'Doctors and hospitals are not in the blame and punishment business'

Should a hospital running low on beds and staff prioritize vaccinated COVID-19 patients before their unvaccinated counterparts? Absolutely not, says Daniel Wikler, PhD, professor of ethics and population health at the Harvard T.H. Chan School of Public Health.

In an op-ed for The Washington Post, Dr. Wikler said the question of whether denying urgently needed care to punish a patient for their unhealthy choices is defensible is hardly new. And the answer has always, and continues to be, no.

He contends that everyone who can be vaccinated should be, but the threat of denying care to patients in need to punish them for their judgment does not warrant a role in public health policy. 

"Many of those who need liver transplants ruined their original livers through overconsumption of alcohol. Treatment for lung cancer would rarely be needed if people didn't smoke. Injured practitioners of extreme sports had safer recreational choices," Dr. Wikler wrote. 

"When patients like these are evaluated for healthcare, their priority depends on how serious their condition is, how urgently they need help and how well they are likely to do if they're treated. What does not matter is culpability, blame, sin, cluelessness, ignorance or other personal failing. Doctors and hospitals are not in the blame and punishment business. Nor should they be. That doctors treat sinners and responsible citizens alike is a noble tradition, an ethical feature and not a bug. And we shouldn't abandon it now."

The ethicist also noted that the physician-patient relationship is built upon trust, which patients are less likely to extend if they feel judged. At the same time, Dr. Wikler argued that unvaccinated patients should expect restrictions to their daily life, including COVID-19 testing and wearing a mask as conditions of receiving care. 

"Even when not following public health advice is the reason hospitals and clinics must resort to triage, priorities should be based on the traditional canons of urgency, need and likely outcome. For some, schadenfreude may be unavoidable when [COVID-19] skeptics find themselves battling the virus for survival. Keep that private. We owe everyone their best chance to come out of this pandemic alive."



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