When Medical Ethics Collide With Basic Fairness
NASHVILLE — It’s hard for me to describe the utter rage that filled me when I opened my local newspaper last Tuesday and saw The Tennessean’s lead article: “Vaccinated Lose Access to Treatment,” the headline read. What new through-the-looking-glass madness was afoot in this Covid-beleaguered leadership vacuum?
“The Tennessee state government now recommends nearly all vaccinated residents be denied access to monoclonal antibody treatment in a new effort to preserve a limited supply of antibody drugs for those who remain most vulnerable to the virus, largely by their own choice,” wrote the reporter, Brett Kelman.
As a matter of public policy, this recommendation makes sense. This experimental treatment is in short supply, and all doses are needed for the people most likely to die from the infection. Those patients include the immunocompromised, whose condition limits the effectiveness of vaccines, and the unvaccinated, whose condition is harder to explain.
Much ink and many pixels have been expended in an effort to parse the possible reasons for people to refuse their best shot at surviving a virus that has already killed 680,000 Americans and left an uncountable number of others with lingering debilities. We know that there’s a difference, for example, between someone who is vaccine hesitant but open to persuasion, and someone who is dead set against any jab in the arm.
Many in the first group managed to overcome their hesitation when the Delta variant began its inexorable march to the sea, but the second group remains unmoved. Even now, only 45 percent of Tennesseans are fully vaccinated.
As a lifelong Southerner, I am not surprised by how many people here hate the federal government enough to forgo a vaccine that would almost certainly prevent them from dying of an illness spreading like wildfire in unvaccinated communities. But instead of blaming the unvaccinated, I fault red-state politicians for soft-pedaling the truth about the safety and effectiveness of this vaccine.
I fault the pastors and other community leaders for failing to teach their membership about the need to protect the vulnerable — the elderly and the sick and the babies, for God’s sake — through widespread vaccination of the healthy.
Most of all, I fault the right-wing pundits and media companies for promulgating harebrained notions of freedom and a baseless suspicion of science. Even as they refuse to provide information that would make the entire country safer, they are raking in piles of money from advertisers targeting the very listeners whom they are leaving vulnerable.
I have always felt more worry than anger for the unvaccinated themselves. People make mistakes. Sometimes they put their trust in “leaders” who turn out to be charlatans and scoundrels. How can we blame them when they themselves often pay the highest cost for that mistake?
But the longer this pandemic goes on, the more l feel fury rising in my throat like bile. I am growing angrier and angrier about the ignorance and the arrogance that keep making things unnecessarily harder, and so much more dangerous, for the rest of us.
Even as Delta ravages the South, too many people stubbornly repeat the lies they’ve been told for months. As a result — not just here but all over the country — others are dying of treatable non-Covid illnesses and suffering unendurable non-Covid pain, all for lack of room at hospitals to treat them.
This stopped being something I only read about in the news when it hit home for my friend Betsy Phillips, a writer and local historian who has been contending all year with a life-threatening condition that remained undiagnosed until very recently. For her, a breakthrough Covid infection could be devastating.
She felt a little better when she finally got a diagnosis for the mysterious condition that had been making it difficult for her to breathe: granulomatous disease, the result of a histoplasmosis infection. Surgery to remove the growth that is pressing on her windpipe wouldn’t make Tennessee less of a Covid hot spot, but at least it would let Betsy breathe freely again.
But earlier this month, the hospital called and canceled her operation. It didn’t have room for her because it was treating too many unvaccinated Covid patients. As Betsy put it in an essay for The Washington Post, “They wouldn’t do their civic duty, but they get access to hospitals in front of those of us who did.”
In one sense, this is nothing new. With communicable diseases, it has always been the case that one person’s choices can affect other people’s health. What’s new with this particular communicable disease is how quickly our scientists and medical professionals have found ways to help keep us safe. And every one of those ways has been undermined by the very people who are now making it difficult or impossible for others to get the care they need.
But also not new is the field of medical ethics, which requires health care workers to provide skilled and compassionate treatment even to patients who arguably bring their problems on themselves. Lung cancer patients aren’t turned away from the hospital door, even if they’re three-packs-a-day smokers, and Covid patients should not be turned away because they have refused a vaccine.
“We can say that the virus has re-emerged in the southern United States, primarily among unvaccinated people, but it doesn’t mean we have to blame the unvaccinated,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, told Ricardo Alonso-Zaldivar of The Associated Press. “The people we have to target are the purveyors of disinformation, and we have to recognize that the unvaccinated themselves are victims of disinformation.”
Betsy knows this, and I know this. It’s enraging anyway. It’s enraging to think of the dreadful job Tennessee governor Bill Lee is doing, even now, to encourage his voters to wear their masks and take their vaccines. It’s enraging to think of how the Tennessee General Assembly will not, even now, expand Medicaid to help keep rural hospitals open and prevent the overcrowding of city hospitals.
And it’s enraging to think of the people who won’t take an “experimental” vaccine but have no problem accepting experimental antibodies to treat an infection they might have avoided altogether. And it’s beyond enraging to know that when they get to the hospital, they will immediately jump to the front of the line.
I know it’s the right thing for hospitals to do. But no matter how ethical it might be, it will never feel fair.
Margaret Renkl, a contributing Opinion writer, is the author of the books “Graceland, at Last: Notes on Hope and Heartache From the American South” and “Late Migrations: A Natural History of Love and Loss.”
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