Editor’s Note: Robert Klitzman is a professor of psychiatry and director of the masters in bioethics program at Columbia University. He is author of “Designing Babies: How Technology is Changing the Ways We Create Children.” The opinions expressed in this commentary are solely those of the author. View more opinion articles on CNN.
One night many years ago, I was looking forward to finally getting some sleep after working 17 hours straight as a medical intern. But before I could leave, I got called to see another patient: A homeless man with black grime covering his plaid shirt and brown pants who had a severe blood infection from shooting up heroin with dirty needles.
His record said he had been hospitalized three times in three months for the same medical problem. If he had stopped using dirty needles, he wouldn’t be in the hospital. And I could sleep. I remember feeling exhausted, frustrated and angry.
I have been thinking about this man and my reaction more recently as my fellow doctors around the country have had to treat an increasing number of patients who ended up with severe cases of Covid-19 after choosing to forgo the vaccine. One colleague told me, “My ICU is full again, with Covid-19 patients who refused to get vaccinated! It’s stressing me out! Why should we have to care for patients who didn’t want to get the shots?”
Front-line doctors I know at a number of different hospitals are growing exasperated with these patients, whose rejection of the vaccines have endangered themselves as well as friends, family and health care providers. Only 54% of the US population is fully vaccinated and several states are experiencing shortages of ICU beds.
More than 18 months into the pandemic, nurses and doctors across the country are understandably overwhelmed and burned out. In a Washington Post and Kaiser Family Foundation survey conducted in February and March, 29% of health care workers said they had considered abandoning the field as a result of the Covid-19 pandemic.
In taking the Hippocratic Oath, however, physicians commit to treating patients to the best of their ability, without prejudice. Health care professionals often see patients who develop emphysema from continued smoking; diabetes from maintaining a poor diet; and severe neurological damage from riding motorcycles without helmets. Of course, it’s different when a patient’s decision can potentially jeopardize the health of others. But the point remains: as physicians, we are responsible for treating patients; even those who make bad decisions.
As doctors, we need to work to overcome any negative emotions we might harbor towards our patients and remind ourselves why we entered the profession: to treat all patients who require assistance. We are privileged to have patients trust us with their very lives and deepest secrets. And any judgment we might cast on them or their prior decisions could have a negative impact, particularly on patients who are skeptical of the health care system or reluctant to get the care they need.
Nonetheless, the situation is more complicated when ICU beds or ventilators are in short supply. In recent weeks, many commentators have argued those who refuse the vaccine should be a lower priority for care when resources are limited.
But this argument contradicts the basic principles of medical ethics that guide our decisions as doctors. We should allocate scarce resources as fairly as possible, based on which patients are most likely to benefit from a medical intervention and which are most likely to die without it.
If patients are equally deserving based on these criteria and shortages remain, a hospital might incorporate secondary considerations as “tie breakers.” In a pandemic, for instance, front-line medical workers might be secondarily prioritized since they can then treat other patients.
Someone might argue vaccinated individuals should get preferential treatment because they are more likely to survive. But while immunization decreases the odds of getting severely sick with Covid-19, once you are already severely ill, there is no evidence having been vaccinated helps your chances of recovery.
Prioritizing medical care based on someone’s vaccine status is problematic since it is often unclear to doctors why patients aren’t vaccinated. Many refused the shot because they believed disinformation spread on social media, or by right-wing pundits and members of their community. Others may have had medical reasons or limited access to the vaccine. Many people are also understandably hesitant due to the long-standing discrimination embedded in our medical institutions.
Given that African Americans and Latinos are disproportionately affected by Covid-19 and face inequities in health care, a policy that takes vaccination into account could fuel mistrust and exacerbate existing disparities.
In the meantime, it is important more people get vaccinated. Many of us have relatives, acquaintances or co-workers who are still hesitant about the vaccines. We should encourage them to get vaccinated, gently clear up any misunderstandings they might have and approach them with empathy.
It is important, too, for our nation to hear and understand the rage, frustration and despair many health care workers are experiencing.
Throughout the pandemic, many health care workers have risked their lives to treat Covid-19 patients. We need to make sure health care workers have access to mental health services as well as adequate time off and compensation. It goes without saying that without them, we’d all be in serious trouble.
We should also make sure doctors who have suffered from mental health problems due to the unrelenting pressures of the Covid-19 pandemic are not penalized. Many doctors still get asked broad questions about their mental health history when they renew their state license and answering yes could threaten their ability to practice. The Federation of State Medical Boards published recommendations to revise the questions in 2018, but a majority of states have not fully adopted these recommendations. Countless doctors remain worried that to admit a problem or seek treatment can impede their ability to work or get malpractice insurance.
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This needs to change.
In the meantime, it is inevitable some tensions between health care providers and their unvaccinated patients will persist. I would like to say all doctors love interacting with all their patients all of the time. But that is simply untrue.
Nonetheless, when patients are in need, we treat them. As medical professionals, it is our job. For everyone else, it is important to encourage the people around you to get the vaccine.
