvaccinated [Barnes]. In a September segment, popular comedian Jimmy Kimmel joked along the same lines in his live show that unvaccinated individuals sick with COVID-19 should not be admitted to Intensive Care Units (ICUs). These are bold ethical proclamations on who deserves to receive care first that violate the principles of the ancient medical text encrypted in the Hippocratic Oath. The modernized version of the Hippocratic Oath declares that physicians and providers must act in sympathy and abstain from harm [Johnson] regardless of the choices of their patients. Turning away care of unvaccinated patients is a gross misunderstanding of how healthcare works.
The principle argument leading to declining care to the unvaccinated is that the COVID-19 pandemic has accelerated burnout and compassion fatigue in healthcare providers. In a cross-sectional survey of intensivists working during COVID-19, 50% of survey participants showed symptoms of anxiety and burnout [Azoulay], and this fact was well emphasized by the media throughout the pandemic. It may seem that the natural response to reduce burnout is to withdraw care from the cause of the continuation of the pandemic: the unvaccinated population. However, burnout in healthcare has multiple contributing factors including poor compensation for staff, non-travel nurses and poor patient to provider ratios [Shah]; ultimately, the same work is being performed with or without COVID patients. Turning down care for COVID patients will still allow the dangerous patient to provider ratios to exist and cannot be ameliorated by rationing care away to only the vaccinated.
Picking who receives care and who doesn’t is unethical and antithetical to the ideology behind practicing medicine as healthcare provides basic care for everyone no matter the choices the individuals make. People make poor decisions regarding lifestyle choices which lead to lung cancer or cardiovascular diseases. Alienating unvaccinated individuals as not deserving of care not only hurts that population, but increases mistrust between that population and the medical community. Denial of care also decreases the opportunity to vaccinate, educate, and improve relationships between the medical community and people who are mistrustful of the vaccine.
Regarding the care of the unvaccinated, there’s also an economical aspect to consider. Even if the vaccine has breakthroughs in infection, it’s been shown to decrease severity of infection and in turn reduce ICU admissions [UArizona]. If health insurance denies coverage to an unvaccinated individual, that is a choice dictated not by the Hippocratic Oath, but by the economical argument that Intensive Care Unit care can cost near hundreds of thousands of dollars with mechanical ventilation in place [Dasta]. The nature of American health insurance involves putting price values on people’s lives, and it is understandable why under the business model, insurance can deny coverage of a disease that could have been prevented. Thankfully, the business model has not corrupted the modern Hippocratic Oath, and the same strategy of picking and choosing who to provide care for is not an option for healthcare providers.
Ultimately, America generally follows a “first come first serve” principle when appropriating healthcare and questions of who deserves care is solved by luck, timing, and capacity. The medical community only pushes those who are against vaccination into further mistrust by turning away care and therefore confirming the suspicions of the anti-vaxxers. In addition, denying care to the unvaccinated is a missed opportunity to give a sick person a second chance and to hopefully educate the misinformed public. Healthcare is a selfless profession that ideally should treat people despite personal choices and act in sympathy toward all.
Post Script
Ironically, the day after I finished writing this article I had a patient who made my stronghold stance on treating the unvaccinated tip away from the crooked seesaw.
I was dispatched for a call that would definitely put me beyond my usual 12 hour ambulance shift; this would not be a bother if it is for someone who needs genuine medical help. My patient’s complaint was that they felt sick and wanted to go to the hospital for a second time since testing positive for COVID in the past week. Their family had not been vaccinated and all were sick with COVID. My patient talked about how they had a hard time breathing when there were no medical signs of difficulty breathing as their vitals were within normal and lung sounds were clear as day. My patient moaned about how tired they felt but said they weren’t eating or drinking because they “didn’t feel like it.” I was prepared to administer medications that ease difficulty breathing, but there was no medical justification for giving medications. Beyond giving them a bed, the hospital would not have given my patient any different treatment than if they had stayed at home. My exhaustion from the shift caused a mental fog which made me hear their concerns less and feel my irritation with the consequences of their choices more.
My article was a good reminder to myself to choose kindness. I suggested that following their sickness, they should vaccinate their entire family three to four weeks after recovery. Will they listen to my advice? I don’t know for sure as it is their choice. All I can do from my position is provide a resource towards what I believe is the right choice.
Works Cited
Azoulay, Elie, et al. “Symptoms of Burnout in Intensive Care Unit Specialists Facing the COVID-19 Outbreak.” Annals of Intensive Care, vol. 10, no. 1, 8 Aug. 2020, 10.1186/s13613-020-00722-3.
Barnes, Adam. “Alabama Doctor Tells His Unvaccinated Patients He Won’t See Them Any More.” TheHill, 17 Aug. 2021, thehill.com/changing-america/well-being/prevention-cures/568254-alabama-doctor-tells-his-unvaccinated-patients. Accessed 30 Oct. 2021.
“COVID-19 Vaccine Reduces Severity, Length, Viral Load for Those Who Still Get Infected.” UArizona Health Sciences, 30 June 2021, healthsciences.arizona.edu/newsroom/news-releases/2021/covid-19-vaccine-reduces-severity-length-viral-load-those-who-still-get.
Jf, Dasta, et al. “Daily Cost of an Intensive Care Unit Day: The Contribution of Mechanical Ventilation.” Critical Care Medicine, 1 June 2005, pubmed.ncbi.nlm.nih.gov/15942342/.
Johnson, Wingate M. “Hippocratic Oath-Modern Version.” Journal of Clinical Psychology, vol. 1, no. 2, Apr. 1945, pp. 140–140, 3.0.co;2-k">10.1002/1097-4679(194504)1:2<140::aid-jclp2270010212>3.0.co;2-k.
Shah, Megha K., et al. “Prevalence of and Factors Associated with Nurse Burnout in the US.” JAMA Network Open, vol. 4, no. 2, 1 Feb. 2021, p. e2036469, proxy.lirn.net/MuseProxyID=mp02/MuseSessionID=00050gt/MuseProtocol=https/MuseHost=pubmed.ncbi.nlm.nih.gov/MusePath/33538823/, 10.1001/jamanetworkopen.2020.36469. Accessed 16 Feb. 2021.