Denying health care to the unvaccinated is one step too far

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It is tempting to want to punish someone or something for the lockdown many of us have again been forced to endure. There are plenty of targets: politicians, public-health leaders, modelling experts … our livers. But no group appears to have attracted as much ire as those who continue to deny a safe, proven, free and effective vaccine. They are, after all, the ones most likely to get severely ill from the Omicron variant and require hospitalization. Thus it is essentially for them (and to a lesser extent, the elderly and immunocompromised) that everyone else is again hunkering down in their homes. It is indeed egregiously unfair to think that we are all languishing through another lockdown because a bunch of people bought into vaccine myths.

It is understandable why many Canadians might be clamouring to see the unvaccinated suffer consequences for their decisions, though there already have been and continue to be repercussions (not the least of which, of course, is an increased risk of serious illness and death). Many have lost their jobs and can no longer participate in recreational activities. They cannot board domestic trains, planes or charter buses (on paper, at least) or dine indoors where vaccine mandates have been enforced (and where indoor dining is still permitted). And yet, these measures still haven’t been enough to compel the roughly 13 per cent of Canadians age 12 and older not yet fully vaccinated to receive their shots.

Some will say it’s time to consider the ultimate stick: to warn those who enduringly resist vaccination that they will no longer be able to fall back on our health care system if they contract COVID-19 and things go awry. We should, some argue, reserve our limited medical resources for those who have made the publicly minded and personally responsible decision to protect themselves from severe illness.

But such an extreme measure cannot and should not ever be seriously contemplated in Canada, even if it might seem deliciously warranted to a parent in his fifth hour of trying to get his kindergartener to pay attention to virtual school. For one, it would be in contravention of the principles of our universal health care system as set out in the Canada Health Act. For another, it would set a corrosive new standard whereby health care is doled out based on assessments of behaviour – where patients who are perceived to have somehow contributed to their own misfortune are deemed less deserving of care.

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Our system does not permit discrimination between patients when doling out services: When a drunk driver and the person in the vehicle he hit are both brought to the emergency room, they are supposed to receive equal levels of attention. (Some will argue that drunk driving is not contagious such as COVID-19, but that’s a red herring; if contagiousness disqualified a patient from receiving care, then no one with COVID-19 – vaccinated or not – would be allowed in hospital.) People who smoke, take drugs, have random unprotected sex, eat poorly and don’t exercise, play extreme sports, go tanning, ignore lumps in their bodies far longer than they should – they are all entitled to the best standards of care possible. That’s because we recognize our health care system treats humans, not droids, and humans have failings.

It is true that in some situations, patient behaviour is factored into treatment plans: Alcoholics cannot receive liver transplants unless they have abstained for a certain amount of time, and bariatric patients must stop smoking to receive weight-loss surgery. But these sorts of considerations are usually based on assessments of the likelihood of successful outcomes – not moral judgments. Where resources are limited and care is rationed, other patient details factor into who gets a ventilator or bed in the intensive care unit; a 20-year-old will probably win out over an elderly cancer patient, for example.

If we do reach a point in this pandemic where hospital care needs to be seriously rationed, we could see scenarios where vaccinated patients take priority over the unvaccinated. But again, that would be based on an assessment of probable outcomes, since research shows that even among patients hospitalized with COVID-19, those who are vaccinated tend to fare better than those who are not.

But where we are now, there is no moral defence for denying unvaccinated patients health care, nor is there a way to practically implement such a policy anyway. After all, who would decide which patients have “legitimate” reasons for declining vaccination? Would someone with one shot be considered unvaccinated? What about unvaccinated patients admitted for another reason who become infected in hospital? Would it be the responsibility of already burned-out triage nurses to turn away unvaccinated patients pleading for care?

One of the many risks of this seemingly never-ending pandemic – beyond uncontrollable blood pressure swings and damaged livers – is collectively losing our humanity as we veer ever further away from normal. We have a right to be angry with those who have made decisions that have de facto made things worse for everyone, but as a society we will suffer greater and longer if we stop seeing them as people.

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