Department of Health, Ethics and Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
Bioethics. 2022 Oct;36(8):883-890. doi: 10.1111/bioe.13069. Epub 2022 Aug 7.
This article provides a systematic analysis of the proposal to use Covid-19 vaccination status as a criterion for admission of patients with Covid-19 to intensive care units (ICUs) under conditions of resource scarcity. The general consensus is that it is inappropriate to use vaccination status as a criterion because doing so would be unjust; many health systems, including the UK National Health Service, are based on the principle of equality of access to care. However, the analysis reveals that there are several unique features of Covid vaccination status in the context of a pandemic that make this issue disanalogous to cases (such as lung cancer caused by smoking) discussed previously. First, there is equality in access to care at the point of vaccination; the unvaccinated refuse the offer of preventive care when they decline vaccination, weakening their claim to ongoing care if they become ill (this is qualitatively different from 'poor lifestyle choices' such as smoking). Second, the decision of one person to refuse vaccination substantially increases the risk that they will become seriously ill and need ICU care; the person who chooses not to get vaccinated thus potentially increases the pressure on intensive care bed provision, as well as increasing the risk that he or she will infect others who in turn might end up needing ICU care. Third, justice cuts both ways, and giving unvaccinated patients equal priority may itself be unjust when other patients have reduced their risk of ending up on the ICU by getting vaccinated.
本文对在资源匮乏的情况下，将新冠疫苗接种状况作为新冠患者入住重症监护病房（ICU）的标准这一建议进行了系统分析。普遍共识认为，将疫苗接种状况作为标准是不恰当的，因为这样做是不公正的；包括英国国民保健制度在内的许多卫生系统都基于平等获得医疗服务的原则。然而，分析表明，在大流行背景下，新冠疫苗接种状况有几个独特的特征，使得这一问题与之前讨论过的案例（如吸烟引起的肺癌）不同。首先，在接种疫苗时，人们获得医疗服务的机会是平等的；未接种疫苗的人在拒绝接种疫苗时，就放弃了预防护理，从而削弱了他们在患病时继续获得护理的权利（这与吸烟等“不良生活方式选择”在质上有所不同）。其次，一个人拒绝接种疫苗的决定大大增加了他们患重病和需要 ICU 护理的风险；选择不接种疫苗的人可能会增加对重症监护床位供应的压力，同时也增加了他们感染他人的风险，而这些人可能最终需要 ICU 护理。第三，公正具有两面性，当其他患者通过接种疫苗降低了进入 ICU 的风险时，给予未接种疫苗的患者同等的优先权可能本身也是不公正的。
