Between strict confinement, the end of free access to health care and compulsory vaccination, punitive reactions to the choice not to be vaccinated (without medical reason) are increasing around the world.
The new pandemic wave particularly affecting the unvaccinated is also stimulating new ethical questions on the part of the medical profession, already exhausted by two years of hard service.
In a column published this week in The world, French doctors expose the tragic consequences and the painful moral choices resulting from the refusal of vaccination against COVID-19.
“Is it normal to deprive patients of resuscitation beds or surgical care, even non-urgent, to take care of people who have chosen to take the risk of having a [e] COVID-19 serious when it can be avoided? Recently asked his colleagues a doctor cited at the outset in the open letter. The so-called resuscitation services in France correspond to our intensive care.
About 70% of the beds in this severe first line in France are occupied by patients without a vaccine dose who have developed a severe form of pandemic viral disease. Health professionals therefore come to wonder whether the protection status should be taken into account when prioritizing access to care. The answer is no, but with a certain squeak.
“We welcome patients every day arriving in a state of distress, bitterly regretting their unconscious decision not to be vaccinated,” says the text. The solution of not admitting to intensive care people who have chosen not to be vaccinated is not possible. “
The signatories, all doctors, still add facts, “which do not reflect any moral judgment”, they take the trouble to specify before making the list: “do not get vaccinated, it is is to risk one’s life, to risk that of others, […] but also prevent some more fragile people from accessing intensive care, delay the care of other patients with chronic pathologies: it is quite simply to accept the idea that our choice also imposes to deprive others of care. “
The ethical puzzle that is reformed with the new wave recalls the questions of the first in the spring of 2020. Philosophers and ethicists then discussed the tragic dilemma forcing us to wonder if, in order to “sacrifice the young to the health of the old”, it was necessary to spend trillions of dollars and confine the entire planet.
Antitherapeutic relentlessness
Of the 59 new patients hospitalized in Quebec on Monday, 32 were not considered to be adequately vaccinated according to data from the Ministry of Health. The Prime Minister, François Legault, recalled in his conference on Wednesday evening that the 10% of unvaccinated in Quebec account for half of hospitalizations.
“It’s very serious,” he said. No matter why you don’t want to go for the vaccine, you are asked, if you don’t do it for yourself, do it for others: stay home, because there is a bigger risk of ending up in the hospital. “
“When you think of the vaccination status to apply very strict measures, it means that you are penalizing a patient for previous personal life decisions. But we do not know anything about the reasons and we find ourselves making subjective choices, ”explains Dr.r Joseph Dahine, intensivist at the Cité-de-la-Santé hospital in Laval, interviewed before the press conference.
At present, confining the unvaccinated would only be useful in terms of public health to protect them themselves from the disease, because with the arrival of the Omicron variant, transmission is now so much by people doubly vaccinated. So such containment would have little effect on the spread.
Among the unvaccinated are as many outright antivax, as people simply fearful or deprived, adds Dr Dahine.
“I don’t think vaccination status should be considered in access to care, because it’s a slippery slope. “
For example, ICU triage protocols are clear and based only on appropriate medical and ethical criteria, he recalls. “The basic criterion, if there is a shortage of intensive care beds, is who has the best chance of survival within a year. One of the things that [les soignants] holds from the start despite the distress, it is the feeling of saving lives and compassion. So we have to protect that, ”he said.
Even though the ICU triage protocol has never had to be applied since the onset of the pandemic, it recognizes that some form of prioritization is already taking place due to overload and understaffing in hospitals. .
“Of course, there is always someone paying somewhere, and now it is people waiting for surgery for chronic diseases or semi-urgent cancers who are put on the ice because of the load shedding. [engendré par la COVID] and absenteeism. “
Blocking minorities
Singapore also does not deprive of care, like France or Quebec, its unvaccinated COVID-19 patients by choice (rather than by necessity, as is the case of immunocompromised people). On the other hand, the city-state has made them pay the cost of their hospitalization since December 8.
The draconian measure was adopted to convince the last recalcitrant to immunize themselves. About 94% of people aged 12 and over in Singapore have already received at least one dose of the vaccine. The unvaccinated accounted for 60% of hospitalizations when the penalty was adopted. This was before the surge of the new Omicron variant.
Some countries offer another model of punishment for anti-tax people (whether they are conspirators or not, the result being the same). Kenya has since Tuesday required proof of vaccination to access public places, in fact transport and official buildings.
Italy and Germany prohibit them from cultural or sporting gatherings, as in Quebec bars, restaurants or gyms are reserved for vaccinated people. Finally, when we leave these places open.
Austria is stepping up the reaction. Its population is only vaccinated two-thirds. The confinement decreed at the end of November ended three weeks later, except for unvaccinated people. “The coronavirus is weighing on people,” said the new conservative chancellor, Karl Nehammer, justifying this decision. And for many, the limit of what is reasonable is exceeded. “
The objectors therefore did not regain the right to leave their homes, except for basic necessities. A new turn of the screw will be given in February with the entry into force of a vaccination obligation for adults. Austria will be the first European country to embark on this path, which Germany is also considering.
“If we have to go there, we will go there”, said the Minister of Health, Christian Dubé, during the press conference on Wednesday evening, speaking of the hypothesis of compulsory vaccination for the 10% of the population. who still refuse it.
Vaccination obligations for certain professional categories are multiplying in the world, in particular for hospital staff, those in retirement homes, ambulance workers, police officers and the military. Quebec gave it a go by trying to impose it this fall on health care workers, but ultimately backed down.