These are all mitigated by circumstance. Punishment will almost always be less severe in such cases. — Isaac

Also, this is actually not true. People from lower socio-economic backgrounds are disproportionally sanctioned for breaking laws with less leniency applied. That's in part institutional racism, in part network corruption and part knowing how to deal with authorities (and sometimes even just speaking the language and understanding your rights).

Most laws that are passed disproportionally benefit rich people.

Well, thank you for that meaningless statement. And why would that be?

People seem to misunderstand healthcare isn't an entitlement but a privilege. So we can definitely decide to set rules for people to receive that privilege.

People seem to misunderstand healthcare isn't an entitlement but a privilege. So we can definitely decide to set rules for people to receive that privilege. — Benkei

And this is why you shouldn't be allowed near healthcare. You don't understand that your personal judgements about people's choices must be placed on the shelf. You treat everyone you come across as is that was you laying there.

The fact that you say bizarre things without any hesitancy indicates that something is awry with your morality equipment.

We never mandated measles vaccines, which was much, much worse in terms of infection rate and slightly higher death rate but also risk of blindness. — Benkei

They were mandated in certain settings. I recall there being a measles vaccine mandate when I was in public school and having to stand in line in the high school gym to get vaccinated.

I know to register my kids in school, I had to submit proof of vaccinations, and they couldn't enter university without providing vaccine proof. In the early 90s, I worked for the prosecutor's office and I had to go to the public health clinic and get some vaccines.

I see the sociological change over the past few decades not as much as a surge in belief in individual liberties, but more as a symptom of political polarization, leading to a decline in trust of non-tribal authority, and only accepting what your political allies advocate.

That you support the right for others to make stupid decisions is a principled one, and one that I can understand, but it's not one I would personally spend time fighting for. Should you win the battle and secure the common man's inherent right to be stupid, I'm not certain the world will be better off.

Another statement as if it's true. Why don't you go express the right to healthcare in countries that don't have any? Or maybe imagine living 500 years ago? Healthcare is a privilege reserved for mostly affluent nations. Everybody else is mostly screwed. It's the same with human rights; they are a privilege.

There's an important distinction between thinking everybody should have access to healthcare and everybody is entitled to healthcare.

The ethics of triage:

1. autonomy, patients can decide if they want care or not and if there are options in type of care, select the option of their preference.
2. normaleficence, don't unnecessarily increase risk to harm others or intentionally harm others.
3. beneficence, do what is right for the patient.
4. justice, treat similar cases, similarly, treat dissimilar cases, differently. Justice as fairness.
5. fidelity, patients ought to be able to trust doctors.

How does my proposal fit in? Pretty well I'd say. A doctor is screwed on 2, 3 and 5 anyways, as a choice for one or the other will harm the other, won't do one of them any good and probably will be experienced as a breach of trust by the person on the wrong side of the equation.

On autonomy it's interesting that this is the primary consideration but already three posters are getting hysterical about including patient autonomy exercised before coming into the hospital. That's rather inconsistent if you ask me.

My proposal rests most squarely on a consideration of justice. If you willfully make decisions that contribute to you requiring care and those decisions are proximate causes to you requiring care, then all other things being equal, you are not the priority patient.

That you support the right for others to make stupid decisions is a principled one, and one that I can understand, but it's not one I would personally spend time fighting for. Should you win the battle and secure the common man's inherent right to be stupid, I'm not certain the world will be better off. — Hanover

We have a bible belt where people don't get the measles vaccine either and every 10-15 years or so there's an outbreak. Maybe longer ago there was an obligation, I don't know, but not for as long as I've been around. I don't think Covid is deadly enough to warrant a vaccine obligation (otherwise we can start with mandating flu boosters in the US and EU as well). And if it isn't obligated, I don't see any reason why people would have to submit proof or carry passports.

. People from lower socio-economic backgrounds are disproportionally sanctioned for breaking laws with less leniency applied. That's in part institutional racism, in part network corruption and part knowing how to deal with authorities (and sometimes even just speaking the language and understanding your rights). — Benkei

As an aside, what you describe isn't institutionalized racism, but institutionalized classism. Race might distinguish class in certain societies, but I think an often overlooked issue is the role of class in society regardless of race. Equating race and class suggests a monolithic white class structure, as if Appalachian whites who originated as indentured servants and freed prisoners are of the same class today as New England whites originating from the English aristocracy.

My proposal rests most squarely on a consideration of justice. If you willfully make decisions that contribute to you requiring care and those decisions are proximate causes to you requiring care, then all other things being equal, you are not the priority patient. — Benkei

Again, this is not the kind of decision a triager makes. Stay in your lane, buddy.

We have a bible belt where people don't get the measles vaccine either and every 10-15 years or so there's an outbreak — Benkei

The outbreaks were in New York, Washington, Oregon, Michigan, New Jersey, and California, not the bible belt.

https://en.wikipedia.org/wiki/Measles_resurgence_in_the_United_States

The original anti-vaxxers were left wing. Today the Trumpians have joined forces to some degree, although they have arrived at their own medical science consisting of ivermectin, hydroxychloroquine, and drinking bleach.

As an aside, what you describe isn't institutionalized racism, but institutionalized classism. — Hanover

I can see how that may have come across like that so let me clarify a bit more how things are going in the Netherlands. Police, public prosecution and judges in the Netherlands like "getting" Johnny Foreigner, they're more often picked out, more often prosecuted and sanctioned more harshly and they are generally part of the lower socio-economic backgrounds based on correlation. That's the part which is "institutionalised racism".

The second part would be where it concerns local governments, that I generally either know them directly or "I know a guy that knows a guy" and since I'm considered a "more upstanding" citizen than a poorer person (because we measure everything in money, including someone's moral worth) I'm treated differently. That's typical classicism. And also shows where upper middle class people make up the majority of employees in the prosecution and judges, those who write the laws, those who enforce administrative penalties and work at the tax office. So they speak "my language", which makes it a million times easier for me to give them a call first, discuss my case, maybe meet in person and ask for leniency and generally try to bend or avoid the rules. And it works. Or at least, I'm pretty certain it's not all just me being a glib lawyer.

Again, this is not the kind of decision a triager makes. Stay in your lane, buddy. — frank

Again, maybe actually make an argument.

EDIT: In fact, I find the idea, that because "triager" does something in a certain way that therefore we can't have an opinion about how ethics should influence decisions that actually had to be made last year, a bit ridiculous. Especially on a philosophy forum.

Again, maybe actually make an argument. — Benkei

Ask your anesthesiologist friend. Hopefully he's got more of a moral compass than you do.

:up:

You keep suggesting I don't know what I'm talking about in a public forum so it would be appropriate to actually explain why. Just because you're a nurse doesn't make you an expert on ethics.

Again, this is not the kind of decision a triager makes. — frank

If it was my loved one's life on the line who needed the bed, then I'd make the decision for the triager. That settles that. Some times a selfish, inconsiderate, disrespectful asshole makes it my lane.

You keep suggesting I don't know what I'm talking about in a public forum so it would be appropriate to actually explain why. Just because you're a nurse doesn't make you an expert on ethics. — Benkei

Healthcare professionals aren't in a position to judge the choices people have made. In a real triage situation, all you have is people in various stages of hurt.

You want to give priority to motorcycle accident over unvaccinated Covid19 because of the choices you think they made? Did you drug screen the accident victim? Was it a suicide attempt? Is the COVID patient really unvaccinated? Or is he just confused as hell and didn't understand the question?

1. You don't have time to deal with any of this. In a severe, disaster type triage situation, where you have to chose who lives and dies, you identity who you think you can save.

2. In a situation where you do have the life histories of your patients in front of you, you still focus on each person as a human being.

Here's the problem: (trying to think how to explain it because I never have). Judging people is something lawyers and judges wrangle with, and bless them that they know how to sort through that stuff. That is not my job. My job is to be part of a team that shows mercy to all.

If you guys want to execute them later, ok, whatever society wants to do. I will not kill them for you, and any healthcare workers who step in that direction need to be eliminated from our ranks.

I'm not a nurse.

it was my loved one's life on the line who needed the bed, then I'd make the decision for the triager. That settles that. Some times a selfish, inconsiderate, disrespectful asshole makes it my lane. — James Riley

People like you abound. That's why we have huge security personnel.

I don't know if irony is the word, but one of the arguments anti-vaxers use is that Covid affects mostly old people who are on their way out anyway. Then, on the other hand, doctors often make judgement calls about the type and level of treatment accorded to people who only have a few years left. They don't get the balls-out, heroic efforts that you see applied to children or the young and healthy. That's as if some old people don't want to live as much as younger people. And it's a simple cost-benefit analysis. Doctors aren't all clean hands on this. They make judgement calls all the time. As do insurance companies and the courts (a finger is worth this, a leg is worth that, a bread-winner is worth more, a child *could* be worth more in the future, an old person, well, put them on an ice sheet and shove them out to sea. They cost too much).

So I really don't see a problem with a doctor inquiring as to whether the patient believed in taking non-FDA-approved Rx before giving non-FDA-approved Rx to a patient. And if a vaxxed person comes in from an automobile accident and needing a vent, and if there are no beds left, I see no problem with ripping the vent out of the yap of a Trumpster, shoving his gurney out in the hall, sterilizing the vent and using it on the accident victim.

That's why we have huge security personnel. — frank

Get the biggest ones you want. Get as many as you want.

Get the biggest ones you want. Get as many as you want — James Riley

You'll wake up tied to a bed with a tube down your throat. If you start struggling, we'll put you back to sleep.

I don't know what all the various triage scenarios are that you have cooked up in your brain. What I'm getting at is a limited number of beds CREATED by assholes during a pandemic. I'm not talking about a train wreck, or a shooter in Las Vegas. I'm talking about assholes during a pandemic.

You'll wake up tied to a bed with a tube down your throat. If you start struggling, we'll put you back to — frank

Uh, no. You'll just end up with more big people to triage. I'll be fine.

Most humans are assholes. How have you not noticed this yet?

Most humans are assholes. How have you not noticed this yet? — frank

I have noticed it. Some are even stupid assholes. Where is Darwin when you need him?

Uh, no. You'll just end up with more big people to triage. I'll be fine. — James Riley

:lol: You'll definitely be fine. You'll end up in the psych ward eventually.

How about the rest of here just stipulate that you can kick Chuck Norris's ass any time you like and you leave off making posts where you remind us?

How about the rest of here just stipulate that you can kick Chuck Norris's ass any time you like and you leave off making posts where you remind us? — Srap Tasmaner

Chuck and a good 50% of the people on the planet (at least!) could easily kick my ass in a fair fight. How about we stipulate to that?

:lol: You'll definitely be fine. You'll end up in the psych ward eventually. — frank

Now that's a possibility.

Thank you.

I can see how in disaster triage making decisions like this is much harder. And I'll definitely grant that the "protocol" I suggested doesn't work in many circumstances. But we have triage all the time also without the pressure. When I had to go to the hospital with my son there weren't enough IC beds available either (pre-Covid). Just a confluence of circumstances.

The 5 principles I mentioned aren't my invention; they're actually used to write protocols and in arriving at decisions. If you're confronted with a triage situation, after assessing it and it fits the protocol, you can follow the protocol.

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?

The 5 principles I mentioned aren't my invention; they're actually used to write protocols and in arriving at decisions. If you're confronted with a triage situation, after assessing it and it fits the protocol, you can follow the protocol. — Benkei

I know. I've had disaster triage training, but never had to use it. I'm not in that kind of role now.

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 would intubate the first one and put him on a vent, then intubate the next one and manually ventilate (we call it bagging). If another needs to be intubated, I would show whoever is nearby with nothing to do at the moment, how to bag and intubate the next one.

I spend a lot of time planning for situations like that, so it's a hellish day if all my planning is for nothing and I have secretaries standing around bagging my patients. I would be aiming to keep people alive and keep their brains oxygenated so it wasn't all for nothing.