Ethics, Personal Responsibility and the Pandemic: A New Triage Paradigm

Background: How much of a role should personal responsibility play in triage criteria? Because voluntarily unvaccinated people are not fulfilling their societal obligations during a pandemic, the ethical principle of justice demands that they reap the egalitarian consequences. These consequences could include lower priority for care, an increasing number of employer and government mandates, and restrictions to entering many entertainment venues. Discussion: Voluntarily unvaccinated individuals increase the chance that the COVID-19 virus will mutate and spread, endangering the entire population, but especially those who cannot get vaccinated for medical reasons, children for whom vaccines have yet to be approved, and older adult and immunocompromised people for whom the vaccine is less effective. When voluntarily unvaccinated individuals seek medical treatment for COVID-19 (94% of patients with COVID-19 in U.S. intensive care units), they use resources needed for those with non–COVID-related illnesses. Conclusions: A method to balance resource allocation between those patients who refuse vaccination and patients who need the same health care resources is necessary. An ethical solution is to give those who are voluntarily unvaccinated a lower priority for admission and for the use of other health care resources. Current in-hospital triage models can easily be modified to accomplish this. This substantive change in practice may encourage more people to get vaccinated.