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WHICH PATIENTS ARE GETTING
PRIORITY TREATMENT FOR COVID-19?
THE UNVACCINATED OR THE FULLY
VAXXED, EVEN IF PATIENTS IN THAT
LATTER CATEGORY MIGHT BE AT HIGH
RISK?
WE ARE JOINED BY A MEDICAL
ETHICIST, KAROLA KREITMAIR,
ASSISTANT PROFESSOR OF BIOETHICS
AT UW-MADISON.
THANKS FOR BEING HERE.
>> THANKS FOR HAVING ME.
>> ARE THERE PRIORITIES
HIERARCHIES FOR WHO GETS
TREATMENT EVEN ASIDE FROM COVID?
>> WELL, YEAH.
SURE.
AND IF YOU'RE IN THE ER AND
YOU'RE TAKING CARE OF SOMEONE
WITH A SCRAPED KNEE AND THEN
SUDDENLY A TRAUMA CASUALTY COMES
IN, IT MAKES NO SENSE TO
CONTINUE TAKING CARE OF A
SCRAPED KNEE WHEN SOMEONE IS IN
SORT OF LIFE-THREATENING
CONDITION.
OR WITH ORGAN ALLOCATIONS FOR
ORGAN TRANSPLANTATION, THERE ARE
PRIORITIES GIVEN TO THOSE WHO
ARE LIKELY TO DIE WITHOUT THE
ORGAN OVER THOSE WHO HAVE MORE
OF A CHANCE OF SURVIVING FOR
LONGER WITHOUT.
SO WE GENERALLY TEND TO
PRIORITIZE INDIVIDUALS WHO HAVE
THE GREATEST NEED EVEN OUTSIDE
OF COVID.
>> SO IN A PERFECT WORLD, ANYONE
WHO NEEDED IT WOULD GET THE
TREATMENT THEY NEED, LIKE AN ICU
BED.
BUT IN THE COVID-19 REALITY
RIGHT NOW, WHO IS GETTING ICU
CARE?
>> WELL, IN THE COVID-19
REALITY, THE FIRST THING THAT
HAS HAPPENED IS THAT ICU BEDS
ARE SORT OF -- THE PRESSURE ON
ICU BEDS IS REDUCED BY
CANCELLING OPERATIONS, NOT
ACCEPTING TRANSFERS IN, TREATING
PATIENTS ON THE FLOOR RATHER
THAN IN THE ICU.
AND SO THAT ALL COMES WITH
COSTS.
OBVIOUSLY WHEN AN OPERATION IS
CANCELLED, OVER TIME A CONDITION
THAT MIGHT NOT HAVE BEEN
LIFE-THREATENING COULD END UP
BEING LIFE-THREATENING.
SO THIS IS SORT OF THE FIRST
STAGE OF WHAT TO DO ABOUT ICU
BEDS IN THE COVID-19 WORLD.
AND THEN THE SECOND STAGE IS
REALLY WHEN THESE CRISIS CARES
ARE IMPLEMENTED.
THIS IS WHEN HOSPITALS IMPLEMENT
SPECIFIC POLICIES WHERE THEY
DECIDE HOW TO PRIORITIZE
PATIENTS FOR THINGS LIKE
VENTILATORS AND ICU BEDS.
I THINK EVERY BIOETHICIST IN THE
COUNTRY HAS BEEN THINKING ABOUT
THESE ISSUES OVER THE LAST TWO
YEARS AND HAS HELPED TO COME UP
WITH A POLICY FOR A HOSPITAL.
AND THE TWO PRINCIPLES THAT
WE'VE REALLY FOUND ARE MOST
IMPORTANT HERE ARE SAVE THE MOST
LIVES, SO GENERATE THE MOST
BENEFIT FROM THE RESOURCES THAT
YOU HAVE, AND DON'T EXACERBATE
EXISTING SOCIAL INEQUALITIES.
>> SO AS TO COVID PATIENTS, ARE
THERE OR SHOULD THERE BE GIVEN
PRIORITY TO PATIENTS WHO "DID
THE RIGHT THING" AND GOT
VACCINATED AND BOOSTED?
>> NO, BECAUSE MEDICINE IS NOT
NOR SHOULD IT BE THE MORAL
ARBITER OF DESERVEDNESS.
IF SOMEONE COMES IN WITH A HEART
ATTACK BECAUSE THEY DIDN'T
LISTEN TO ADVICE AND CONTINUED
TO EAT CHEE CHEESEBURGERS OR DIT
RUN ON THE TREADMILL, WE DON'T
SAY, TOUGH, THAT WAS YOUR OWN
FAULT.
WE TREAT PEOPLE BASED ON WHAT
THEY NEED.
SAME WITH ADDICTION.
WE LEARN THAT ADDICTION IS
BETTER CONCEPTUALIZED AS A
DISEASE RATHER THAN PEOPLE
MAKING REALLY STUPID DECISIONS
FOR NO REASON.
SO IT'S THE SAME WITH
VACCINATION STATUS.
WE SHOULDN'T BE BLAMING PEOPLE
FOR THEIR LACK OF VACCINATION
STATUS OR THEIR LACK OF
VACCINATION.
IF WE WANT TO BLAME SOMEONE, WE
SHOULD BE BLAMING THOSE PEOPLE
WHO ARE SPREADING LIES AND
MISINFORMATION THAT IS CAUSING
PEOPLE TO THINK THAT THEY ARE
BETTER OFF IN THEY'RE
UNVACCINATED.
>> SO SIMILAR TO THAT, WHY WOULD
UNVACCINATED PATIENTS BE IN LINE
FOR NEW TREATMENTS, THE PILL
THAT'S JUST OUT, OVER VACCINATED
PATIENTS?
>> YEAH.
SO LIKE I SAID WITH THE
ALLOCATION OF CRITICAL CARE
RESOURCES, WE WANT TO GIVE THE
RESOURCES TO INDIVIDUALS WHERE
THEY CAN HAVE THE MOST BENEFIT.
AND IF SOMEONE IS GOING TO GET
VERY SICK FROM COVID, THEY'RE
LIKELY TO TAKE UP A LOT OF OUR
RESOURCES, MAYBE TAKE UP A ICU
BED AND THAT WOULD BE BAD FOR
EVERYONE.
SO PRIORITIZING UNVACCINATED
INDIVIDUALS IN SOME CASES MEANS
THAT THOSE PEOPLE WHO ARE MOST
LIKELY TO GET SICK, MOST LIKELY
TO TAKE UP RESOURCES DON'T END
UP TAKING THAT RESOURCE AND THEN
IT ENDS UP BEING BETTER FOR
EVERYONE.
SO IT MAKES SENSE FROM A
SOCIETAL LEVEL PERSPECTIVE.
>> THINGS ARE HAPPENING SO FAST
IN HEALTH CARE RIGHT NOW WITH
THIS PANDEMIC.
SO THESE KINDS OF TRIAGE
DECISIONS ARE BEING MADE ON THE
SPOT, I IMAGINE.
WOULD YOU SUGGEST CHANGING THAT?
>> WELL, IT'S HARD BECAUSE
TALKING ABOUT TRIAGE MAKES IT
SOUND LIKE THERE'S A POINT WHEN
WE DON'T DO TRIAGE AND THEN WE
STEP OVER INTO THE REALM OF
TRIAGE.
BUT TRIAGE OCCURS KIND OF ALL
THE TIME.
AND WHEN WE DON'T HAVE THESE
EXPLICIT POLICIES THAT GIVE
PROVIDERS THE GUIDELINES ON HOW
TO BE MAKING THESE DECISIONS AND
KIND OF TAKE SOME OF THESE
DECISIONS OUT OF THEIR HANDS,
WE'RE REALLY FORCING THE BEDSIDE
NURSES AND DOCTORS TO MAKE SOME
OF THESE DECISIONS AND THEY'RE
NOT IN THE BEST PLACE TO MAKE
THESE DECISIONS, NOR SHOULD
THEY.
THAT'S NOT PART OF WHAT IT MEANS
TO ACT AS A NURSE OR A DOCTOR.
SO I DO BELIEVE THAT IF THERE
WERE MORE LEADERSHIP FROM
CENTRAL PLACES, STATE OR
FEDERALLY, ON WHAT THE PROTOCOLS
SHOULD BE THAT SHOULD BE
IMPLEMENTED IN THESE SITUATIONS,
WE WOULD HAVE MORE ETHICAL
OUTCOMES.
>> ALL RIGHT.
VERY INTERESTING STUFF.
WE COULD SPEAK A LOT LONGER.
BUT, PROFESSOR, THANKS VERY
MUCH.
>> THANKS.