Obviously it feels right. My fear is that the precedent will be used to make things much worse for already marginalized groups whose condition can be fairly or unfairly blamed on their own choice.
I think this is it:
There's something to be said for the state and institutions not being agents of harm, so perhaps that's the nut of the argument against denying care.
That said, if the hospital is about to crash, I'd be in favor of stopping treatment to those with the worst prognosis and that would probably be the same thing mostly.
There's a slippery slope argument here about what would happen if hospitals stopped treating people for any disease or injury that the person could or should have prevented. Should they stop treating the injuries of people who were in car accidents without seatbelts? Motorcyclists without helmets? Smokers with lung cancer? People who eat a lot of fried chicken and then have heart attacks?
The counterargument would be that denial of treatment to unvaccinated Covid patients should only happen during a state of emergency in which hospitals are specifically overwhelmed by unvaccinated Covid patients. The other types of preventable injuries and diseases are bad, but they don't by themselves cause hospitals to be overwhelmed.
So denying treatment to unvaccinated Covid patients is basically saying to them, "You guys have effectively sabotaged the health care system, so if anyone doesn't get treatment, it's going to be you guys."
Haven't there been triage-under-duress procedures in ERs that have already amounted to this? I thought this had happened in a few particularly pressed hospitals.
4.1 is it. If we start restricting treatment to people who need it because of their own bad decisions, are we going to refuse to treat alcoholics with liver disease? People who don't exercise with heart disease? People who grill a lot with colon cancer? I think a lot of slippery slope arguments are nonsense, but this seems to me to be a real and very slippery slope.
What if we don't treat broken bones for people who walk on slippery slopes?
Triage conditions, yes. Also it would be a precondition to be able to reliably screen out the involuntarily unvaccinated.
but my wife found it too monstrous to even engage. But...why?
Because your wife isn't a monster.
Let's let people be treated by doctors they agree with. Alcoholics with liver disease can still be treated by western medicine. Unvaxxinated people can go have Alex Jones encourage them to go drink their own pee. Freedom.
Aside from the slippery slope, there's a big logistical question given that our system for tracking people is a little paper card. If someone shows up struggling to breathe at an emergency room, but say they're vaxxed, then what?
If we start restricting treatment to people who need it because of their own bad decisions, are we going to refuse to treat alcoholics with liver disease? People who don't exercise with heart disease? People who grill a lot with colon cancer?
Consider who would be denied AIDS treatment under this rule, for that matter.
3 is a good point. There is a name for what you do when your hospital is so overworked that you need to start denying or withdrawing life-saving care to people; that name is "triage by resource" and it hasn't had to happen yet at all, at least not in the UK. Delaying elective care, stepping down staff ratios etc is a horse of a very different colour. Triage by resource is literally saying "we will treat this patient, but we will not treat this one, who will as a result die".
Note that this is different from "triage". Triage is what everyone does when there are multiple patients - you treat them in order of urgency. This one has an obstructed airway, that one has a broken leg; the airway gets treated first.
Remember also that quite a lot of the unvaccinated sick may lack capacity in relation to the decision - serious COVID is a disease of the old.
American blacks
Rhetorical conventions shift quickly enough--though perhaps only in certain parts of the culture, I suppose--that this read as glaringly wrong to me. But I bet there's a rugby team or two known by this name.
I think this is right though.
The counterargument would be that denial of treatment to unvaccinated Covid patients should only happen during a state of emergency in which hospitals are specifically overwhelmed by unvaccinated Covid patients.
The specific circumstance is that so many people are making this particular bad decision that other people are dying. To put it another way, it's not a moral trigger; it's a capacity trigger with a moral delineator.
American blacks
If I'd capitalized the "b," I think I would have been olive golden.
I reject the slippery slope argument as unnecessary. Denying healthcare to sick people is wrong. Full stop.
I think you can differentiate between behavior that that offers rewards that are offset by risks and behavior that is just antisocial bullshit. So when you talk about smoking or triglyceride consumption or whatever, you aren't really describing a slippery slope. You are making a (gasp!) analogy.
Healthcare is always rationed, but triage decisions need to be made based on medical, and not moral, judgments.
143: There were news stories here last winter about doctors having to decide who would get ventilators in a few places based on likelihood of treatment success (so preference to younger, healthier patients in general). I'm not sure whether it was a lack of ventilators or a lack of staff (or both), but it seems to have happened here.
Given the data we now have on vaccination, it seems clear that in a similar situation, vaccinated patients would have significantly better chances of survival, so when (if?) we reach the same point in this surge, it seems clear that vaccinated patients would get resources, but we wouldn't be denying care.
There's a very recent paradox here which is that medicine has gotten much better but it takes serious limited resources, and that's not really compatible with pandemics. During the 1918 flu pandemic they didn't have ventilators, so they couldn't run out of them. Even putting aside issues around vaccination, I don't think we've often been in this situation where you have a pandemic which does have useful treatments but which can't scale to match the pandemic. It's a hard problem to figure out how to deal with. It's really genuinely hard to keep a highly contagious pandemic at low enough levels that it doesn't cause problems for health care.
I'm ok treating unvaxxed people if there's space, but they should get unceremoniously booted if the hospital is at capacity. ECMO in use but you have a CF patient waiting for a double lung transplant? Too bad, anti-vaxxer. The hospitals can set up field tents outside with unlimited supplies of Vitamin C, Ivermectin, and empty water bottles to collect pee.
re: 13.2
I'm pretty sure that a reasonable number of people have died who otherwise might not have died because hospitals were over-stretched. A lot of that is a decade of Tory sabotage and under-resourcing, rather than COVID, of course, and it might not have involved medical staff explicitly making the choice to deny or withdraw life-saving care, as you say. But the effect of a large influx of sick people* is going to be that some people are going to die who otherwise wouldn't have. Some hospitals have gone into, iirc, Critcon level 4 (where they might start triaging by resource), even if they haven't actually had to carry out formal triaging by resource.
I'm fully on board with not denying care to the unvaccinated for reasons already enumerated by others above, though.
* something that happens every winter, anyway, but this is more extreme.
I mean some version of 11 seems like the clear solution here, but it's unclear how you get there. Who would actually set them up and advertise them on Fox News? I think people would be too scared of getting sued.
22: I assume that here too. That includes people dying because of a delay.
If someone shows up struggling to breathe at an emergency room, but say they're vaxxed, then what?
This does seem like the toughest nut to crack. But since we're already on the dreaded slippery slope, I guess we let the disorganized die.
That's probabilistic, so you maybe don't have a specific dead person to point to.
Vaccine passports are the answer, but not for healthcare. In a sensible society, you are free to not get a vaccine, but you aren't free to serve beer or go to school unvaccinated.
(I mean, once vaccines are available to all schoolkids. Today, I really mean "college" rather than "school.")
The other big problem here is that since FERPA doesn't allow cameras in hospitals it might as well be that any problems at hospitals don't exist.
Wrong acronym.
26: See, that's a problem. What you need is specific people who ought not be treated. "I've got a little list ..."
What happened to the other post? Was it unvaccinated?
That isn't the post you were looking for and you'll see it tomorrow anyway.
32: I took this post to mean that I should give myself a posting holiday tomorrow.
34: Everything is sliding down the slippery slope into the fog.
Perhaps some of you with exceptional memories remember a previous epidemic in which unsympathetic people were often denied medical care.
Several decades ago, I worked on a daily newspaper for an editor who issued an edict: All stories on fatal car accidents must answer the question: Was the victim wearing a seatbelt?
I didn't like this, and I analogized: Are we going to start reporting whether lung cancer deaths involved smoking?
This was long before I understood the folly inherent in analogies. Seatbelt information was a matter of public record in police reports. Whether someone was wearing a seatbelt is an important piece of public health information. And I gotta say, it really brings home how important seatbelts are when you seldom find yourself reporting a belted fatality.
It was pretty weird. These stories were often, like, four sentences long, and one of the sentences was, in effect, "Dumbass had it coming."
Readers complained about it much less than you might think, though.
54 written before realizing that the conversation had moved on.
56 was written before seeing 55, and was not the defensive retort that it appears to be.
FWIW, our local paper is reporting the vaccination status of covid deaths. For example
Six of the seven COVID-related deaths were among unvaccinated or partially vaccinated residents, according to the [local] Health Department's latest COVID Data Report. Among the deaths were: ▪ One unvaccinated man in his 40s. ▪ One unvaccinated man in his 50s....
Also, as I mentioned in an earlier thread they are reporting the case rate for vaccinated and unvaccinated people, which I find very helpful and, at the moment, the ratio is ~2.5:1
Based on the [xxx] residents in the county who would have been fully vaccinated by Dec. 26 ... that works out to a weekly infection rate of [~400] per 100,000 vaccinated residents, [Among unvaccinated there was] a weekly infection rate of [~960] cases per 100,000 residents.
How about we compromise and say voluntarily unvaccinated can't get any restaurant food, takeout or delivery included. Grocery store obyl.
62: Come to think of it, you see that all the time -- and it's obviously appropriate. So that's another point in defense of my old editor, who was overseeing coverage at a time when seatbelts were controversial among the same sorts of nitwits who don't get vaccinated today.
(But that, too, is an analogy. Seatbelt use is probably more similar to mask-wearing, and it's not like mask-wearing either.)
The thing about seat belts is that I only started wearing them after a collision in which I cracked the windshield with my head.
Fortunately, I was a very careless driver so that happened before I attained my majority.
Blaming the victim related- LB, is Adams really as much of an asshole as I've been hearing? His administration blamed the Bronx fire fatalities on people not closing their doors when fleeing. Then it turned out the doors are supposed to close automatically and they'd been cited many times for it but the landlord who didn't bother to fix it was an Adams inner circle donor? And also there were heat complaints that were ignored which is why they were using a space heater in the first place.
Plus there's appointing your unqualified brother to a high paying job but at least that hasn't killed anyone yet.
Give people time to grow into the job.
I've also been curious. Is New York just gonna have a clown mayor for the next few years? Are you resigned to it?
How hard can it be to kill someone if you work for the NYPD?
I prefer vaccine passports, and, in some settings, mandates. Quebec was requiring proof of vaccination to buy alcohol or cannabis. It was a very effective incentive.
Isn't it pretty normal for NYC to have clown mayors?
I thought that's what they were going for too.
When is the last time NY's mayor wasn't a clown? Dinkins? It's fascinating how that keeps happening.
I wouldn't describe Bloomberg as a clown exactly. But at any rate Giuliani set a really high bar for clowning that I doubt Adams can match.
The mayor in Ghostbusters felt compelled to explain that Mayor LaGuardia was a ghost, so I assume they have to respect for the intelligence of the voters.
hiv is not a good analogy bc even adequate health care for hiv patients was never near soaking up so much capacity that other patients were at risk, & hiv patients do not pose a serious infection risk to caregivers.
with covid we have this: https://twitter.com/NEOsborn/status/1434965456985722883?t=l4LmgdwYoxRarDls0xqg2g&s=19
my kid had appendicitis at around age 7-8. it took hours to diagnose him in the er bc it is apparently difficult to get a good scan of the innards of really skinny little people. understandably they are reluctant to do abdominal surgery on people who don't need it, hence many scans. in the time between the penultimate & ultimate scans his appendix burst. the surgery took a couple of hours & the kid was really quite ill for a number of weeks, and frail-poorly for some longer time. this was a robust extremely fit kid. another kid could have a significantly worse outcome. it is not unreasonable to ask why we would prioritize treating an unvaccinated 30 year old over a vaccinated 12 year old with appendicitis.
when my better half had a heart attack this past spring the icu doctors & nurses were open about how lucky he was to have had it post the winter surge, as they'd been chock full then & his care would have suffered. also my better half has chronic kidney disease - not bad enough for dialysis, but bad enough to meeit a close relationship with a great nephrologist, & the post heart attack & heart attack treatment has definitely taken a toll. if he catches covid i don't like his chances. i'm super unenthused by the prospect of him needing care & accessing it putting him at high risk of infection bc of all the unvaccinated people in the hospital shedding more virus than they would if they were vaccinated.
deny care to the unvaccinated? no - but deny them access to all public indoor spaces excepting grocery stores - absolutely.
sure although would also endorse subsidized mail order only.
It's a trilemma: three things we treasure, that we can't have them all:
1. America is a land of "freedom", where people are free to refuse vaccines and still enjoy the benefits of our society
2. we want our medical system to triage only based on clinically relevant data, not morality
3. we want a functioning medical system
1+2: where we're headed
1+3: where ogged (and I) want to go
2+3: mandatory vaccination, or maybe confine the unvaxxed to their dwellings (ankle monitors, daily checks, weld shut their doors), like China does
We can't have all three: that much is clear. And nobody wants to actually think thru the implications of these things. So instead, we just muddle thru, and last night I read that in California, health care workers who are asymptomatically infected can return to work *immediately*, which is *so* great, truly, I'm relieved and it'll all be better now.
It's worth keeping in mind that the shit heads have won many recent battles. The negative effects of that are baked into reality and we're just waiting to see how it plays out.
I think you can make a distinction between making a moral judgement about patients before treating them, and making a large-scale policy decision with warning. "You have three months to get vaccinated or get an exception, or else you don't get to enter a medical facility until the state of emergency is over." There's a difference between not treating people because you don't like their non-medical decisions, and not treating people because they refuse the appropriate treatment.
As far as I can tell, Adams is both an asshole and a clown. I don't have a lot of hope for the next four years. Our new DA is the cat's pajamas, though.
It's a slippery slope from prioritizing the vaccinated to prioritizing nonsmokers, the nonobese, etc.... And That's Good (although ideally expressed as higher copays rather than rationing). If we're all gonna take care of each other collectively (the universal health care dream), it's nice for people whose choices cost the system more to pay a bit more.
Adams is kind of the future of American politics though, right? Lower-education people, especially men, across all races, unified in their desire to be lead by clowns.
85: I get the slippery slope, but I also think there's a huge difference between refusing appropriate treatment and non-medical lifestyle choices.
(Also literally smokers pay more for healthcare. And me every other year when I miss the two week window for telling them I'm still not a smoker.)
We pay the same regardless but we get pestered to enroll in a thing about high blood pressure if we have high blood pressure.
The odds of Adams losing in the primary for reelection, switching parties, and becoming besties with Trump seems... 1/4? 1/3?
it's nearly a non-issue here in sf given our vax & booster rates & i have no problem with the we're-all-this-together phase when we *are* all in this together. together means getting a safe & free vaccine. at that point i deal with my trepidations & we all support each other.
There are many anecdotes of antivaxxers being hospitalized and then abusing staff when doctors won't prescribe them the latest "secret" cure. In order I think these have gone hydroxychloroquine, ivermectin, testosterone blockers, your own urine. At a minimum treatment should be refused if people are going to be abusive on top of making themselves more vulnerable to severe illness.
87: I don't think we officially have higher premiums, although I think there are some cash wellness incentives. And it might only amount a discounted price for a smoking cessation program.
I was thinking of saying something like 91, the problem is distinguishing this from say treating schizophrenic people. We don't want hospitals to deny treatment to belligerent unstable people in general.
More fun: there's an argument for *prioritizing* the unvaccinated in getting treatment like antivirals. They're more likely to get seriously sick, where someone who is vaxxed will probably recover. That also seems bonkers to me.
I'm just assuming I'm getting sick this month.
My wife saw her doctor back in December, they wanted to schedule a colonoscopy, which with typical scheduling would this summer sometime. The GI department never called her to schedule. When she called in last week to try to schedule it, she got some medical assistant nearly in tears, saying she couldn't schedule anything, everyone else is out, please don't call back. Which probably is about Omicron directly hitting health care workers rather than with their work being overloaded, but it was a pretty stark failure of a not-obviously-COVID-connected specialty.
It's a slippery slope from prioritizing the vaccinated to prioritizing nonsmokers, the nonobese, etc
I was nodding along to this but then I remembered that we're sized for ambient levels of smokers/obese/diabetics (more or less). It isn't a slippery slope because we aren't at capacity restrictions for these groups. Or, um, the slope returns to horizontal.
I still remember seeing the bariatric sitz bath when my dad was in the hospital.
Some people have values and priorities that aren't like ours, and to suggest that their lives deserve a lower priority than ours is Trumpism.*
*Analogies, I just can't quit you.
Cala: https://www.nbcnews.com/news/us-news/tennessee-limiting-monoclonal-antibody-treatment-unvaccinated-residents-n1279740
"Tennessee limiting monoclonal antibody treatment to unvaccinated residents"
"Extraordinary demand coupled with the federal government's need to cap shipments of these scarce drugs has forced Tennessee health officials to recommend limiting the treatment to unvaccinated patients with the worst cases of Covid-19."
That was in September.
As far as I can tell, antivaxxers tend* to be the class of people (white, entitled, loud, high-status in their communities) who get good healthcare by default, unlike so many of the classes of people who occupy the hypothetical slippery slope (those with obesity, addiction, etc). Moreover, if you specifically target people who are abusing you as in 91, you are escalating a conflict that the broader Ivermectin cavalry/hydroxychloroquine navy are very eager to keep fighting, and that will fuck up healthcare. The net effect is that horrible people get treated with kid gloves. That's why it's so fucking infuriating, even if, as many of you say and I basically agree, it's morally wrong to refuse medical care full stop. The question is whether anything can be done to limit the perverse effect of rewarding bad behavior.
* I've seen many exceptions, so have you, but on the whole...?
10: Barely-readable right-wing Twitter personality B*th*ny Sh*nd*rk M*nd*l got incensed last year when the people in her head called her "Grandma Killer" for saying we should just get over COVID, and yet today was wondering how many of the COVID victims were "well beyond life expectancy". This is because she's pro-life, I assume.
She also doesn't understand actuarial stats. Life expectancy at birth is very different from expected years of life remaining once reaching age x.
Is that actually her middle name? Is it a coincidence it contains the word "shonda"?
Maybe we can exclude people via a breathalyzer for urine.
100: For the purposes of this conversation (and despite your asterisk), many here are conflating "people who aren't vaccinated" with "anti-vaxxers." The latter group is a subset of the former. A lot of the vaccination problem is a result of a lack of socioeconomic privilege.
It's not quite a subset. The worst anti-vaxxers, like Tucker or Hawley, are vaccinated.
True enough. They still should be denied medical treatment, and if they are on fire, should not be pissed upon.
102: It's the middle name she adopted, and it's a coincidence only in the sense that the writers of "2016: The Series" and its myriad spinoffs are utter hacks.
If they aren't drinking their own urine, they aren't really anti-vax.
103: Right, I myself am talking specifically about people ideologically opposed to getting a vaccine, or inclined to believe "authorities" who are. I'm not sure this conversation would be happening if that class of people didn't exist. There would be some frustration at people who didn't get their shots for various desultory reasons taking up beds, but probably not this level of animus, right?
I'm with Mrs Ogged, because I think it is an essential professional norm for doctors to treat assholes and idiots without any moral judgment. Unless you have an absolute rule of that sort, you will end up killing people just for being obnoxious and stupid. I suspect that medicine is a profession always threatened by nihilism -- and one that needs strong taboos as a result.
There is an interesting question, though, about the level at which decisions about the allocation of resources are made. For instance, it is very clearly the case that the poorer you are, the less likely you are to be treated. This is true on a global scale; it's true in the US especially; even in the UK it's becoming truer as the NHS collapses. Yet no one person bears an individual responsibility for deciding this.
Similarly, the ambulance service is completely dysfunctional in large parts of England today (see eg today's Guardian). I do not expect, if I get a heart attack, to make it to the nearest hospital in time. This is clearly a result of a decade or more of underfunding, but who is as an individual responsible?
NICE, here, does triage by resources quite explicitly when it decides which drugs the NHS should buy and at what price. But it does not do so to named patients, only to conditions and statistical assessments of the chances of success. Who is responsible, again?
What's more, it's quite right that NICE should make these decisions. There has to be rationing on some grounds. The reason for doctors not doing it is that if they did, they would themselves be harmed, morally or if you'd prefer psychologically; not that patients would suffer, for some patients must suffer anyway.
lurid: I'd say that your description is a straightforward application of Wilhoit's Law.
So have the intake people kick them out, no doctors involved.
As far as I can tell, antivaxxers tend* to be the class of people (white, entitled, loud, high-status in their communities) who get good healthcare by default, unlike so many of the classes of people who occupy the hypothetical slippery slope (those with obesity, addiction, etc).
I think there's a pretty sizable overlap. White rural America (and semi-rural, or poor suburbs, or wherever) is hella unhealthy and strung out.
Yeah, that's more or less implicit in Talia Lavin's piece here (comments seem to be indignant visitors from reddit, IMO not worth reading), and maybe the answer is that the whole thing is shit and hangs by the thread of responsive emergency care and triage in good times as well as bad. Or that it's all complicated. I should maybe have gone with plan B and stayed offline today after my first comment got eaten.
Yeah. Herman Cain Awards isn't a healthy community but it's hard to resist.
But the whole chiding Biden for failure to reach people who are, by their own memes, clearly making choices to piss of the invisible Biden supporters in their head, seems a bit much.
||Holy shit, it looks like the Serbian government faked Djokovic's positive covid test. It was added to their database on Dec 26 with a Dec 16 date on the document. According to Der Spiegel |>
That's got to be a huge relief to the Australian government.
Wow. I'd been following out of general antipathy for Djokovic, but would not have expected that twist.
I didn't expect it in the sense that I didn't expect him to get caught.
Why "the Serbian government"? I can't get through to the article, but if there's a fake record, presumably there are a lot of functionaries who could have been bribed to add it.
It's like a first grader is writing history and instead of the Austria-Serbian war we're going to get the Australian-Serbian war.
It's a big field of battle so play close to the net.
At some point, you exhaust your appeals and a Hemsworth beats you up.
Is it medically appropriate to eat what's left of the of the pig that was used to grow your replacement heart?
I'm not a big tennis fan, but I've always disliked Djokovic just for seeming like an asshole. Validated! This is pretty funny. https://youtu.be/0v3fuG3yIAc
Oh brilliant, Der Spiegel just looked at the QR-encoded URL right there in the test result and noticed a Unix timestamp and database ID consistent with the (presumably) real date of the result, not the fake date displayed on the document. That's some sloppy-ass forgery right there, cowboys.
They still should be denied medical treatment, and if they are on fire, should not be pissed upon.
The morally appropriate response is to piss on them, but only to the extent you can do so without materially slowing the fire.
I say we use one right-wing pathology to combat another right-wing pathology. We authorize grifters to create "covid crisis centers" that offer the full-spectrum of quack cures. We use the tax money to help pay for universal health care.
Some hospitals have gone into, iirc, Critcon level 4 (where they might start triaging by resource), even if they haven't actually had to carry out formal triaging by resource.
I would be really interested to see a link on this. I am only aware of one hospital declaring CRITCON 4 last year, Darent Valley Hospital in early January, and that was an administrative error.
NICE, here, does triage by resources quite explicitly when it decides which drugs the NHS should buy and at what price.
No, it does not. That is not triage by resource. "Triage by resource" is a phrase with an actual defined meaning, you can't just use it whenever you like.
Why "the Serbian government"? I can't get through to the article, but if there's a fake record, presumably there are a lot of functionaries who could have been bribed to add it.
I don't think you'd need to bribe them tbh. Djokovic is THE GREATEST SERB ALIVE (at least now that Milosevic and Arkan have gone to their long homes), and thus, by definition, the greatest human being alive, and defending this Christ-like figure against the brutal machinations of the foreigners is the sacred duty of every Serb.
S.S.S.S., remember. Only Unity will Save the Serbs. They still have that spray-painted on about 50% of the roadsigns in Republika Srpska.
OK. If there is a precise, term-of-art meaning for "triage by resource" I will use a different phrase, like "rationing care by resource". But the underlying process is exactly the same and it seems to me that the use of technical language here is obscuring one facet of reality as much as it illuminates another one.
I agree that the difference in who makes these decisions and when is morally salient, as well as administratively so: the moral salience was the point of my comment. But they are still in an important sense the same decisions.
cosign 130 (and don't forget that it was Spiegel which broke the story -- yet another in the history of German aggressions against our sacred Serbia.
re: 129
That is the one I saw a reference to, I hadn't realised it was an error. Lots of references to other hospitals being "about to" or "in danger of" declaring Critcon 4, but I can't find any other than Darent that actually declared it. Lots of them hit Critcon 3, though.
If there is a precise, term-of-art meaning for "triage by resource" I will use a different phrase, like "rationing care by resource".
I think there is a real difference between "rationing care by resource" and what NICE does. "rationing care by resource" sounds like, and I am sure is deliberately meant to sound like, "I have only one ventilator and two patients who need it. Who gets it?"
What NICE does is not that. What it does is say "you should not spend money on treatment X because you can have more effect by spending the same money on treatment Y". That is a very different process from triage, which is explicitly deciding which of several actual patients in front of you should be treated (first, or at all).
It's all well and good to want to punish the unvaccinated by refusing treatment when there is a crisis, but you are aiming at the wrong people. The great majority of them have been brainwashed by sophisticated techniques, and they believe they have made the right choice. We do not refuse to treat morons in general, and we can't start now - it is literally a form of eugenics. It's no different than any of the other pressures we put on the individual that should rightfully be turned back onto the government (see climate change, welfare reform, other healthcare disparities, etc). This is a societal failure, and the fault lies with our leaders. Along with the complete immorality of punishing individuals who have made poor choices for any number of reasons by denying them access to medical care, I believe it would further divide the country and play into the hands of Republicans, who would then accuse us of murdering people who are simply exercising their right to bodily autonomy. And if you want to break the backs of the doctors and nurses who have managed to stick it out thus far, just ask them to do this. Moral injury is no joke, and you will put the strain on the people in the system who least deserve it.
As a transplant surgeon, I worked in the only field in the US that has an absolute limit on resources - the number of transplantable organs available. We did have to deny treatment to people either proactively by not listing them, or passively because they died before an organ was available. Those we chose not to list for transplant were only denied after extensive evaluation that took months, and many of those decisions were made based on the patient's ability to properly care for their organ based on their past behaviors - did they try to quit smoking, were they still drinking, did they miss a lot of dialysis sessions, etc. People were judged based on factors that were often related to their SES, and while we made many attempts to ameliorate these issues, the ultimate decisions often punished people unfairly in my opinion. This is one of the reasons I ultimately left the profession.
There will certainly be unvaccinated people who deserve care - how will you identify them on the fly? What if they couldn't get vaccinated because they couldn't get time off or childcare? How will you be able to determine that in the emergency room? We as a country built this system, and I think you have to let the chips fall where they may at this point. Many of the vaccinated people who are dying of heart attacks because they can't get a hospital bed in time are probably Republicans who put these assholes in office, or Democrats who didn't vote, or whatever. Ration care by chance of success, first come first serve, or whatever impartial metric you choose, but do not ask medical professionals to make judgments on the moral fitness of individuals to receive treatment.
The heart attack thing worries me, unless the super efficient pig replacement hearts are coming to all soon.
Did it used to be "Oops" not Whoops"?
125: I'm not a big tennis fan, but I've always disliked Djokovic just for seeming like an asshole.
Way back in the day he seemed like a decent enough person with his impressions of other players and the like. A refreshing addition to the Federer/Nadal duopoly. But it appears his ample inner asshole has taken over.
An inner asshole can't possibly work.
The good doctor makes an appearance!
(although was it by chance and they were looking for unfoggef.com?)
This is one of the things that keeps me from commenting, I can never remember which one is right...
Either way is fine if I can have a new hip.
I suppose I can't get that from a pig.
What NICE does is not so much "Who gets the ventilator?" as "Do we spend the money on ventilators or [handwave] an MRI machine".
For all the important differences between these cases, the ultimate effect on the bloke who doesn't get a ventilator (or the scan) as a result is the same, in a way which they, at least, will also consider important.
This is really not meant as an attack on those who are at present juggling with limited resources and managing, just, to keep all the balls in the air.
I agree with 136 overall but this
"What if they couldn't get vaccinated because they couldn't get time off or childcare?"
Is bullshit. No one is in that position. Any US adult has been entitled to a vaccine, free, since April 2021 and it is now January 2022. If you wanted a vaccine, you'd have had one by now.
I bet China knows which of its citizens deserve care.
149: they certainly know when it comes to organs.
Over the blog years, I don't remember these surprising Brit consensus topics coming up much, but recently we've learned that a Brit liberal is way more likely than their American counterpart to be kinda anti-trans, and now we learn that Brits have a definite conception of Serbs as more Nazi than not, whereas your American is going to have no idea what a Serb is.
I'm also disappointed that Nikola Jokic isn't the greatest Serb alive. He's way bigger and funnier than Djokovic. And reigning NBA MVP!
Croats are Nazis. Serbs are commie.
Nah: it was the Croats who were the Nazis. The Serbs are just old-fashioned homicidal nationalists. I spent most of my early childhood in Belgrade, AIMHMB, and we were very clear who had fought on which side in WW2.
145: I still don't think that reasoning is valid. It seems as if you are arguing that triage by resource - in the literal, awful sense of doctors looking at a patient and saying "unplug her and let her die, we need her ventilator for someone else with a better prognosis" - is awful but not anything particularly unusual, because something pretty much the same is happening all the time in every health care system in the world, simply because they all have limited resources and need to decide where to spend them; that the only difference, in fact, is the moral injury impact on the doctors.
Not a conclusion that can be supported, I think.
145: I still don't think that reasoning is valid. It seems as if you are arguing that triage by resource - in the literal, awful sense of doctors looking at a patient and saying "unplug her and let her die, we need her ventilator for someone else with a better prognosis" - is awful but not anything particularly unusual, because something pretty much the same is happening all the time in every health care system in the world, simply because they all have limited resources and need to decide where to spend them; that the only difference, in fact, is the moral injury impact on the doctors.
Not a conclusion that can be supported, I think.
Have you tried using long wait times, vindictive insurance companies, and near-random billing to decide who gets care?
The link in 153 does an interesting thing.
They still should be denied medical treatment, and if they are on fire, should not be pissed upon.
Of course not. They want to be pissed on if they have Covid.
Pissed in, not pissed on, because they're pissed off.
That is, I think close to what I am saying, although I disagree with the idea that it is happening all the time in every health care system. Where I started from was trying to tease out what the difference is.
The moral injury to doctors is something I take very seriously indeed. It's a very significant difference. What are the other ones?
Do you remember the scene in the Cruel Sea where the captain charges with his destroyer through a scatter of drowning men on his own side in pursuit of a U boat? That is presented (convincingly) as the right decision. HIs job is to kill Germans and to sink U boats, and the drowning seamen are collateral damage. But the wrenching nature of the decision is not concealed. Front line doctors have no such over-riding commitment. They are to save the lives of the people immediately in front of them.
It may well be a morally significant difference that health system administrators do have an overriding, or strategic framework to work in. NICE, for instance, works within a straightforwardly utilitarian framework. They have to find the greatest qalys (quallies?) for the greatest number. Morally and psychologically this makes an enormous difference. But the sailors still drown and the untreated still die.
I'm thinking with my mouth open here. But I still don't feel I have teased out more of a difference than the effect on those who are aware that they take the decisions.
Was not Serbian nationalism the sole cause of World War I?
I think it was German nationalism.
Have also disliked Djokovic long before I had a good reason to. Jokic is world's greatest Serb ez.
157, 162 and the others, so there is this trolley...
I thought Google could resolve this controversy, but I'm more puzzled.
https://www.cafepress.com/+the_worlds_greatest_serb_wall_clock,121524001
Do you remember the scene in the Cruel Sea where the captain charges with his destroyer through a scatter of drowning men on his own side in pursuit of a U boat? That is presented (convincingly) as the right decision. HIs job is to kill Germans and to sink U boats, and the drowning seamen are collateral damage. But the wrenching nature of the decision is not concealed.
I think I read that scene differently from you. The job of the captain was not to kill Germans and sink U-boats; he was commanding an escort vessel. His job was to protect the convoy. If the convoy gets across the ocean without seeing a single U-boat, he has been totally successful.
That's where the real conflict came from; not that he's having to kill some friendlies in order to kill some enemy, but that he's having to do exactly what the Germans are doing - kill helpless men in the water - in order to (as far as he knows) accomplish his job of keeping the rest of the convoy safe.
I disagree with the idea that it is happening all the time in every health care system.
Every healthcare system in the world operates with limited resources and has to decide where to spend them. Even in a very simple case like "where shall we put our ambulance Make Ready Centre" - if you put it in Maidstone, then people in Maidstone are going to get their ambulances faster, and people in Eastbourne are going to have to wait a little longer, and some of them are going to die as a result. If you'd put that centre in Eastbourne, some people would be alive who are now dead. Because of your decision. (And vice versa of course.) There is no health care system in the world that does not have to make these decisions all the time.
But I disagree that this is comparable to actual triage by resource.
147 - I'll concede that, although there are enough barriers so that someone who doesn't think it's that important may have not been motivated to push to get the vaccine - we should have required that people got time off, especially guaranteed time off if they got post vaccine symptoms. The calculus that poor people are forced to do when there are no job protections is very different from what we go through.
147 - I'll concede that, although there are enough barriers so that someone who doesn't think it's that important may have not been motivated to push to get the vaccine - we should have required that people got time off, especially guaranteed time off if they got post vaccine symptoms. The calculus that poor people are forced to do when there are no job protections is very different from what we go through.
As to triaging resources, it is very rare that a resource is purchased but not offered equitably. No one says we have a CT scanner but only good people can use it. As far as taking people off the vent so someone else can have it? I have heard people talk about this in the abstract, but generally care is not withdrawn from an individual unless it is deemed futile, not because someone else needs it more. I am sure there are cases on the margins where a doctor is torn between the needs of more than one patient, but overwhelmingly you stick with the patient that's in front of you.
172: absolutely agreed. It has not happened at all during the pandemic, at least not in the UK.
But, of course, the decision would rarely be as clear as that. It would be much more likely to be something like: we have 24 Level 3 ICU beds, all full. We have an admission here who needs a Level 3 ICU bed otherwise she will probably die. Now, this other patient has been in a Level 3 bed for ten days and is doing well. We were already planning to move him to a Level 1 bed tomorrow or the next day, unless his condition got unexpectedly worse. Of course ideally we would leave him where he is tonight, but... maybe he's going to be OK if we move him now?
OK, London is falling off more now than before - case rate 25% down from peak, hospitalizations 22% down. The big question that emerges for me now is where will it stabilize.
That happens all the time here, even without the pandemic, because hospitals routinely staff so close to the edge. And the doc looks at the patient in the ICU and decides if the transfer is safe. Right now we depend on the medical judgment of individuals, and until you come up with an algorithm for these decisions that is better, you have to leave it with them. This does mean that errors will be made and lives will be lost, but you need to prioritize those you are already taking care of.
Greater Boston's shit is looking cleaner.
The inside of the bowl still looks awful.
But at least you don't live in North Korea, where it appears that people are required to shit before they can shop.
The point isn't to *punish* the unvaccinated, the point is that I'd like to be able to go to the hospital for non-covid things without having everything taken up by people who chose to get severely sick to own the libs.
No one says we have a CT scanner but only good people can use it
So, I'm going to use an analogy, because I think we've veered into the "can only people we morally approve of get care?" which is not what's going here. If every day 200 people showed up to each ER with the same strange ailment, and the doctors said "take this pill and you'll be fine, but if you don't take it, you'll get really sick" and all those people said "fuck you, satan," and left, and came back in a few hours being, indeed, very sick, and needing to be admitted, I feel very confident that the response of the hospitals would not be "alas and verily have we sworn to treat with equal devotion every dumb motherfucker who staggereth through our doors...." In fact, I'm pretty sure that at lots of hospitals, the police would be involved.
"I don't want you to set my arm, I want to wait here and not get treatment until the pain gets bad enough that you have to give me the good pain medicine."
What I would want is something less like triage by resource and more like discharge against medical advice.
Does 181 work? Asking for a friend.
179 - How many of these people have you spoken to? How do you know they did this to 'own the libs'? The guy who is putting in floors for me is a good, kind, thoughtful man who gives to the poor and employs people who are down on their luck. He does not believe a vaccine that was developed this quickly could possibly be safe and doesn't think his situation is high risk. He couldn't give a fuck about owning the libs, and while the idiots you see on TV sound like that, you have no idea what is going through the majority of people's minds. I hate to say this, but there are 'good people on both sides'.
180 - Every day people show up in the ER or are hospitalized, end up leaving 'against medical advice,' and come back. We welcome them with open arms (although we say mean things behind their backs), and don't call the police. And these people haven't refused treatment in any case, they refused prophylaxis. The odds of not requiring hospitalization even if you are not vaccinated are excellent. We can't ask individuals to take on societal problems if we can't present our case successfully. We won't mandate vaccines in most cases (SCOTUS will soon drive the final nail in that coffin), multiple governors and congresspeople are encouraging anti-vax conspiracy theories, and let's not talk about the media. We as a country have failed miserably, but the answer is not to punish the victims. Since we all like analogies so much, I would suggest that many of these people are analogous to domestic violence survivors. Some of them keep going back no matter what you do, some of them have deathbed conversions, and some have a big scare and come out better in the end.
179 - How many of these people have you spoken to? How do you know they did this to 'own the libs'? The guy who is putting in floors for me is a good, kind, thoughtful man who gives to the poor and employs people who are down on their luck. He does not believe a vaccine that was developed this quickly could possibly be safe and doesn't think his situation is high risk. He couldn't give a fuck about owning the libs, and while the idiots you see on TV sound like that, you have no idea what is going through the majority of people's minds. I hate to say this, but there are 'good people on both sides'.
180 - Every day people show up in the ER or are hospitalized, end up leaving 'against medical advice,' and come back. We welcome them with open arms (although we say mean things behind their backs), and don't call the police. And these people haven't refused treatment in any case, they refused prophylaxis. The odds of not requiring hospitalization even if you are not vaccinated are excellent. We can't ask individuals to take on societal problems if we can't present our case successfully. We won't mandate vaccines in most cases (SCOTUS will soon drive the final nail in that coffin), multiple governors and congresspeople are encouraging anti-vax conspiracy theories, and let's not talk about the media. We as a country have failed miserably, but the answer is not to punish the victims. Since we all like analogies so much, I would suggest that many of these people are analogous to domestic violence survivors. Some of them keep going back no matter what you do, some of them have deathbed conversions, and some have a big scare and come out better in the end.
i only hit the button once, goddamit
So the answer is to punish everyone else?
The point isn't to *punish* the unvaccinated, the point is that I'd like to be able to go to the hospital for non-covid things without having everything taken up by people who chose to get severely sick to own the libs.
I gotta admit, they owned us good! now can they stop strangling the health care system?
188 - This isn't punishment, it is reality. We as a society allowed this to happen - we can't then pretend that picking and choosing the victims is 'fairer.' How many of the people who are going to die because they couldn't get treatment for a heart attack or stroke ate french fries last week? Are you going to ask them that? I am furious that so many people are unvaccinated and would like to punch each one of them in the nose, but you can't do it this way. I would give you a list of people I am personally willing to shoot, if I didn't think someone might find it, but they are not the poor idiots who have fell for the lies.
188 - This isn't punishment, it is reality. We as a society allowed this to happen - we can't then pretend that picking and choosing the victims is 'fairer.' How many of the people who are going to die because they couldn't get treatment for a heart attack or stroke ate french fries last week? Are you going to ask them that? I am furious that so many people are unvaccinated and would like to punch each one of them in the nose, but you can't do it this way. I would give you a list of people I am personally willing to shoot, if I didn't think someone might find it, but they are not the poor idiots who have fell for the lies.
you have no idea what is going through the majority of people's minds
Sure. I've made a similar point here a while back. And I personally know some super nice (basically uneducated) folks who won't get the vaccine. But the system also doesn't work if at some point we don't treat adults as adults, and demanding proof of vaccination to get covid care would also be a very good signaling mechanism that the medical establishment isn't fucking around and it's time to get your vaccine already.
Listen, I know this is never going to happen, and I understand and even appreciate and mostly agree with the reasons it won't happen, but I'm disturbed at how little people are grappling with the real harm the unvaxxed are causing to others. Medical orgs aren't going to fix the Fox News problem, but they do have levers they can pull. I wouldn't make doctors make these decisions; I think it's great that (most of) y'all want to treat whoever walks through the door, but I think there could be changes at the level of hospital policy that could have an effect.
My big frustration with the "what about the innocent unvaxxed?" bit is that they are literally not the problem, because the way vaccines work isn't that you need perfect compliance. If 10% of the population is just unreachable for structural reasons*, then we get herd immunity and societal disruption basically ends. But the gap between where we are and 90% consists entirely of ideological antivaxxers, and I have literally zero sympathy for those people, because they're duping themselves. They seek out dishonest news that flatters their prejudices, and they're now victimized by dishonest news--and are victimizing us all.
I'd add here that chasing down the innocent/indifferent antivaxxed, while obviously good for them, would NOT solve the societal problem--that's not what the numbers are. So the do-good notion that, instead of punishing ideologues, we need to be chasing down the indifferent is orthogonal to the actual societal impacts of having so many unvaxxed.
*intentionally vague formulation
My big frustration with the "what about the innocent unvaxxed?" bit is that they are literally not the problem, because the way vaccines work isn't that you need perfect compliance. If 10% of the population is just unreachable for structural reasons*, then we get herd immunity and societal disruption basically ends. But the gap between where we are and 90% consists entirely of ideological antivaxxers, and I have literally zero sympathy for those people, because they're duping themselves. They seek out dishonest news that flatters their prejudices, and they're now victimized by dishonest news--and are victimizing us all.
I'd add here that chasing down the innocent/indifferent antivaxxed, while obviously good for them, would NOT solve the societal problem--that's not what the numbers are. So the do-good notion that, instead of punishing ideologues, we need to be chasing down the indifferent is orthogonal to the actual societal impacts of having so many unvaxxed.
*intentionally vague formulation
Medical orgs aren't going to fix the Fox News problem, but they do have levers they can pull.
Insurance companies are the very devil, but I'd feel just fine if they refused to pay for any COVID medical services for the unvaccinated. (Yes yes, with warnings and some time to get vaxxed etc.)
Insurance companies are the very devil, but I'd feel just fine if they refused to pay for any COVID medical services for the unvaccinated.
More likely I could see them charging the unvaccinated higher rates, like they do smokers. I would be just fine with that.
This may be relevant, if it actually happened.
Ajay: oh, hm, I hadn't thought about the possibility that this writer fabricated the incident. I've read stuff by her in The Guardian a number of times, and that thought never crossed my mind.
I am fairly confident that a Guardian news story wouldn't just be fabricated. But this is a comment piece, which the Guardian doesn't generally check very hard. If it's from a regular columnist, it doesn't seem to check them at all.
And this one is particularly impossible to fact-check, because no doctor is ever going to confirm details of either patient involved, as it would be grossly unethical.
So, did any of it happen? Really? "It was in a Guardian comment piece" is basically "someone wrote it on Facebook". We can be fairly confident that the author actually is a doctor in a hospital. Other than that, who knows.
"Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death. This isn't some rando off the slushpile and I think you're out of line here.
I wouldn't trust Guardian America to know the difference between news, comment, and wishful thinking, but the Australian operation just seems worthy and boring. The woman editing it worked alongside me for a couple of months and I thought her professional and energetic as well as ambitious. And no one on the Guardian would consciously and deliberately publish lies (except perhaps the news reporters when they are quoting people).
This piece strikes me as a bit overwritten but there's nothing in it that's intrinsically unlikely. The only suspicious point is that it describes something we expect to be true.
Look. By all means raise health insurance premiums on the unvaccinated. Prevent them from buying alcohol and weed as the Quebecers are doing.
The Quebecers plan to charge them an extra fee if they are unvaccinated and wind up in the hospital. I don't know how I feel about that, because I'm not sure that it doesn't violate the Canadian health act by charging extra for services that are covered. BUT the number of people making appointments to get vaccinated went up.
202: What makes the story implausible? Isn't it basically the same situation you brought up above in 172, except rather than a doctor to another asking "I have a Covid patient who needs an ICU bed, is your patient doing well enough to free up a bed by moving to a lower level of care?" it's the first doctor "I have a Covid patient who needs an ICU bed, is your patient close enough to death to free up a bed by moving to palliative care?" In both cases it'd be unethical, I think, for the second doctor to actually make the decision on the basis of anything but the condition of her own patient, and the second question is a sadder situation than the first, but I don't see what makes asking the question either implausible or unethical.
Being in the factual situation that makes questions like that necessary certainly risks someone acting unethically, and the fact that unvaccinated people are in large part the cause of hospitals being in situations like that now is why people want to deny them care, but the situation doesn't seem implausible to me at all.
"This isn't some rando off the slushpile and I think you're out of line here."
I think the author of that piece probably received as much editorial scrutiny, and is entitled to just as much trustworthiness, as George Monbiot.
I'm not saying the piece is implausible at all; I think there's a more than 50% chance it is basically true and happened more or less as described.
Personally, the only thing I find hard to believe about it is that the cancer patient's insurance company didn't call first.
She's not some rando off the slush pile! She's a published author who's won awards!
https://www.theguardian.com/gnm-press-office/3
204: The Quebec plan lacks detail (one of many reasons for thinking it won't happen) but it doesn't look like an extra fee just on unvaxxed who seek hospital care. Instead, it looks like a fee/tax for ALL unvaxxed adults without medical exemptions.
I'm agnostic on the merits of this, but it's going to be goddamned annoying if Legault walks it back in the face of complaints that it's unfair. After all, he is the premier who banned women wearing hijabs from working in the public service.
Justice delayed is justice denied. You can see this most trivially in the LA cops who were fired for not doing their jobs in order to catch a Snorlax. It sounds inexcusable because who doesn't have a dozen of them? But if you read the story, you see it happened in 2017. Back then, it was a true rarity.
multiple governors and congresspeople are encouraging anti-vax conspiracy theories
I don't think this is a good excuse for vaccine refusers. The reason we have all these elected officials encouraging conspiracy theories is because too many voters choose to elect these types of people to public office. If you elect and re-elect officials who embrace conspiracy theories, propaganda, and general ignorance, you are not an innocent victim when those officials persuade you to do something harmful to yourself.
Likewise, the so-called "victims" of misinformation from right-wing media all have TVs or computers or phones that can be used to obtain credible factual information from real experts. Nobody is preventing them from getting real information. They are responsible for their own ignorance.
From a practical standpoint I can see why hospitals don't refuse to treat unvaccinated Covid patients. But morally, they don't deserve hospital beds when they are preventing others from getting the medical care they need.
Figure 26 on page 45 of this [404] has admission rates to ICU per 100,000 people, divided up by vaccination status. If you are vaccinated, at all, your chance of ending up in intensive care is pretty much zero.
Whoops, could someone please substitute the correct URL https://www.icnarc.org/DataServices/Attachments/Download/5d46be46-e36f-ec11-913a-00505601089b
They are responsible for their own ignorance.
I think well-meaning liberals often fail to reckon with this. They see this type of ignorance as a malfunction. Sure, sometimes the situation can be ameliorated with education, but mostly it's a choice.
I don't much use the phrase "logical fallacies" any more, because it implies some kind of error. These are quite often logic choices, and there are concrete benefits to these choices.
The only thing to get mad at is the sources of disinformation and those who benefit from its perpetuation. Those are the people to attack/neutralize/focus on.
What I mean is that we need to deny them healthcare.
Prevent [unvaccinated people] from buying alcohol and weed as the Quebecers are doing.
Okay, I kind of love that idea.
In general my sympathies are with everything Dr. Whoops is saying in the thread.
216: Yes. We covered this in 104-105.
my sympathies are with everything Dr. Whoops is saying
Yeah, I usually don't miss having a "like" button, but I appreciate the doctor's contribution and don't have anything intelligent to add.
I do wish that we could just say 'personal responsibility', because it would be very easy to sort out the deserving from the undeserving, but I really think it's bullshit. Even if you want to divide this along partisan lines and say that they voted for the people who are peddling the disinformation, so did the 60% of republicans who are vaxxed. They are getting it both ways, the benefit of the science and the ability to fuck over the poor people in their own party while telling them that they are protecting their 'freedoms'. If you want to deny care to the people who put us here, check voter registration cards, because a fully vaxed republican is just as blameworthy, if not more, than an unvaxed democrat. (not that dems don't
Responsible for their own ignorance is baloney. Even the best 'liberal' media plays the both sides game, the CDC cant get its messaging straight, and I call bullshit on anyone here who says they haven't been confused about what was the best thing to do at various points in the past 2 years. Y'all were wiping down all your groceries and leaving them outside for 2 days, some of you have probably gotten 4 or 5 shots so far, and everyone probably has different risk tolerances. There are schoolboards all over the country that refuse to implement mask mandates, and state governments that block them if they want to.
How do you teach someone to be suspicious of some institutions and trusting of others? Do you trust the CDC? Do you trust individual scientists within the CDC, but look askance at an institution that will set guidelines based on political considerations like not destroying the economy, especially when they don't clearly state that they are changing the quarantine requirements after a positive test because we simply don't have enough teachers/pilots/bus drivers to keep everything going, and you don't have to test out of quarantine because we can't seem to provide enough rapid tests, and that this decision was largely steered by private companies?
This crisis is the natural result of policies that were decades in the making. We have no respect for public education, we have clearly stated that the purpose of schools is not to teach critical thought but to produce an obedient workforce, and every time we are threatened with 'poor economic growth' we collapse like a house of cards. The only way out of this is for the federal government to mandate behaviors, and we can't do that because SCOTUS is clinically insane.
208: like I said, Guardian US.
A hospital doctor, whose place of work can easily be established, describing something that actually happened to her, is kind of different to a professional bullshit artist like Naomi Wolf.
And I would like to thank you all for letting me rant, when I realize that you are mostly being very supportive. I have trouble keeping up with the conversations here mostly because I spend most of my days outside, and my comments end up being too asynchronous to participate in a dialogue. Also, my conversational partners for the majority of the day are goats, who can be charming but don't really hone the wit. And now I am off to feed them pumpkins from the post-Thanksgiving haul.
Will that make the milk taste like 2021?
220: Yeah, this is what I mean about well-meaning liberals. I think we can agree that there is a legitimate continuum starting with genuine uncertainty (Do we need to wipe down surfaces? When should we go back to school?), moving toward ignorance that can be remedied by education (What do we do about masks?), and then ignorance as an act of will (Should we vaccinate?).
The legitimate media, so poor on so many things, has actually been really good on vaccination. Pretty much anybody who puts a kid in school -- or who has been to school -- has signed on to vaccination. The various leaders downplaying vaccination are doing so largely because of democratic pressure -- not, for the most part, because they believe in Jewish space lasers, and the space laser people were elected.
I started to understand things this way in 2016 -- when everybody knew exactly who Donald Trump was, and a significant minority voted for him for president. That was largely volition, not ignorance.
Similarly, Mitch McConnell makes occasional feints in the direction of human decency -- saying recently, for instance, that the 2020 election wasn't stolen. But he keeps being whipped back into line by his own constituents.
Liberals see this as a failure to recognize the benefits of liberalism. I think liberals overstate those benefits, and completely fail to acknowledge the very real, concrete benefits of ignorance. It's a variation on the old "What's the matter with Kansas" debate. Sure, there's a failure of communication and education, but mostly, Kansans just want different things than we do.
Dr. Whoops is correct, and the rest of you are monsters.
220: Some confusion and even distrust with regard to quarantine rules, masks, sanitizing, and such things is understandable and not blameworthy under the circumstances. But the topic at hand is refusal to be vaccinated. On that issue, all the reasonable and credible sources of information say that you should get vaccinated to protect yourself and others because the approved vaccines are safe and effective. On that issue, people's ignorance is their own fault.
And sure, by all means, direct some blame at vaccinated Republicans too -- at least those who aren't countering misinformation. But at least they deserve partial credit for not being the ones actually overcrowding the hospitals and preventing others from getting care.
Holy shit: short and brutal case for firing Biden's "COVID Czar."
ZIENTS ISN'T A PUBLIC-HEALTH EXPERT: He's a former corporate executive whose track record bolsters the worst possible impulses for a Biden appointee in command of the federal government's resources. He cut his teeth at Bain Capital, the private equity firm Barack Obama ran against in 2012, which has erased pensions and health benefits for tens of thousands over decades of leveraged buyouts. Then he made a name for himself running a pair of management consultancies, where he advised CEOs to be blunt with their employees: "The social contract is never coming back, and your employees know it."
via Twitter, which also notes that the guy's Twitter account "isn't following any public health experts. Just 17 mormon accounts/pop stars".
Lots of good accountants are Mormon.
These guys are like fucking mildew on the bathroom tiles of the Democratic party. Nothing works! They always come back!
Also, can an FPP fix the suspected indiscretion in comment 212, per request in 213?
So the Supreme Court says you can only vaccine mandate in health care places.
I have very low standards and was a little relieved.
Not even trying to pass the laugh test with their logic. "COVID isn't just a workplace hazard so OSHA can't regulate it in the workplace because that might indirectly regulate it elsewhere and Congress never said they could." As others have already pointed out, just about everything OSHA regulates could be found in places besides work- risks from fire, electrical, poison, sharp objects, things falling on you or you falling from heights. "Gravity and chemistry are not exclusively found in the workplace so the government can't regulate hazards related to them." - John Roberts. Basically this is the first step in gutting all federal regulatory agencies.
Maybe a rare bit of good news from Ohio will cheer you up -- the Ohio Supreme Court rejected the Republican redistricting map.
220: That stuff makes my blood boil. I read about and talk about it on Twitter. Not here.
233: Exactly. How. Long do we give them to dismantle the regulatory state.
relevant to the beginning of this thread is the discovery that the pig heart transplant recipient had also been a violent criminal who ruined another man's life.
aaargh i've discovered, too late, what screws my links up. Should be this.
237: I see no reason why that should have been mentioned.
Does being the first guy to get a pig heart installed seem risky enough that maybe it's not a huge privilege? At least not except retrospectively.
My feeling on the stabbing is that while the transplant people shouldn't have given it a moment's thought, there's nothing wrong with the news media bringing it up. You stab someone enough to permanently disable and probably ultimately kill them, people are going to bring it up whenever you do something newsworthy for the rest of your life, and I can't see that as an injustice.
Not a reason to deny someone any medical care at all; a perfectly good reason to write an article saying "wow, seems somehow unjust how this worked out."
Yeah, I'd go so far as to say if someone wants to write a story about the victims of the crime committed by Madeline L'Engle's correspondent, that's okay with me. But the original L'Engle story and the original pig heart story had different subject matter. Doesn't seem like a hard judgment, as far as the journalistic (or medical) ethics go.
What do we need to know about the subjects of news stories? I think this iconic example offers a situation that doesn't lend itself to easy answers.
(I first became aware of that story in the movie Absence of Malice, which I highly recommend.)
I wonder what the consent form is like for becoming a cardiac chimera.
Right, in both cases (L'Engle correspondent; Stabby McPigheart) either story is fine (in general. There may be specific considerations that affect what should be said) -- you can write about later-in-life events without mentioning prior wrongdoing, or you can bring it up. I think the error is believing that you either must always or may never address the subject of the story's full history.
If you fuck one goat, that has to be in all stories about you.
The weird thing here is that in the pig transplant story the person just isn't an important part of the story, and so writing about him at all seems weird. He's not really a public figure.
Anyway, I think the story is "doctors install pig heart in human and human does not die" as opposed to "the one guy got a new heart. "
That I was pwned isn't important either.
246: Human interest. If he were remarkably nice (spent his life rescuing kittens in his free time after being a human rights activist) it'd be perfectly normal to write a cute story about how Snugglebunny McHero had his life saved through an advance in medical science. The reverse story is just as interesting.
INDOOR kittens, I hope.
The cat people on Nextdoor are really, really into not letting cats outdoors. It's like they want the eagles to go hungry.
Plus they feel compelled to provide winter homes for feral cats. This involves old coolers and straw.
I guess some people are worried about birds that get eaten by cats. I don't hear that locally. I guess our small birds are pointless.
SP: [IANAL, no sirreee] Some here might remember the Johnson Controls lawsuit. Wherein the company banned all women who might be fertile, from employment at their battery plant, b/c a woman who became pregnant while working there might inadvertently poison her fetus, etc, etc. SCOTUS ruled that that was wrong, and the company needed to remediate their working conditions.
I don't remember all the details, but: obviously these female employees wouldn't fall pregnant during working hours (barring (well, maybe we shouldn't rule it out) workplace sexual assault or harrassment). And yet, somehow it was still within-bounds to require the company to remove this hazard.
Shocking, I know. Thank goodness we live in better, more enlightened times.