In Canada's Western province of Alberta, hospital beds are running out and forcing officials to "triage" to decide who does and doesn't get care. The same formula should not apply to those who have chosen not to get the COVID vaccine.
CALGARY — The province of Alberta in western Canada has a reputation for being outdoorsy, somewhat conservative, and laid back. Well, it's not laid back anymore. Over the past week, both medical administrators and the media have been warning that due to steeply rising numbers of COVID-19 cases and rapidly filling hospitals, medical workers may soon have to apply the triage policy to determine who is allocated medical care …and who is not.
In reality, triaging already began several weeks ago — and to the detriment of the vaccinated and children.
A common definition of triage is "a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it"
Alberta has a framework for this process titled Critical Care Triage during Pandemic or Disaster, documented for the first time earlier this year. It says that "the triage protocols create an objective process to guide health care professionals in making the difficult determination of how to allocate resources to critically ill adult and pediatric patients when there are not enough critical care resources for everyone."
The objective of the framework is to ensure that "a fair and equitable process is applied to all people of Alberta." The main criterion for allocating critical care is the 'capacity to benefit,' which is a way of saying: "prioritizing the admission of patients who have a substantially better chance of surviving after receiving critical care."
A fair and equitable process
There are several challenges with this approach. The first is the lumping together in the document of two very different situations. The term 'disaster' implies something that is a natural, sudden calamity, where we are all equally caught off-guard. This pandemic, instead, has been more than two years in the making, highly publicized and analyzed — and for the past six months, highly effective vaccines have been easily accessible.
Second is the phrase "when there are not enough critical care resources for everyone." And why are there not enough critical care resources now for everyone? The answer is simple: a section of the population (adults with no medical reasons) consciously and knowingly decided not to get vaccinated, despite being presented with every opportunity, and are now catching COVID in large numbers.
Third, the document claims to offer a fair and equitable process. Only it doesn't. We are now rationing care towards those with COVID, which means we are now rationing care largely towards the unvaccinated. This is appropriate and necessary when it involves children and adults who for medical reasons cannot be vaccinated. But it is unacceptable when it includes adults who have purposefully refused to be vaccinated.
90% in hospital are unvaccinated or partially vaccinated
Some 90% of the people in hospitals now with COVID are unvaccinated or only partially vaccinated. The adults among them have declined the chance to get vaccinated, various reasons including distrust of the government, distrust of medical science, and not wanting a foreign substance in their body.
They should not occupy hospital resources.
Fair enough; I can respect someone standing up for their principles. But using the same logic, when they catch the virus, they should stay at home. They should stay far away from government-run hospitals, where medical staff will be injecting various drugs into their bodies and performing various invasive procedures in an attempt to treat them and keep them alive. They should not occupy hospital resources. But because they are, the medical system is already triaging and that too, in favor of the unvaccinated.
In addition, by postponing surgeries, the medical system has further prioritized the care of the unvaccinated over the care of others – who may need a hysterectomy due to cervical cancer, as the Calgary Herald reported, or who may need surgery due to lung cancer, who may be waiting for a knee or hip replacement and suffering from severe pain and reduced mobility in the meantime.
When surgery 'postponement' is a euphemism
These surgeries are being canceled so as to create space in ICUs for the unvaccinated. Even children's surgeries are being postponed, the CBC reports and some staff from the Alberta Children's Hospital have been deployed elsewhere. Of course, often the term 'postponed' is euphemistic. If the patient happens to die due to the postponement, call it 'canceled.' While we know the numbers who have died of COVID, we don't know the numbers who have died and will die due to postponement of their treatment.
We're sacrificing the health and indeed the lives of children, the vaccinated, and those who genuinely cannot be vaccinated in order to treat those who have consciously and callously refused to be vaccinated. We are giving up our hospital care for them.
Lastly, triaging solely on the basis of 'capacity to benefit' is simplistic, narrow-minded, and unfair. We also need to triage on the basis of whether patients have taken the trouble to get themselves fully vaccinated. So two criteria are needed to allocate hospital care: 1. Capacity to benefit; 2. Full vaccination. While the first reflects the patient's physical ability to survive, the second is indicative of perhaps even more important things: their healthy fear of a serious illness, their mental desire to survive, their respect for medical science, and their concern for the rest of society.
Ranjani Iyer Mohanty is a commentator and academic editor. Her articles have also appeared in the New York Times, the Wall Street Journal, the Atlantic, and the Globe and Mail.