Could you give your perspective on whether healthcare should be allotted according to the choices a person has made? So that if resources were tight, vaccinated people would be prioritized over non-vaccinated?

Does that sound ethical to you? — frank

If you show up in the ER from a car wreck and you weren't wearing your seatbelt, end of the line for you!

Typically a patient is triaged based upon the seriousness of their condition and not upon the cold demands of justice. It's for that reason a doctor would doubtfully wish to exit the medical arena and enter the legal or ethical one and decide who should get treatment based upon some non-medical reason.

It's for that reason (in part), I'm in favor of requiring vaccines. We live in a society that, for better or worse, does not force you to sleep in the bed you made. If someone, through all his stupid decisions, finds himself drunk, broke, and beaten in a gutter, the same ambulance that would swoop me or you up is going to swoop him up, and he's going to be taken in for the same treatment as you or I will.

So, no, I don't think it's ethical to ask doctors to triage based upon non-medical reasons, and I don't think it's ethical to put yourself in a position where you are going to require greater use of limited public resources when you could so easily have done otherwise.

My response is to some degree pragmatic because you asked what should be done, and I said what will be done, regardless of the should. We're just not going to prioritize the responsible people over the irresponsible people in the ER. The responsible people are going to have to accept that they receive their positive comeuppance every day other than while in the ER with better jobs, better relationships, and overall better existences.

:up:

Despite your cherry-picked press clippings, the group you describe are not one homogeneous legion. Attempts to lump everyone who disagrees with the party line in with the tinfoil hat brigade are just political. There's a convenient bunch of loonies who can be called on to besmirch any view you don't like by association. Should we do the same with climate change? Environmental issues? I could definitely rustle up some seriously dodgy hippies who are all in for those sorts of causes. Shall we make the serious climate scientists look like fools by associating them with a few tree-hugging children of Gaia? — Isaac

While I agree with your sentiment about the extremes, I think cloaking them in moderation is no better. Once you pierce the veil of high-sounding rhetoric, appeals to outside minority peers who can speak the language, start blaming subordinate proximate causes, or failures to abide subordinate recommendations, you find the extreme that will not stand the light of expert analysis.

Anyway, I've shot my wad on this subject, I have to run to town, and I cede the floor to you, Isaac. I'm sorry you won't pitch in and help you people out. (Secretly I wonder if you might not be right, in that this might all be a way to thin the herd and the vax is getting in the way. In that case, I should take a seat. It's just the "Tomorrowland" in me that keeps trying.)

Adios.

When Trump first tried to misappropriate the moniker of “War Time President” he said we were at war with an invisible enemy. He was right, but the misappropriation came in his failure to fulfill his role, Warp Speed notwithstanding. Anyway, the minute he said that, a cornucopia of analogy flooded my mind, from protesters and supporters in the rear, to front line troops, to generals, and armchair generals, to pundits, legislators and the President. You can use your own imagination.

Regardless, I do liken a pandemic to a war. While one might question who they are in this scenario, and whether they view Covid as an enemy, I was lately thinking about this discussion of the prioritization of risk. So, I asked my old Combat Corpsman what the principles were that they operated under. To paraphrase, this is what he said:

I don’t recall a prioritization, but in general a corpsman takes care of his Marines first.
We are obligated to provide care to wounded enemy prisoners as well.
In the DOD during combat operations, we are obligated to triage those patients which will ensure victory in battle first.
So, we’re fighting the battle, and I’m treating a Marine who’s hopeless and who will not help us win the battle. I should leave him alone.
If treating marine will give him back in the fight, he should be my highest priority.

It’s just an analogy. But you can consider it. Who is who in this pandemic? You’d think a virus and those who aid and abet it might get short shrift. To throw all the shit back in the Republican’s face from the spin up to Iraq: “You don’t support the troops?” “You question a President in a time of war?” “Don’t spit on the troops.”

Karma, bitches.

But let's start somewhere. Let's assume you have perfect knowledge and there are two patients, male, 26-years old, both have COVID, one is vaccinated the other isn't. Both need a vent and there's only one vent. Who gets the vent? Is this an obvious case to you? If not, why not? — Benkei

I responded to this just above, and I'd add in the equation that justice does not demand that the consequences of bad behavior naturally flow or bear direct connection with the bad act. That is to say it is not just to require my son to walk with no shoes in the snow because he forgot them at home. Maybe he will have an extra chore or the like, but frostbite is not a just dessert just because it's a naturally occurring dessert.

So, applying the same logic, I would not demand you lose priority for the vent based upon your bad behavior of vaccine refusal, but I could certainly see insurance refusals, hospital surcharges, or other penalties short of having your medical care altered.

:up: :up: :up: :up: :up:

1 Pfizer vaccination, female, 17 years old, oxygen drop, blood clot, various symptoms:

Welsh teen in hospital with Covid targeted online by anti-vaxxers (Aug 31, 2021)

(y)

By the way, some concerns about pregnancy have been raised. Don't know current status, can't keep up with it all, workday tomorrow.

Is exactly an answer to it — Isaac

Nay, just running with your narrative. (Sorry, not going repeat.)

Questionable humor? A grumpy ol' philosopher I know out Ohio way, that spends much time dishing out grades (correlates with grumpy?), posted this one... :)

, that was how I read it, but may have to re-read, after a cup of coffee, some other day.

Says "in the same population", and 19.6M AstraZeneca + 9.5M Pfizer = 29.1M vaccinated, with 1.8M infected. I think. So, all 29.1M had 1 vaccination, and 1.8M out of those were infected, i.e. 27.3M uninfected. And then something in the range of 10 times more cases of clotting for the infected.

But it's not entirely clear. The paper says (in ever so many words) that there's an increased risk of clotting shortly after the 1st vaccination (albeit small) without clarifying what the comparison here is. I guess it's assumed the unvaccinated uninfected has no or insignificant cases of clotting. Or something.

There's a whole lot of stuff about the timing, which might be of some relevance as well.

In summary, infection ups chances of clotting noticeably.

So, applying the same logic, I would not demand you lose priority for the vent based upon your bad behavior of vaccine refusal, but I could certainly see insurance refusals, hospital surcharges, or other penalties short of having your medical care altered. — Hanover

But it's not the same logic because there's nothing barring you to return home and get the shoes. In the examples I give, a decision has to be made. Both patients need care equally. Justice isn't the first consideration in triage but it certainly is one of them. Other things being equal, I think the decision not to get vaccinated and requiring a scarce resource like an IC bed or a vent as a result of that decision and when other people need it just as badly can and should be taken into account.

And while we're at it. In the Netherlands we have universal healthcare and there are serious debates about whether to treat certain patients due to limited resources. The anesthesiologists I mentioned recently took a minority position to treat a 90-year old woman for heart surgery. Everybody else argued not to do it, too old, much too likely to develop complications from the procedure and likely not to fully recover. He argued differently because in her particular case she had never had need for extended care or other operations.

In retrospect she did develop complications and kept an IC bed occupied for 5 weeks.

Do we provide care or not? She did take up resources that could've been used by others. At what point has a person lived a full life that, as part of our decision to ration care, we say we don't treat you for heart issues anymore? These are serious ethical questions that have been an issue here for a decade now because it's becoming increasing clear, with an aging population, our healthcare system cannot indefinitely provide all care needed. These questions don't involve a "first come, first serve" solution or "who has the most acute need".

It's the same about whether to insure extremely expensive drugs for very rare diseases. Both these issues put the system under stress.

And that brings me back to the point I've made before: healthcare is a privilege not a right and we can and should establish requirements as to when you get that privilege. This is not an issue when the system isn't under stress, then everybody gets care and we can prioritise based on need but if the healthcare system is under stress other considerations can and should be taken into account.

healthcare is a privilege not a right and we can and should establish requirements as to when you get that privilege. — Benkei

And clearly then, those who do not receive such a priviledge should not have to pay?

On another note, I must say it is a bit disheartening to see grand ideals of healthcare for all be dismissed at the first sign of trouble.

Should people who misbehave in a restaurant be served even though they paid? The other customers paid too and to ensure they can get the service they paid for, the misbehaving customer is asked to leave instead of causing all other customers to suffer the misbehaviour.

Payment is not the only requirement for access to a privilege. Meanwhile, in the real world, its actually those people that don't need care who effectively pay for the people who do need care. Otherwise the system wouldn't be affordable.

On another note, I must say it is a bit disheartening to see grand ideals of healthcare for all be dismissed at the first sign of trouble. — Tzeentch

Total mischaracterisation of other people's positions.

I think you've misunderstood how discussion works. Either the matter of it's wrongness can be established (or at least furthered) dialectically, in which case you need to answer the points I've raised, or it can't, in which case this is little more than an opinion poll and you've already had your go. — Isaac

I've given enough arguments and given real life examples of what the Dutch healthcare system is already struggling with that have laid bare that this approach cannot continue. It's not sustainable so they are looking at it differently. The prevailing position will go the way of the dinosaurs.

I don't disagree that a system of free healthcare to all, regardless of the extent to which preventative measures have been adopted, is unsustainable. I disagree with the ideologically motivated selection of just one such measure (vaccination) and one point of intervention (triage).

If preventative measures are needed to sustain an effective healthcare system, then such measures should be based on normal principles of autonomy, fairness, justice, normaleficence, and fidelity.

Prophylactic medicine is way down the list in meeting all those criteria. It's an external biological alteration, so compromises bodily autonomy right off the bat. It's produced by private corporations, so neither fairness (in terms of access), nor fidelity can be guaranteed, nor are even very likely given their track record. It's a constantly changing intervention (in terms of both composition and batch production of the same formula) so cannot guarantee normaleficence. It's necessity is not a given (one might have not needed it), so the consequences of not taking it are not necessarily just (they do not derive from the action). Also, it's incredibly inefficient as it's a cost in itself, compared to other interventions (such as banning smoking) which are free.

In all, whilst I think vaccination has a few merits as a choice of preventative measure to bolster a flagging health system, it's knocked out of the water by a half dozen other far more suitable candidates, all of which are being ignored solely for ideological reasons - they represent aspects of a lifestyle we've come to be used to, and, of course, one of the most profitable and influencial industries the world has ever seen makes it's entire living out of people getting sick. The last thing it wants are solutions which prevent that.

If I can take your lead in declaring things to 'obvious', it seems 'obvious' to me that failing to even meet a baseline of normal bodily health and safety is causally prior to failing to take preventative action such choices might make necessary.

Should people who misbehave in a restaurant be served even though they paid? — Benkei

You are not forced under threat of violence to go to a restaurant.

Apart from the problematic framing resulting from such a narrow individualistic and capitalist worldview that isn't shared by most here (certainly not me), you're not forced to go to the hospital either. You're paying for the option to use healthcare at a cost far below what you can actually afford because other people are effectively paying for it. In other words, you effectively pay for insurance and by mandating this type of insurance, costs of healthcare are kept lower. Universal healthcare makes economic sense.

You can frame it any way you like - it doesn't change what taxation is.

You are not forced under threat of violence to go to a restaurant. — Tzeentch

You're forced under threat of violence to stay out.

But it's not the same logic because there's nothing barring you to return home and get the shoes. In the examples I give, a decision has to be made. Both patients need care equally. Justice isn't the first consideration in triage but it certainly is one of them. Other things being equal, I think the decision not to get vaccinated and requiring a scarce resource like an IC bed or a vent as a result of that decision and when other people need it just as badly can and should be taken into account.

And while we're at it. In the Netherlands we have universal healthcare and there are serious debates about whether to treat certain patients due to limited resources. The anesthesiologists I mentioned recently took a minority position to treat a 90-year old woman for heart surgery. Everybody else argued not to do it, too old, much too likely to develop complications from the procedure and likely not to fully recover. He argued differently because in her particular case she had never had need for extended care or other operations. — Benkei

A couple of things from this:

When the US was debating universal public healthcare, one of the things that derailed it was the Republican argument that there would be "death committees" that would be charged with determining who was provided care and who wasn't. The Democrats responded that was hyperbolic and inaccurate. As you've stated it though, you seem to accept that some government accounting committee would in fact intervene in the decision of who gets what health care and who does not. That is, you seem to be generally agreeing there will be and should be such death committees. That seems to me a hard strike against public health care ever coming to exist in the US if it were to move forward in the way you've suggested.

The way I see it is far more moderate though. I would expect at some level decisions have to be made regarding protecting limited resources. If we have but one heart and 5 who need it, we do need to have some criteria for determining who gets it. The question is what the criteria should be for making that determination. I would limit the question to the medical issues, such as what is the prognosis of this procedure on person A versus person B. If you find yourself a in true to life situation where providing care to A will mean B will go without (and I don't think your example of the 90 year actually was that), then you would need to look at potential outcomes when determining who gets the care.

What we should be forbidden to consider are factors surrounding the ethical worth of the two individuals, where the good hearted humanitarian gets the heart but Ebenezer Scrooge is left to die or where the prostitute is overlooked, but the community leader gets the nod, or, more pointedly, where the vaccinated gets care and the unvaccinated gets denied. We also should be forbidden to use the operating room as a means to advance social justice or the like, where certain historically disadvantaged groups are provided special (or reduced) privilege. Should that occur (and when you opened the door to looking at justice as a means to divvy up care, I think you do that), that would create a significant ethical problem for me. It would also create a pragmatic problem because it would be politically rejected and it would likely unravel the system, with people creating all sorts of work arounds and refusals to participate.

The point here is that if we have less beds than we do sick people, we need to triage those beds to those who are most in need, as opposed to weighing the ethical value of the people before us and then assigning beds.

The support for my ethical argument is that I hold to the proposition that all people are of infinite value, rejecting the idea that people become ethically devalued under any circumstance. I'd also add that even if I did allow that some do become worth less through their behavior (which I don't), I would still believe that making the determination of how reduced their value now is is well beyond the determination of any committee.

Just to summarize, should we need to assign health care due to limited resources, those decisions are to be made from need considerations, not from justice considerations. Let's leave the politics out of the OR.

ou can frame it any way you like - — Tzeentch

Great: I will frame it as a capitalist, free-market, arm's-length, voluntary transaction that is apparently the only language that you speak: If you don't want to purchase what we are selling, quit using our product. Leave. If you don't want to buy, go live in Afghanistan or Somalia. But if you live here, you will be forced, under threat of violence, to pay for what you took. Otherwise, you are thief in the candy store, trying to steal what society is providing at price set by society. Don't like our price? Tough. Go shop elsewhere or don't buy.

Don't like that we charge you more than him? Tough. Our house, our rules. He doesn't order as much, or as extravagantly as you do and he doesn't take up the space. And no, we are not going to treat you like a king just for coming into our store and honoring us with your exalted presence and your tight-wad money. In America, we tell kings to go fuck themselves. Ask Georgie boy.

Life nor citizenship is something the individual voluntarily participates in - these are imposed by their parents and the state respectively.

"If you don't like it go away" makes as little sense when said by a state as it does when said by a child's parents.

One key difference is that (good) parents will support their child in gaining indepence and eventually will relinquish their authority over it.

Questionable humor? — jorndoe

Maybe if the execution weren't so perfect, but holy shit that's dead on! (I work in retail, in Georgia, and have been the recipient of multiple lectures about masks from my customers. On at least one occasion, the lecturer also had a piece on his hip, which spices things up.)

Life nor citizenship is something the individual voluntarily participates in — Tzeentch

Bull Shit. You can kill yourself or go to Somalia or swim to Cuba or whatever.

"If you don't like it go away" makes as little sense when said by a state as it does when said by a child's parents. — Tzeentch

So you are a child and the state is your parent? That flies in the face of your freedom we honor.

One key difference is that (good) parents will support their child in gaining indepence and eventually will relinquish their authority over it. — Tzeentch

Well, if you're going to use that analogy, then, by the time you can pay taxes, leave. We relinquish authority over you. That doesn't mean you get to run wild in the mall and take what you want without paying for it. There is a world out there beyond mommy and daddy that isn't charged with taking care of you unless it chooses to do so.

Bull Shit. You can kill yourself or go to Somalia or swim to Cuba or whatever. — James Riley

"If you don't like it here just kill yourself" holds even less merit.

So you are a child and the state is your parent? — James Riley

A citizen, just like a child, is put under an inescapable authority involuntarily.

That flies in the face of your freedom we honor. — James Riley

Indeed it does.

Well, if you're going to use that analogy, then, by the time you can pay taxes, leave. We relinquish authority over you. — James Riley

Except that citizenship isn't simply relinquished, but even then, this would only make sense if states gave individuals an option to opt out - they don't. They spend the entire duration of a citizen's formative years to make it more dependent of the state - like a mother afraid that her child will one day leave her.

What we should be forbidden to consider are factors surrounding the ethical worth of the two individuals — Hanover

Well said. Excellent points all around, @Hanover.

"If you don't like it here just kill yourself" holds even less merit. — Tzeentch

BS. The suicide rate is off the charts. People do it all the time because they don't want to pay the price of life.

A citizen, just like a child, is put under an inescapable authority involuntarily. — Tzeentch

And the parents get to choose which child needs help and for how long. When a child reaches majority and doesn't want to contribute, they can get the hell out of the house. We raised you up right, you can work and pay taxes. Get to it, or get out. This is a family here and if you don't want to be a part of it, if you don't want to help your little sister, or help pay for her education, leave.

Indeed it does. — Tzeentch

So leave. No one is stopping you. Sell your shit, pack your bags and leave. Ever heard of "ex-pats"? The world is full of them. "There's a race of men that don't fit in, A race that can't stay still; So they break the hearts of kith and kin, And they roam the world at will." R. Service.

Except that citizenship isn't simply relinquished, but even then, this would only make sense if states gave individuals an option to opt out - they don't. — Tzeentch

Citizenship can be simply relinquished. Do it. Get out. States DO give individuals an option to opt out. There's the door. But if you mean by "opt out" you get to avail without paying for it, or you get to decide how much and what for, then you are in the wrong house. What states don't do is give you the right to avail for nothing, unless we find you in need of help. The only help you need is 1. empathy; 2. personal responsibility; 3. a sense of civic duty; 4. love for your family that raised you up when you were weak, taught you, made you strong enough to care for your brothers and sisters like a real man does. But you want to bail? Fine, get out.

Oh, and P.S. When you pack your bags and leave, don't take any of our shit with you and pay your tax bill before you go. Otherwise we will claw back. (speaking to all the 1% ers who try to hide in tax free havens around the world after pulling yourself up with our bootstraps)

The suicide rate is off the charts. People do it all the time because they don't want to pay the price of life. — James Riley

Ah yes. Suicide - a simple matter of weighing the costs against the benefits and making a rational decision based on that.

Didn't I recall you posting something about caring for others a while back?

When a child reaches majority and doesn't want to contribute, they can get the hell out of the house. We raised you up right, you can work and pay taxes. Get to it, or get out. This is a family here and if you don't want to be a part of it, if you don't want to help your little sister, or help pay for her education, leave. — James Riley

What you describe is failed parenting. Parents who resent their children for not growing up the way they envisioned. They fail to understand that the child never asked to be theirs, and that children shouldn't be had to fulfill the parents hopes and fantasies in the first place. It is their failure.

But if your point was that bad parenting exists, this I already knew.

The idea that a parent can force existence upon their child, and then present them with a list of things they expect of them holds no moral weight. It's nonsense. (And similarly for citizens and governments)

A parent can always reach for the belt, and force compliance - additional confirmation of their failure. (And similarly for citizens and governments)

States DO give individuals an option to opt out. — James Riley

Yes, and this option is no more tenable than telling a child to run away from home if they don't like their parents.

You sound a lot like a failed parent "It is not my fault you don't enjoy the circumstances I imposed on you" - or is it? Of course it is. It is entirely the parent's fault, and their responsibility.


Also, you seem to be getting awfully personal. Let me assure you I enjoy my time within the state's boundaries just fine for now. But that doesn't stop me from considering the immorality of this whole ordeal.

Regardless, I do liken a pandemic to a war — James Riley

Read Hanover's responses. He puts it better than I'm able to. Healthcare is not where we administer justice. That would be a path to a horrendous ethical fuckup.

Ah yes. Suicide - a simple matter of weighing the costs against the benefits and making a rational decision based on that. — Tzeentch

You're the one who finds life's rules not to your liking.

Didn't I recall you posting something about caring for others a while back? — Tzeentch

You did. I don't find you the suicidal type. I see you as a disrespectful, inconsiderate, selfish, young tough guy who wants to suck down all the benefits of society without having to pay for them. People like that don't commit suicide. You just need a little tough love. Go out and wander the world on your own two feet, come back and tell us what you learned.

What you describe is failed parenting. Parents who resent their children for not growing up the way they envisioned. They fail to understand that the child never asked to be theirs, and that children shouldn't be had to fulfill the parents hopes and fantasies in the first place. It is their failure. — Tzeentch

It's failed parenting to raise kids who don't contribute or want to contribute. So yeah, we can agree on that. We've not only turned out kids who want to "opt out" but they want all the benefits too. And worse yet, they want a hand in the teaching of their siblings to hate their parents demand that they contribute.

They fail to understand that the child never asked to be theirs, and that children shouldn't be had to fulfill the parents hopes and fantasies in the first place — Tzeentch

You didn't ask to be ours, so get out if you don't like it. You don't want to help out, leave. But don't expect us to pay you for our having fucked up and brought you into this life, failing to learn simple lessons of playing ball. You can only blame your parents for so long. You can't be an entitled little twit all your life.

The idea that a parent can force existence upon their child, and then present them with a list of things they expect of them holds no moral weight. It's nonsense. — Tzeentch

That is why we leave you with an option to quit. Any time you don't like our house, our rules, leave. Life is tough. We don't regret bringing you into it. We love seeing you grow and learn life's lessons. It's part of growing up. You'll see when you mature. All you need is to be punched in the face, hard, at least once. Well, maybe more than once if your head is really hard, like mine.

A parent can always reach for the belt, and force compliance - additional confirmation of their failure. — Tzeentch

No one is reaching for the belt. Leave. We only reach for the belt if you continue sucking our tit without playing by our rules.

Yes, and this option is no more tenable than telling a child to run away from home if they don't like their parents. — Tzeentch

LOL! I can't tell you how many times I ran away from home before I ran away for good at 14. Worked, hard, paid taxes, availed myself of government benefits, like Job Corps and the Marine Corps, and the G.I. Bill, continuing to work hard and pay taxes all along, got schooled, advanced degree, made a shit ton of money and guess what? I paid taxes all along. I got punched in the mouth, many times. But I also learned that not everyone can do what I did and I don't begrudge their needing help. I don't decide to not help 500 just because there might be one fraudster in there milking the system. Nor do I begrudge people who were smarter than me and didn't have to learn the hard way but who were raised to play ball and help out.

You are right that we failed as families and government so long as we have entitled little shits blaming parents for bringing them into this world and then demanding an opt out free ride. But that's okay. Life will come home, hard. Unless, of course, you are a silver spoon little bitch like Trump who never once in his entire life got punched in the mouth, hard. But dealing with dishonorable cowards and liars is also part of life. He's just doing his part. Why anyone would fall in line behind him, I'll never know. Another example of societies failure I guess. But the failure is not on those who willingly come to the rules of the house, either cognitively or intuitively. If it's their fault, then it's only because they didn't punch the bully who needed to be punched.

Also, you seem to be getting awfully personal. — Tzeentch

Your analogy, the family. I thought it was awfully paternalistic and contrary to what I perceive as your bent. But I ran with it.

Let me assure you I enjoy my time within the state's boundaries just fine for now. — Tzeentch

I bet you do. Now pay up, and quit whining about what you perceive to be the immorality of having to pay.

Healthcare is not where we administer justice. — frank

Justice has nothing to do with it. As William Mony said before he shot Little Bill in the face, "Deserve's got nothing to do with it." It's about winning the war. If you don't think we are in a war, or that you are on the front line of that war, fine. Make it harder on yourself and the rest of society.

Doing that would be a path to a horrendous ethical fuckup. — frank

You just described war: A "horrendous ethical fuckup." Now tell that to the enemy and those who aid and abet. This reminds me of M.A.S.H. I'm sure Hawkeye, et al, had empathy for the enemy. They may have even had an episode that discusses exactly what we are talking about here (not just treating the enemy, because I remember that one, but prioritization). Anyway, it's just a T.V. show but I always did respect those guys and I think the script came from real life experiences in Korea.

Oh well, it would not be self discipline if you were to help me exercise it. I must extricate myself from this debate with my own shear will power. Let's see how I do. :lol: