Why Do Anti-Vaxxers Get ICU Care and the Vaccinated Don’t — and Die?: The Ethics of Hospital Rationing

Twentieth in an ongoing series, Notes from a Plague-Time

It had to happen, sooner or later. With the pandemic now “a pandemic of the unvaccinated”; with the nation’s intensive-care units (ICUs) packed to the point that hospitals must now ration care; and with nearly 100% of those ICUs taken up by the unvaccinated who, exercising their freedom, chose freely not to take the life-saving vaccine but then got deathly ill with COVID-19, sooner or later it had to happen: A fully vaccinated patient, suffering an equally deadly event but one not freely induced (like heart attack, stroke, accident, etc.), is denied ICU treatment — and dies.

How fair is that? In what universe is this outcome ethical?

This was the tragic case of Ray DeMonia, an Alabama man who suffered a “cardiac emergency.” His local hospital, in Cullman, Alabama, unable to provide him an ICU bed, contacted 43 hospitals in three states — repeat: 43 hospitals in 3 states, a fact his family noted in his obituary — but to no avail: All ICU beds were full with COVID patients, again occupied almost 100% by the unvaccinated. Finally, an ICU bed was located at a hospital in Meridian, Mississippi, 200 miles away. Mr. DeMonia was transported there, where he died. An antiques dealer and auctioneer, Mr. DeMonia was beloved in his community for his tireless fundraising for charitable causes.

Mr. DeMonia’s daughter confirmed to The Washington Post: Her father had been vaccinated. His obituary carries this pointed appeal: “In honor of Ray, please get vaccinated if you have not, in an effort to free up resources for non COVID related emergencies.”

Again, how fair or ethical is this? The unvaccinated get intensive care and the vaccinated, not?

It should be noted, Alabama has the fourth lowest vaccination rate in the U.S. — only 40% — after Idaho, West Virginia, and Wyoming. This tragic contingency — the unvaccinated hogging ICUs needed by the vaccinated and thus causing their death — was most likely to happen in these states. (No help is Alabama’s Republican governor Kay Ivey, whose response to President Joe Biden’s proposal of vaccine mandates was “Bring it on,” instead only recommending getting vaccinated.)

But, with more states experiencing similar crises in their ICU capacity — Idaho and Alaska have activated “crisis standards of care” in their hospitals, in other words: rationing — and with the more virulent Delta variant showing no signs of abating, while vaccination rates remain stagnant, more and more hospitals will be facing this Solomonic dilemma: Who lives and who dies?

Indeed: That is the central question. At the moment, per The Post’s explainer, “crisis standards of care” prioritize ICU beds for “those most likely to recover.” Hospitals typically operate on a first come, first served basis. But in a crisis, they must “triage by prioritizing some patients over others to save the most lives.” Writes the Post, most plans, aiming for a “best calculus,” “typically start by scoring the health of major organs such as the brain, heart, kidney and liver,” judging the chance of recovery and life expectancy. In other words, the criterion appears to be physiological.

But there is the ethical criterion — fairness — which hospitals for a “best calculus” must consider (and pardon the repetition, but it’s warranted): If your ICU beds are fully taken up by the unvaccinated — those who insist on their personal freedom to think, not of the public health (also a hospital’s mission, by the way), but only of themselves, choosing not to “get the jab” — they thus have landed in your ICU due to their own irresponsible behavior. So how can the responsible patient, who “got the jab” not only to improve his/her own chances with the virus but also out of kinship with fellow Americans and concern for public health: Truly, how can this responsible patient be denied ICU care, when they petition that care, driven not because of their own irresponsible exercise of personal freedom, but through forces outside their personal control: heart attack, stroke, accident, etc. In brief: One patient basically asked for it — a medical emergency — while the other didn’t.

It would be a hideously difficult decision to move the unvaccinated patient out of the ICU. But how is that any less hideous than a responsible — vaccinated — patient like Ray DeMonia dying, simply because he could not get the ICU care that the irresponsible unvaccinated got?

And how does turning away the vaccinated from the ICU encourage responsible behavior in the larger public, that is, to get vaccinated?

Apart from the emergency cases of the vaccinated turned away, again unjustly, there are the legions of vaccinated patients awaiting elective surgeries — repairing a leaky heart valve, for example — which have been endlessly postponed because of this endless pandemic. The title of a lead story in The New York Times speaks volumes: “’I Just Cry All the Time’: Non-Covid Patients Despair Over Delayed Care.” And, in addition to hospital capacity being stressed, medical personnel are voicing increasing distress and anger at all the unnecessary suffering and death, with increasing numbers, ominously, speaking of quitting the field. All this, thanks to the anti-vaxxer’s mentality which is, at bottom, death-loving: Stick it to the libs, don’t get stuck.

All of this I write more out of sorrow than anger, although, as we are being forced into a second winter of the pandemic precisely because of the irresponsible unvaccinated, my anger is considerable, and it prompts me to ask: If you, Anti-Vaxxer, are so big on personal freedom, then take full responsibility for that freedom and accept the consequences. Do not insist on nor accept an ICU bed, should you get COVID. And do not demand the “miracle” cure, monoclonal antibodies, like Texas Republican governor and anti-vaxxer Greg Abbott did, when he contracted COVID (which cure he hypocritically boasted of in his official statement).

In this pandemic, all is being revealed. One revelation is: how vital personal freedom is to Americans, though as a people we have yet to comprehend how the exercise of personal freedom impinges on and can even imperil the commonweal. That is grist for our mill, post-pandemic.

But for now, we must get through this pandemic — in a way that fortifies the body politic. It is crucial that, in rationing care, hospitals, while weighing the vital signs of their ICU patients, also weigh another set of vital signs: the ethical. The vaccinated and thus responsible patient should be prioritized over the unvaccinated and thus irresponsible one. To Life! To Justice!