Thread by @WheatNOil

From my DMs. This is a classic medical ethics question.

I understand the anger and frustration driving this. The philosophical question of fairness & who gets treatment and who doesn’t.

However if we believe in universal healthcare, we can’t ration healthcare based on morality.

If you speed going 200 km/hr, if you give yourself alcohol poisoning because someone dared you to a Centurion, if you lost a game of South Park Roshambo, if you broke your hand in a pointless hockey fight b/c of some dumb “Code”, you shouldn’t get rationed healthcare differently.

We can triage based on severity, based on prognosis, on how likely you are to benefit, on what it is the most appropriate level of care.

But I don’t think we can triage based on whether you made a single bad decision. No matter how poor that decision was.

In a universal, public healthcare system, the cost of that system (both in $ and capacity) should be shared by the public despite being used individually.

Even if at times that seems unfair.

Because some day it might be ‘your’ dumb decision.

HOWEVER…

Because we share this public system, we have laws and policies to protect that system.

We have seatbelt laws. Driving laws. We regulate safety in businesses. Have building codes. Tax cigarettes.

We encourage some things, disincentivize others, regulate & make laws.

Some of the those rules and policies explicitly protect other people. Others protect the individual and some do both.

But we use public policy and rules to protect the public interest & institutions all the time.

These rules keep public systems from collapsing.

Now, the line of how far rules should go, what should be outlawed, what is left to individual choice is an area of reasonable debate.

But, if an action threatens the sustainability of an entire public healthcare system… surely that if nothing else should public policy!

Some people may break those rules despite policy/laws. They’ll speed. They’ll commit horrendous crimes. And if they do do, we STILL treat them.

But the policies/laws exist to decrease those events & maintain public functioning.

So BECAUSE we should ethically treat people who are unvaccinated, and BECAUSE having too many unvaccinated will / is crushing the healthcare system, we NEED to therefore have policies about vaccination.

Clearly no one should be ‘forced’ to be vaccinated.

However, much like other acts that are potentially dangerous to self or others, there needs to be consequences for that choice.

How far those consequences go is also up for debate. But having none is untenable. We’re seeing that. It’s a failure to govern & to lead.

A failure to protect the public interest and manage the public institutions that help society function.

For these reasons, I argue we treat & triage people who are unvaccinated the same as anyone else.

But we also have vaccine requirements for non-essential public events. For some occupations & roles. And support private businesses who do the same.

And there will be some to break those laws, who forge a document or whatever. And if & when that happens, should they get sick, they get treated, and then they face whatever public consequence exists for breaking those rules.

Like any other public rule.

In sum:
Making very poor decisions shouldn’t impact your access to healthcare. But if these poor decisions are threatening the entire healthcare system then the gov’t needs to intervene to make those poor decisions much more difficult to make.

Like we do w/ other poor decisions.

That doesn’t mean you can’t be angry or frustrated with people who are unvaccinated. But once they step into the hospital suffering from the consequences of their choices, they get treated like everyone else suffering from the consequences of their choices.