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Comment by mlyle | Hacker News Reader

> This is so simple and newspapers trying to make it into a matter for debate is actually compromising that.

Even if one were to consider moral character when allocating organs in general: the researchers needed someone who was sick and likely to die, ineligible for human organ transplant (here, because of severity of condition), and not so sick that there was no chance of success or useful data.

So, we're already picking someone who doesn't meet the normal rules.

And, of course, considering moral character when allocating organs probably isn't a great idea.

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Yeah, the Post complaint (echoed elsewhere) is basically a call for having a social credit score that can say “you’re not a good person, so we’re not going to let the doctors save you.”

There was an episode of Star Trek Voyager that had this system in place, ep 7x5 Critical Care

Naturally it was corrupt

We already have that laundered through something else. Like if you’re a drinker you won’t get a liver.

That's not a moral judgment: that's a judgment about whether you're likely to not wreck the new organ and have a good outcome.

That's a common rationalization for the moral judgment, but without evidence. "Recent studies have shown similar survival rates among individuals who undergo LT [liver transplant] for ALD [alcoholic liver disease] and those who undergo LT for other chronic causes of end-stage liver disease." [1]

[1] https://pubmed.ncbi.nlm.nih.gov/30018475/

As your link says, there's an association between sobriety and liver transplant outcome.

As your link also says, in most areas, you can receive a liver for ALD; there's just a 6 month sobriety rule.

So we know:

- 6 months of sobriety increase odds of ongoing subsequent sobriety

- Sobriety improves LT transplant outcomes.

Many believe, without strong numerical evidence either way:

- 6 months of sobriety before procedure improves outcome of LT transplantation.

Fewer believe:

- A 6 month sobriety requirement is an unnecessary impediment to transplantation.

Your paper says:

"An interval of sobriety prior to LT is very desirable from a medical point of view. Abstinence may markedly improve liver function"

i.e. in many cases, if people could stop drinking, they might not even need the liver!

That is not a universal statement[0]. They may get lower priority in many cases, but MELD[1] or a similar model is used to determine who gets priority for liver transplant.

[0] https://www.hopkinsmedicine.org/news/articles/destigmatizing...

[1] https://en.wikipedia.org/wiki/Model_for_End-Stage_Liver_Dise...

...and the next step would be "we're not going to treat you for Covid because you're not vaccinated".

This is not same.

The non vaccinated are actively choosing to be a danger to people around them.

It is like actively carrying concealed unlicensed gun which can silently and anynomously fire at people.

I'm vaccinated myself and basically I have the same opinion as you. But David Bennett also actively chose to stab someone seven times in 1988 - "only" leaving him paralyzed, but probably with the intent to kill him? Ok, he probably served time for that and it was a long time ago, so judicially you can consider him rehabilitated. My argument was that once you refuse to treat (former) criminals, that's a slippery slope. And apparently I was right, since some here seem to consider people who choose not to get vaccinated worse that violent criminals...

Worse? No. The unvaccinated are far more likely to get sick or die as a part of any medical procedure right now just because of the base risk of COVID in hospitals. If you can’t take the first step to protect yourself and others, there’s not much health care providers can do to change your mind.

I think you're confused on what the word 'actively' means.

'Actively' seems to be accurate for the scenario when one is choosing to make body conducive to incubate virus, or already incubating them (albeit unknowingly if asymptomatic).

[Edit] And if you meant active in context of 'Active shooter', then still use of the word active is not wrong. Virus laden body is like carrying a concealed gun which is on 'auto pilot', it is actively spraying bullets; it IS active all the while.

I can't think of a single person I know that hasn't ducked down to the shops to pick something up when they have the flu. By your definition, they are actively attempting to cause harm to others - which is an interesting take.

Even before covid, I would always wear a mask if I had a flu and would try as much as possible not to go to shops or pick up anything. A lot of people I know do the same.

I haven’t “ducked down to the shops” when I’m ill. It’s not that hard to keep necessities around.

> This is not same.

> The non vaccinated are actively choosing to be a danger to people around them.

> It is like actively carrying concealed unlicensed gun which can silently and anynomously fire at people.

What about giving a life extension to someone who stabs other people?

The recipient of the heart transplant, David Bennett, actively chose to be a danger to people around him.

Yes. Why not stick to that topic. Why to conflate by bringing in vaccine one?

That's different because there's no moral judgement in that position. If you refuse treatment for a condition, even a preventative one, then there's no moral imperative to offer a different treatment later. Doctors did their best to save you, but you didn't do your part. That's on you.

I couldn’t disagree more. Everyone deserves the same level of care.

Everyone deserves care. It’s unpleasant to think about giving emergency care to people who actively refuse preventative treatments at the cost of canceled appointments and surgeries for non-COVID patients. Triaging really sucks.

They're getting it. Everyone is offered the vaccine. If people choose not to accept that care then what happens afterwards has to be assessed and prioritized on a case by case basis. If there's an ICU bed and two patients, one who's a Covid patient who refused to protect themselves and the other someone who has something not preventable, the second one should get priority.

Ideally there would be two beds, and everyone would get the care they need, but reality means choices have to be made. Refusing a vaccine should send you to the back of the queue.

Absolutely not, that's not how it works.

You won't be denied tramua treatment for a gunshot because your doc told you to stop playing with guns.

You won't be refused heart medicine because you didn't stop eating bacon when your doctor told you to 5 years earlier.

You won't be denied ER treatment because you were drunk when you crashed your car.

There is no rule where we have to treat all patients equally (including mass murderers) except those who didn't accept n earlier-offered treatment or who did something that caused their own medical condition (i.e which probably includes most medical conditions).

Medical care is not an exploding offer.

Honestly - shame on you for trying to sneak in an absurd exception just so you can abuse the medical system to hurt people you don't like. That's not what hospitals are for.

I think if we really ran out of health care capacity, it might make sense to prioritize people who took preventative measures over those who didn't.

Especially with COVID: if you're at the point of triage and rationing resources, you need to consider likely outcomes, and people with the vaccine presenting at hospital are more likely to survive than those presenting without.

It seems like we're not going to bump into those limits, though, so it's moot.

> people with the vaccine presenting at hospital are more likely to survive than those presenting without

In my opinion, that logic is flawed.

The currently available COVID-19 vaccines vastly reduce the likelihood of developing severe symptoms from a SARS‑CoV‑2 infection. They also somewhat reduce the risk of getting infected in the first place.

So, getting vaccinated against COVID-19 makes you far less likely to need to be hospitalized, should you contract the virus, which apart from of course being beneficial to yourself also helps with keeping the healthcare system from being overwhelmed.

However, if you've already been hospitalized, it is because you've developed severe symptoms, which in turn means that, in that situation, for you, the vaccine has failed.

At that point, all other factors being equal, your likely outcome is no different from that of a person who hasn't been vaccinated. Therefore, using vaccination as a criterion for triage (which - like you said - is all about rationing resources, not passing judgement) doesn't make sense.

Now, it could very well be possible that being vaccinated improves your outcome even once you've already developed symptoms sufficiently severe to require hospitalization. However, I'm not sure there's conclusive evidence suggesting that is indeed the case.

> Now, it could very well be possible that being vaccinated improves your outcome even once you've already developed symptoms sufficiently severe to require hospitalization. However, I'm not sure there's conclusive evidence suggesting that is indeed the case.

Current data seems to show that fully vaccinated people who require hospitalization have hospital stays that are 33% shorter and are also about 33% less likely to die (despite having more comorbidities on average than unvaccinated hospitalizations).

So, if you have one bed left, and can put either an unvaccinated or vaccinated person in it-- all else being equal-- the vaccinated person is less likely to die with hospital care, and is more likely to free up the bed for someone else soon.

(We don't know, though, if you deny hospital care to both what the death rate for each would be-- here's where you have to guess. If you assume both die without hospital care, then you should give the bed to the vaccinated patient).

It seems like we're not going to bump into those limits, though, so it's moot.

Only because people who got the vaccine are significantly less likely to require hospitalization though. At the start of the pandemic there was a very real possibility that we'd actually run out of ICU beds and ventilators. Much of the 'flatten the curve' effort was to protect healthcare services.

If a collapsed lung from a gunshot wound was contagious you sure would.

If having your head split open in a DWI accident was contagious you would.

Like 99% of the arguments against vaccination this isn't nearly as pithy as you think.

After seeing what going through the initial wave of COVID in a medical provider in the ER did to my mother I could not care less about how many loopholes in efficacy people want to tout.

Vaccines help reduce severity in some capacity. If you can be vaccinated (and not everyone can), and you chose not to because you know better, ask your YouTube doctor of choice to patch you up.

Honestly - shame on you for treating self-preservation as some sort of moral judgement against people someone doesn't like. People don't like to risk their lives for people who won't help themselves.

> People don't like to risk their lives for people who won't help themselves.

That's an entirely reasonable position that I can understand - my advice to those people would be to avoid careers in which they are required to risk their lives for people who won't help themselves.

There's a good reason I'm not a police officer, doctor, fireman, etc. The risk/reward payoff in those careers is far, far too low.

What on earth are you blathering about?

Comparing armed police sent in to deal with possibly armed suspects... firefighters who get sent into infernos... with doctors.

The risks doctors normally face from one patient to another are identical, so it was nonsensical to say they were risking their life for a specific patient. Especially since we've known how to protect from _normal_ bloodborne and airborne pathogens for a long time. The difference is COVID had no vaccine and treatment was limited at the time, it was repeatedly a death sentence.

That's why COVID already forced a rethinking of how far we expect providers to go to save someone: https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006...

There's a good reason you're not a doctor, let's leave it at that.

You seem to have very strong views on this and I don't but as a natural follow up from your arguments, how do you propose we deal with the obesity crisis under the lens of people who don't self preservate and have all sorts of cardiovascular issues and bring healthcare costs to unbearable highs for everyone else?

To be clear my position is that you should treat everyone, fatties, smokers, antivax, whatever, merely because I don't know when I'm going to find myself in one of the "wrong" groups and I'd like to get treatment then, so I think they should get it too.

The data I saw suggested these people are actually significantly cheaper in total for society since they die so much earlier. YMMV depending on the details of your social system of course.

This is not that complicated:

Is a heart attack going to infect your provider?

Is neck cancer going to infect your provider?

We have a vaccine that significantly reduces the odds of putting our healthcare providers at risk and becoming part of the group of people crippling our ability to provide emergency medical care... if you don't take it not because you're ineligible, but because you've decided you know better, you should not be a priority.

And really this is already how it works. When ICUs get overwhelmed, people with COVID who code might not get resuscitated.

The massively increased risk to the provider combined with the chances of recovery mean you will just die:

https://www.cdha.nshealth.ca/system/files/sites/documents/co...

And I guess saying I have strong feelings supposed to be some backhanded ad hominem? I mean clearly you have strong feelings as well, writing tirades about the "fatties", the difference between us is what I write is based on reality

I understand your point about infectiousness I think it's good and I agree.

My comment was as a follow up to your statement: "Vaccines help reduce severity in some capacity", there's a lot of behaviors that reduce severity in some capacity, and doing those would translate in lots of time savings and less pressure on the healthcare system in the same way as the vaccines do, the vaccines just have the extra "bonus" of being able to infect healthcare workers, so their negative effects compound. But if your argument is about first principles, any sort of self preservation has the same problem. So I was just commenting on that.

You're right the bit about feeling strongly was probably a subconscious dig, sorry about that, but I was amused at the "shame on you" and had a moment of weakness, my bad.

Also I didn't intend much with the fatties, I find it eandearing and have been a fatty myself at times in my life and have many I like, if that offended I'm sorry and I wish I hadn't used the term, but that's life and these are just internet comments.

Your examples are not the same, you're presenting cause and treatment. The parent comment discussed one treatment over another: refusing preventive treatment over curative treament.

Problem is that there is not enough capacity for curative treatment only. In this case it would make sense to allocate some hospital capacity for people without vaccination, and more capacity for people that have been vaccinated (maybe in the same ratios as population vaccination).

And also allocate some hospital capacity for people with other diseases so they're not impacted by the fact that some people refuse vaccination.

You won't be refused heart medicine because you didn't stop eating bacon when your doctor told you to 5 years earlier.

Yes, you would. Doctors refuse to give people treatment until they've lowered their weight, reduce their cholesterol, given up smoking or drinking, or increased their level of exercise all the time.

There is no point giving someone life-saving medical treatment if it isn't going to work because of some other factor. That's a waste of time and money. In every case the patient has to show that they're willing to do their part. Medicine is not just popping a few pills or turning up for surgery. There's effort required in order to get better.

In the case of Covid, having the vaccine is part of that effort. Someone who hasn't tried to improve their long-term health by, for example, giving up smoking, and someone who hasn't tried to improve their long-term health by having the Covid vaccine are basically the same - they're both putting their health at risk unnecessarily. Doctors should consider that when they're prioritizing treatment.

I’m all for providing telemedicine to those who choose not to be vaccinated against COVID (compared to those who medically can it be vaccinated). But letting them into health care facilities? Nah, get your shots and come back.

It probably happens more than you think. Organs are doled out based on a rating system as evaluated by a small review board

In the case of ties, the question of who “deserves” the organ is relevant to the board members. Uncomfortable but true.

Also doesn’t really apply here as this guy had a last ditch experimental operation. The family in the article just wanted revenge.

The organ board base their decision on likelihood that the receiver will benefit from the transplant (for a long time), so some habits that are medically relevant are taken into account: smoking, drinking, taking drugs, and when AIDS was a concern, having sex with people who might transmit it. All those also come a moral judgement so many people assumed that the board was making a moral judgement. They are not: having other conditions complicating the process is relevant; being old too. Being a crimimal is morally relevant but doesn’t come into the judgement of the board.

For lack of a better word, they are maximising the duration of the organ.

Yes, most of the time that’s true, and just about everything you mentioned can be boiled down to a single number.

Genuine ties do happen though, and at the end of the day the board is human.

Considering a person's criminal record is not the same as considering their moral character.

>Considering a person's criminal record is not the same as considering their moral character.

Although some might argue that there was a certain correlation between the two.

https://www.nbcnews.com/news/crime-courts/anthony-stokes-tee...

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