Triaging hospital beds using patient responsibility as a factor

[LuckyR]

As the fourth wave of Covid cases rises, in some areas there is not enough hospital capacity to accommodate Covid cases and other acute, severe cases. Currently, Covid patients fill the beds because they are sicker and because their recovery is so lengthy that the bed is tied up for a very long time.

There is resentment from some staff who treat nonCovid patients that: 1) the Covid cases are "preventable" if those people would have not refused vaccination and 2) making the connection that exercising one's "right" to refuse vaccination should come with a parallel "right" of the health care system to reserve some capacity for nonCovid cases.

The current reality uses a triage system based solely on severity of illness coupled with the chance of treatments working. However there is an opinion that there is a sort of culpability among the actively unvaccinated that should be included in the calculation.

Thoughts?

[stevie]

However there is an opinion that there is a sort of culpability among the actively unvaccinated that should be included in the calculation.

Thoughts?

If that is so then one should generally take into account people's way of life (eating, hobbies, etc.) in terms of fostering health or not or being accident-prone or not.

[Gertie]

As the fourth wave of Covid cases rises, in some areas there is not enough hospital capacity to accommodate Covid cases and other acute, severe cases. Currently, Covid patients fill the beds because they are sicker and because their recovery is so lengthy that the bed is tied up for a very long time.

There is resentment from some staff who treat nonCovid patients that: 1) the Covid cases are "preventable" if those people would have not refused vaccination and 2) making the connection that exercising one's "right" to refuse vaccination should come with a parallel "right" of the health care system to reserve some capacity for nonCovid cases.

The current reality uses a triage system based solely on severity of illness coupled with the chance of treatments working. However there is an opinion that there is a sort of culpability among the actively unvaccinated that should be included in the calculation.

Thoughts?

I can understand the feeling, health workers are putting their lives on the line and working in awful conditions, for reckless idiots who just needed to get a jab.

But no, clinicians shouldn't get to judge who is worthy of treatment, it should be on clinical grounds.

[Steve3007]

There is resentment from some staff who treat nonCovid patients that: 1) the Covid cases are "preventable" if those people would have not refused vaccination and 2) making the connection that exercising one's "right" to refuse vaccination should come with a parallel "right" of the health care system to reserve some capacity for nonCovid cases.

As I understand it, there is quite a large proportion of the population who take the libertarian view that healthcare should be an entirely privately funded service which should be treated just like any other privately traded goods and services. I presume those people would say that the preventability or otherwise is irrelevant. They would advocate that all patients wanting hospital treatment ought to pay for that treatment, just as they pay for anything else that they desire and can afford. So if a person who refused the vaccine, for whatever reason, catches Covid and needs a long stay in hospital, that's fine because they'll pay for it themselves. There would be no need for a triage system to prioritize patients. If patients pay they get treated. If they don't, they don't. Simple. Presumably, in that scenario, there would be a sudden influx of money to hospitals which would fund a sudden increase in the number of hospital beds.

For those of us who don't hold those views, and who believe in some form of centralized (e.g. taxation) funding of healthcare, there has always been the kind of dilemma that you're talking about here, about the concept of partially self-inflicted conditions. It's the same as the argument about, for example, treating smoking, drinking or over-eating related medical conditions. There's always an argument to be had about the extent to which a patient is responsible for their condition and therefore the priority they might get compared to patients deemed less responsible for their condition. Those libertarians are free from these arguments and dilemmas.

[Steve3007]

The current reality uses a triage system based solely on severity of illness coupled with the chance of treatments working.

In that purely market-based system of healthcare advocated by some people, which I mentioned above, I guess we'd have a simple supply and demand issue here. If the hospitals are overwhelmed with Covid patients then it's a sellers' market, so the price goes up until the number of people who can afford treatment matches the amount of available treatment. I suppose rather than triage we'd have a sort of auction, with treatment going to the highest bidder. So the combination of the increased income from higher prices funding more treatment and the increased costs pricing more and more people out of the market would eventually bring the market back into balance.

[LuckyR]

However there is an opinion that there is a sort of culpability among the actively unvaccinated that should be included in the calculation.

Thoughts?

If that is so then one should generally take into account people's way of life (eating, hobbies, etc.) in terms of fostering health or not or being accident-prone or not.

Well, that is currently done in cases of limited resources such as not giving lung transplants to smokers or liver transplants to alcoholics.

[LuckyR]

As the fourth wave of Covid cases rises, in some areas there is not enough hospital capacity to accommodate Covid cases and other acute, severe cases. Currently, Covid patients fill the beds because they are sicker and because their recovery is so lengthy that the bed is tied up for a very long time.

There is resentment from some staff who treat nonCovid patients that: 1) the Covid cases are "preventable" if those people would have not refused vaccination and 2) making the connection that exercising one's "right" to refuse vaccination should come with a parallel "right" of the health care system to reserve some capacity for nonCovid cases.

The current reality uses a triage system based solely on severity of illness coupled with the chance of treatments working. However there is an opinion that there is a sort of culpability among the actively unvaccinated that should be included in the calculation.

Thoughts?

I can understand the feeling, health workers are putting their lives on the line and working in awful conditions, for reckless idiots who just needed to get a jab.

But no, clinicians shouldn't get to judge who is worthy of treatment, it should be on clinical grounds.

As you have worded your response, I suppose most would agree with you. Though most of the practitioners I referenced would advocate what I wrote: reserving a number of beds for nonCovid patients.

You are free to disagree, of course (just don't get in a car accident).

[LuckyR]

The current reality uses a triage system based solely on severity of illness coupled with the chance of treatments working.

In that purely market-based system of healthcare advocated by some people, which I mentioned above, I guess we'd have a simple supply and demand issue here. If the hospitals are overwhelmed with Covid patients then it's a sellers' market, so the price goes up until the number of people who can afford treatment matches the amount of available treatment. I suppose rather than triage we'd have a sort of auction, with treatment going to the highest bidder. So the combination of the increased income from higher prices funding more treatment and the increased costs pricing more and more people out of the market would eventually bring the market back into balance.

True enough, with the understanding that "advocated" means "talked about online by folks without experience but doesn't exist anywhere in the West and likely never will".

[LuckyR]

There is resentment from some staff who treat nonCovid patients that: 1) the Covid cases are "preventable" if those people would have not refused vaccination and 2) making the connection that exercising one's "right" to refuse vaccination should come with a parallel "right" of the health care system to reserve some capacity for nonCovid cases.

As I understand it, there is quite a large proportion of the population who take the libertarian view that healthcare should be an entirely privately funded service which should be treated just like any other privately traded goods and services. I presume those people would say that the preventability or otherwise is irrelevant. They would advocate that all patients wanting hospital treatment ought to pay for that treatment, just as they pay for anything else that they desire and can afford. So if a person who refused the vaccine, for whatever reason, catches Covid and needs a long stay in hospital, that's fine because they'll pay for it themselves. There would be no need for a triage system to prioritize patients. If patients pay they get treated. If they don't, they don't. Simple. Presumably, in that scenario, there would be a sudden influx of money to hospitals which would fund a sudden increase in the number of hospital beds.

For those of us who don't hold those views, and who believe in some form of centralized (e.g. taxation) funding of healthcare, there has always been the kind of dilemma that you're talking about here, about the concept of partially self-inflicted conditions. It's the same as the argument about, for example, treating smoking, drinking or over-eating related medical conditions. There's always an argument to be had about the extent to which a patient is responsible for their condition and therefore the priority they might get compared to patients deemed less responsible for their condition. Those libertarians are free from these arguments and dilemmas.

Are you referring to an official argument or theoretical?

[AverageBozo]

If people who are non-compliant with medical advice or who don’t practice healthy preventative measures are triaged such that they won’t be given healthcare unless resources are still available after treating others, what will be the next criteria on this slippery slope — should care be deferred or delayed for those who ride motorcycles or engage in hang gliding? What about people who go on a camping trip in an area with Lyme disease? What about a person who hasn’t vaccinated his dog against rabies? What about someone who doesn’t use a crosswalk when crossing the street? Where should it end?

[Gee]

Has anyone else heard rumors that insurance companies are considering reducing benefits for people who refuse the vaccine? Or maybe they were talking about raising their deductibles? Not sure if that would be allowed or even if it is true. It could be a ploy to get more people to get their vaccines. It could also affect triage beds.

Gee

[LuckyR]

If people who are non-compliant with medical advice or who don’t practice healthy preventative measures are triaged such that they won’t be given healthcare unless resources are still available after treating others, what will be the next criteria on this slippery slope — should care be deferred or delayed for those who ride motorcycles or engage in hang gliding? What about people who go on a camping trip in an area with Lyme disease? What about a person who hasn’t vaccinated his dog against rabies? What about someone who doesn’t use a crosswalk when crossing the street? Where should it end?

Your argument is quite moving. Not least because the folks dying are labeled "others", whereas there are detailed descriptions of the reckless.

https://www.wmtw.com/article/family-say ... s/37413371

[LuckyR]

Has anyone else heard rumors that insurance companies are considering reducing benefits for people who refuse the vaccine? Or maybe they were talking about raising their deductibles? Not sure if that would be allowed or even if it is true. It could be a ploy to get more people to get their vaccines. It could also affect triage beds.

Gee

Yup, happening. But the source is not insurance companies, it is coming from employers (who pay for their worker's coverage).

It is in the form of increased premiums, not reduced benefits. Though there is a long history of different coverage costs for different health risks (smoking for example).

[Pattern-chaser]

However there is an opinion that there is a sort of culpability among the actively unvaccinated that should be included in the calculation.

Thoughts?

Where need exceeds supply, some sort of rationing is unavoidable. Difficult decisions have to be made. On the face of it, there is an element of culpability in those who refused vaccination. But when I think a bit more deeply, all kinds of things spring to mind.

Many Americans have refused a vaccine because they are confident that the Lord will protect them. Those who do not share their views will scoff, but these people genuinely believe(d) that they are protected from covid, and really don't need further protection. If someone has honestly tried to keep themselves safe, but followed advice that proves to be wrong, should they be held to account? Should someone be punished for being wrong? Does 'being wrong' make someone culpable? Perhaps not.

It's not just fundamentalist Christians who can make such mistakes, though. We all do what we believe is right, and often hindsight proves us to have been wrong. This is just part of human life. Should we be punished for it, or should those who proved to be right be rewarded for that? The ones who are right today will be wrong tomorrow, and vice versa...

"Thoughts?" My thoughts are that I thank the Gods I don't have to make such difficult decisions! Maybe that makes me a moral coward? Or maybe I'm just recognising the extreme difficulty in making some moral decisions, this one among them?

[LuckyR]

However there is an opinion that there is a sort of culpability among the actively unvaccinated that should be included in the calculation.

Thoughts?

Where need exceeds supply, some sort of rationing is unavoidable. Difficult decisions have to be made. On the face of it, there is an element of culpability in those who refused vaccination. But when I think a bit more deeply, all kinds of things spring to mind.

Many Americans have refused a vaccine because they are confident that the Lord will protect them. Those who do not share their views will scoff, but these people genuinely believe(d) that they are protected from covid, and really don't need further protection. If someone has honestly tried to keep themselves safe, but followed advice that proves to be wrong, should they be held to account? Should someone be punished for being wrong? Does 'being wrong' make someone culpable? Perhaps not.

It's not just fundamentalist Christians who can make such mistakes, though. We all do what we believe is right, and often hindsight proves us to have been wrong. This is just part of human life. Should we be punished for it, or should those who proved to be right be rewarded for that? The ones who are right today will be wrong tomorrow, and vice versa...

"Thoughts?" My thoughts are that I thank the Gods I don't have to make such difficult decisions! Maybe that makes me a moral coward? Or maybe I'm just recognising the extreme difficulty in making some moral decisions, this one among them?

Kudos to you for recognizing that under the current system cancer patients, liver disease patients and their families feel they're being "punished" for not being the flavor of the day ie Covid pandemic patients, and folks are dying because of a lack of capacity right now.

Under current triage guidelines every Covid patient who gets an ICU bed and ends up dying represents a mistake on the part of the triage officer. Because under current guidelines priority is given to patients with the most severe survivable illness.