In clear violation of the protocols I mentioned in the "About this Blog" section, I will focus on an issue that is both current and complex. I planned to eschew the present because most topical subjects tend to be ephemeral and this blog is designed to be eternal. In this case, however, the current issue has long been around, but avoided, and it will linger for a long time to come and will still be avoided. I also deliberately planned to avoid the difficult subjects because I am not equipped to handle them. I can't handle this one either, but at least I can point out the questions if not answer them. Perhaps you hadn't even thought about them, so I am at least helping in that regard.
The 'issue' in this case we will define simply as the question raised above: Who Should Get the Vaccines First? Complex ethical problems are involved, as are logistical ones which complicate further the ethical ones. I will avoid the problems associated with the rationing of the vaccines, if there are not enough of them and focus on how the delivery of them should be prioritized, which is what the question is getting at. I am sure most of you know the answer to the question - You Should.
The problem with your solution is that there are several million people who disagree with you and that only includes the ones on this continent. The disagreements have started to surface and will, like the virus, increase exponentially as the vaccines are only slowly dispensed. To give one example, which is an irritating one if you are quarantined on a cold day in Canada, consider this question: "Why in the hell is that Snowbird in Florida, getting the vaccine before I do?" That question is not only being raised here. I have a relative in Florida, who indicated that she was not happy with those northerners who were getting the shot before she was unless, perhaps they owned property there. I have another relative in Maryland who is not too pleased that those who are in prison might be given a priority ranking higher than his. You may be getting the feeling now that the question is not so easy to answer.
Increasing numbers of such questions will be asked with increasing urgency over the next few months. While I indicated I don't have the answers, I can at least list some of the questions that are going to be asked and direct you to some of the resources that will help answer them. Unfortunately, it is unlikely that they will indicate you should be first in line.
This post was prompted by an article I read this morning. It provides a clear account of the ethical issues which are rather murky when examined closely. In the middle of the essay, which should be read if you are at all interested in the emotional costs of this pandemic, is this paragraph of questions:
"Given this, who should get the vaccine first? If we prioritize people who are more likely to contract and die from the illness—which is one common method of allocating vaccines—should Black, Latino, and Indigenous Americans be on the top of the list, given their documented vulnerability? Should the risks associated with being among the first to receive the vaccine be distributed more broadly? Should health-care workers get the first doses? What about schoolchildren, or teachers? Should we prioritize people most likely to die from the disease (say, the elderly) or those most likely to transmit it widely (say, college students)? Can a government compel some citizens to get inoculated? Should it? If the U.S. is the first country to develop the vaccine, should it share its limited early doses with the international community? Should the federal government get to decide how the vaccine is allocated among different states? What if multiple vaccines arrive on the market with different levels of effectiveness, or different side effects? Who gets which one?"
It is not very difficult to translate these questions into 'Canadian.' It is being suggested here, for example, that being in the older cohort, I should be vaccinated first. But, is not the student on campus more likely to spread the virus and have many more years to live and be more productive? Will the shot I get come when Trudeau, Ford or a local authority determines it will? Why did that province, get the vaccine first? Should those on P.E.I. be put at the end of the line because they are on an island? Should Canada outbid other countries for the limited supply? One could go on.
The good news is that there are plenty of bioethicists around and available to provide clinical advice in difficult situations. There are also well developed guidelines, protocols and "crisis standards of care" about such things as whether to bother with resuscitation or determine which of the five patients gets the last ventilator. The bad news is that the desperate decision will probably have to be made by a first year resident who to you, looks like an adolescent. No one wants to be in the position to make such a decision, just as our Prime Minister or Premier will have difficulty determining who gets the first vaccine.
The bad news continues. Even if there was conclusive evidence indicating exactly what should be done and a leader willing to make the decision required, there would be many followers who would object. There are some in communities close by who are not willing to obey the rules and there are many, particularly, south of our border, unwilling to submit to government protocols and trust the government even though they believe in The Protocols of the Elders of Zion.
Sources:
The article: "What the Chaos in Hospitals is Doing to Doctors," Jordan Kisner, The Atlantic, Jan./Feb. 2021. On the cover, the question is raised: "Who Should Get the Vaccine First --- and Last?" I will not put the link in because it is unlikely to get you behind the firewall, but the article is very good.
"Guidance on the prioritization of initial doses of COVID-19 vaccine(s)," Government of Canada.
“COVID‑19 Vaccination Program Interim Playbook for Jurisdiction Operations” Center for Disease Control, Oct. 29, 2020.
"Fair Allocation Mechanism for COVID-19 Vaccines Through the COVAX Facility," World Health Organization, Sept. 9, 2020.
"National Academies Release Framework for Equitable Allocation of a COVID-19 Vaccine for Adoption by HHS, State, Tribal, Local, and Territorial Authorities," The National Academies of Sciences, Engineering and Medicine, Oct. 2, 2020.
The Bonus:
Ethical issues can be perplexing and confusing and sometimes even symbols are not clear. If, like me, you associated the caduceus pictured above with the field of medicine, you were correct. But, apparently it is not a good choice. See: "Caduceus as a Symbol of Medicine", or "Things You Don't Learn in Medical School."
No comments:
Post a Comment