The historic COVID-19 pandemic has brought us to a critical point. Pillars of our advanced society — hospitals, schools, businesses — have been severely stressed or on the cusp of failure. As both veterans of medical institutions and patients with serious chronic conditions, we are keenly aware of the fragility of our beleaguered emergency room, intensive care and other hospital staff. We fear for their future.
Yet, each day our health care system faces the relentless demands of a daily tide of the nearly dead — largely unvaccinated, but needing and demanding sophisticated care nonetheless. Exhausted doctors and nurses try heroically to treat all comers. A general, vague understanding of the Hippocratic Oath seems to demand that everyone requires care regardless of the why of their conditions. Although the so-called oath is neither a true oath nor a binding contract signed by doctors and hospital administrators, the very notion of denial of care seems to betray the essence of the caring profession.
Nonetheless, a growing number of people have begun to suggest that vaccination should be a condition of treatment, with the simple phrase, “No vaccination, no hospitalization.” This emerging sentiment was challenged in a recent Atlantic article, “It’s a Terrible Idea to Deny Medical Care to Unvaccinated People.”
A physician and ethicist at the University of Colorado, Matt Wynia, summarized this view, “It is completely contrary to the tenets of medical ethics, which have stood pretty firm since the Second World War.”
“We don’t use the medical-care system as a way of meting out justice. We don’t use it to punish people for their social choices,” he added.
This view seems to miss the essential point of our current quandary. In our uniquely and deeply individualistic society, discussions of social dilemmas are quickly reduced to questions of personal liberty, choice and compulsion. Threats to essential institutions take a back seat to the widely reported and always moving stories of individuals.
Given the resultant deep cleavage in worldviews, two camps emerge. Those who value science, American medicine and our health care systems are those who get vaccinated, wear masks and try to follow the evolving rules. We make every effort to stay out of the hospital unless all else fails.
Those of us facing regular visits to hospital clinics, the emergency room, dialysis or pre-transplant appointments must go the extra mile, answering the COVID-19 symptom questions, taking the test of the day and showing our vaccination cards — just to get through the door. We do this to protect ourselves, other patients and hospital staff. Because we survive on the fruits of this amazing system, we honor its demands.
At the same time — and in the same country — tens of millions of people differ strongly. They expect health care professionals to practice some version of the Hippocratic Oath, but they seem to practice what could be called “the Curse of Hypocrisy.” They appear to be comfortable treating society’s institutions as dispensable and disposable. Many ridicule medical best practices, promote fraudulent cures and demonize the nation’s leading infectious disease expert Anthony Fauci as well as tireless physicians and nurses. Yet, the people turn to them in breathless agony when, at warp speed, their ongoing vaccination denial turns to deadly disease. This solipsistic concern of the unvaccinated for only their well-being is at its heart profoundly anti-social.
The unvaccinated so crowd ERs and ICUs that in some cities, hospitals have at times ordered EMTs to stop sending ambulances to pick up the desperately ill. “Elective surgeries” for pacemakers or organ transplants have been postponed or canceled. The impact of this endless wave of preventable illness over years risks the erosion if not destruction of the health care system our complex society depends on now and will in the future.
The time has come to pull back the curtain and prioritize the maintenance of our health care system and its worn out staffs. In pre-pandemic days, shortages and system collapse were not on the horizon. This pandemic is a massively disruptive event, raising the most basic issues of life and death. It is not business as usual.
COVID-19 has attacked our society, its institutions and its people mercilessly. With nearly 1 million dead and with thousands more ill and our hospitals on life support, we cannot be guided by a distorted reading of Hippocrates or a rampant epidemic of hypocrisy. Ideally, those who seem to live in a distorted reality will somehow begin to revise their anti-science and anti-medical views. Failing that, they can abandon their hypocrisy and stay true to their skepticism by avoiding hospitals and, when stricken, treat themselves with the questionable cures they tout at home.
Otherwise, when new variants may emerge and our fragile systems could again begin to fail, the larger society will do what it must to defend itself. After all, there can be no greater harm to all of us than catering to the hypocrisy of some of us and killing the safety net of our health care system for the rest of us.
Just as individuals make the choice of life over possible death, of vaccination over likely hospitalization, so must hospitals choose to persevere and serve patients rather than commit institutional suicide.
“No vaccination, no hospitalization” may move from slogan to policy, because of the continuing collective choice of the unvaccinated themselves.
Carol Hutner Winograd, M.D., is professor of medicine emerita at Stanford University. She served on the medical faculty at both UC San Francisco and Stanford and was the clinical director of Geriatric Medicine at Stanford for 10 years.
Paul Rupert is CEO of Rupert Organizational Design, has been a consultant on workforce recruitment and retention strategies for four decades. His clients include hospital systems, health care organization and major corporations.