Should anti-maskers forfeit COVID-19 medical care?
This past weekend, hundreds of Albertans rallied against masking orders, demonstrators gathered outside a house in Montreal’s posh Westmount neighbourhood they thought, mistakenly, belonged to Quebec’s premier, while in Ontario, police and bylaw officers saw to an illegal, 60-person party at a Mississauga Airbnb. Some guests fled as police arrived, 27 others were slapped with $880 fines, and the hosts issued summons carrying minimum $10,000 fines.
“These antics,” tweeted Peel deputy police chief Marc Andrews, “help no one.”
Given all that, some ethicists have argued that people who flout or publicly protest pandemic public health measures should willingly forfeit medical care in favour of those who play by the rules, should hospital resources become strained. An average of 2,111 people with COVID-19 were being treated in Canadian hospitals each day during the past week.
“We’re not saying don’t treat,” Arthur Caplan, founder of the division of medical ethics at NYU School of Medicine said Monday. “We’re saying, if you’re going to run around and claim exemption to endorsed and established behavioural policy, you should volunteer, if you get sick, to go to the end of the line.”
Others contend that a person’s political ideals should have no bearing on who should get care ahead of others.
In an opinion piece published earlier this year, an opinion he still holds, Caplan, along with his co-authors, argued that while most people are diligently and heroically adhering to public health asks, thousands of others haven’t fully grasped the gravity of the situation, or believe the economic consequences of stay-at-home orders disproportionately outweigh the health benefits.
In Canada, demonstrators have argued that appeals and orders to mask or limit social gatherings violate their Charter rights, including freedom of peaceful assembly and freedom of association.
But Caplan said there are no free-for-alls in a “plague,” and that a threat to others justifies limitations on individual civil liberties. “Doctors have
a long-standing obligation to treat everyone, regardless of sin,” Caplan said. “We have an ethic of trying to treat all comers in medicine, and that’s good.” However, should people willfully engage in behaviours known to potentially harm others, “then if you get sick, I think you have an obligation to think about saying, ‘let others go before me, because I wasn’t responsible,” he said. “If you are a real believer in liberty, then you have to say, ‘I’ll pay the price.’”
Health care isn’t rationed for people who smoke cigarettes, but smoking is a selfharm behaviour, Caplan said. “It generally hurts you, but not others. If you’re obese, generally it’s harming yourself. If you are not controlling your blood pressure, same thing.” The scarcity of donor organs sometimes requires giving lower priority to people unable to control harm to themselves, he said.
“If you were just running around hugging yourself and you made yourself sick, OK. But if you run around not wearing a mask and hugging other people, or assaulting people by going mask-less and standing close, then you’re really harming others.”
At a minimum, protesters should sign a pledge stating that they are willing to forgo medical care should emergency rooms or intensive care units become saturated — in the name of their political beliefs, Caplan and his co-authors wrote. “Patrick Henry’s famous proclamation, carried by many protestors, is ‘give me liberty or give me death,’ not ‘give me liberty and, if that doesn’t work out so well, give me a scarce ventilator.’”
Vaccines are a different matter, Caplan said, “because if you get vaccinated, you may stop infecting other people.”
“I think the thing that motivates people to not wear a mask, to go where they want to go, oddly enough that’s what a vaccine will let them do,” Caplan said. While some have mused that pandemic protesters might be more likely to reject vaccines, “I think it’s more consistent with what the anti-mask, anti-social distancing, antiquarantine crowd wants,” Caplan said — “as soon as they understand they can get on a plane or go on a cruise if they get vaccinated, I think they’ll shift their attitudes.”
While he has a great amount of respect for Caplan, McGill University’s Daniel Weinstock couldn’t disagree more with the assertion protesters should forfeit their right to care before others.
A basic principle in medical ethics, particularly in a country like Canada, is that “you get medical care, if and when you need it, and need is really the only criterion that we should use,” said Weinstock, a professor of law and the Katherine A. Pearson chair in civil society and public policy.
There absolutely should be sanctions visited upon people who break laws, Weinstock said, including criminal sanctions for criminal acts. A 30-year-old man was charged with assault last week after an employee at a Dawson Creek, B.C. Walmart was attacked and repeatedly punched after he requested that a shopper wear a mask. Masks are required by B.C. government order, and are mandatory in all Walmart stores across the country. “Certainly, that assault on the Walmart employee would seem to qualify, but that doesn’t disqualify them from receiving care,” Weinstock said.
“I think everybody is kind of operating at a level of anxiety and fear that has polarized societies,” Weinstock said, but someone has to be the adult in the room. “Even though it might be tempting when seeing people flouting common sense public health directives to say, ‘you guys, back of the line’ … I think it really behooves the medical establishment to look beyond the crisis,” he said.
“We’re all going to have to live in society together and avoid any acts that may exacerbate polarizations or fractures in society.”
It’s also a principle of biomedical ethics that people have full information, but the pandemic has seen an unprecedented glut of misinformation and disinformation, “and I don’t think the consequences of that should be laid” at the feet of protestors, Weinstock said.
In exceptional times, people can become locked into messages thrown at them from all corners, but offer a way of rationalizing their denial, Weinstein said. “I don’t think we want to make matters worse by making them pay the price for what is a much broader set of problems.”