Alcoholics are put at the bottom of the list for liver transplants

[cinematicdiversions]

Why are not anti-vaxxers at the bottom of the list for oxygen?

I am not against palliative care but at this point they are a hazard to the general health and welfare of outr nation and need to be treated as such.

[mucifer]

1. People in hospice get oxygen. Although using fans and opioids can help comfort more

or as well as oxygen. Oxygen might extend someone's life a little bit on it's own.

Yeah, I'm a hospice nurse.

[MineralMan]

2. Receiving Oxygen Is Very Different from Getting a Liver Transplant

That's a poor example, really. On the other hand, heroic measures provided to COVID-19 patients come closer to a comparison. Hospitals and medical staffs are going to try to save lives. That's what they do.

The reason that liver transplants are withheld from habitual alcohol users is because they don't work very well if the patient returns to using alcohol. There's a huge undersupply of human livers to be transplanted, so there is a triage system in place to make sure that the transplants go to patients with the best chances of long-term survival.

Arguments could be made in the case of COVID infections among the unvaccinated, but not the one you suggest.

[Sympthsical]

3. When do we start rationing care for obesity?

People have known better for a long time. The overwhelming majority of people Covid hospitalizes are obese or overweight - 78% in the last study I saw.

Why should someone who doesn't care about their health take up space for care that someone who does maintain their health might need? So inconsiderate of them. 21% of our annual health care is tied up in obesity related care. Why am I paying more for other people's unhealthy choices?

By all means, go down this path.

Just know what you're saying and the standards you'd like to be part of our healthcare system.

Health care isn't a weapon, to punish those we don't like week to week. At least, it shouldn't be.

We should be caring for all people, no matter how they got there. The liver transplant question is actually pretty controversial and by no means universally accepted.

About 21,000 people die of alcohol related liver disease a year. So, it's a bit of a niche argument relative to the fact we have 46% of all Americans unvaccinated at the moment.

Man, but the inner authoritarian is just coming leaping out in all this. Big yikes from me, dawg.

[Mr.Bill]

10. Not a scientific study,

but my casual observation of the general public is that 78% of them are overweight or obese.

[kcr]

13. When obese people

are overrunning the hospitals to the point no one else can get care, we can talk.

[Sympthsical]

14. They are

Did you not see the bit about the relation between obesity and Covid hospitalization?

We'll just make a list of things people should've done, prioritize accordingly, and then let's move on down.

Unvaccinated - you lose first
Obese - you lose second
Didn't wear a mask - Ok, out you go.
Didn't socially distance - feels like we're cleaning up here.

Any other factors you can think of to bring down your rendered judgement on others, the supreme arbitration of who lives and dies according to your tastes? We're judging behaviors here. Obesity didn't fall out of the sky.

I love bringing up obesity in these things, because the people who decide they know best who lives and dies according to their moral judgements are often obese themselves. They don't want their morals and logic in thinking applied to themselves. Not at all. Just those Others over there. Not me! I'm on the good side! I get to live!

Or maybe - just maybe - we provide health care to people who need it as much as we can. Maybe put that political axe away for a day. Because tomorrow, it might end up in your own back.

[Maru Kitteh]

19. When the obese are pushing ER capacity to 230%, causing innocent kids

to suffer ruptured appendixes waiting for care because there are not enough nurses or beds to be seen.

When the obese infect social media with memes about normal BMI getting microchipped and enlist the abetment of an entire media network and about 40+% of the elected officials of one political party to repeat their paranoid lie.

When the obese attack children on the grounds of their own schools for simply caring for themselves and others.

When the obese deliberately endanger the lives of the very nurses they expect to treat them, as well as those nurses' families.

When the obese cause entire states to declare a universal DNR order because they have pushed the entire system so far beyond the breaking point we will be decades in collective recovery.

That's when.

FUCK THE UNVACCINATED. They should be LAST IN LINE for care, including oxygen, especially as our supplies become more limited.

[Hortensis]

4. As MM says. Our first move, in any case, is to increase oxygen supplies

so no one suffers unnecessarily, much less dies, for lack of it. That's our first task.

The enormous weight and complexity -- and impact on society -- of these questions are why panels of experts on medical ethics make these decisions, subject to legal standards and guidelines. Rather than polling the public to see who they think should get to have medical care today.

[MineralMan]

24. When my 96 year old father was taken to the ER with COVID

pneumonia, I got a call from the ER doctor. They had his health directive, which had him listed as DNR and no intubation. She called me to confirm. We had a conversation, and she shared his vitals. I confirmed his wishes, so they sedated him and kept the oxygen going. The next morning, I got the call that he had passed. I knew that would be the outcome, but I also knew my father would have made the same choice.

Sadly, my mother had also died that morning, about an hour earlier, from complications of Alzheimer's. A very weird day that was.

[Hortensis]

25. Remarkable day. She may have in some sense gone well before,

but they had a good life together and remind me of historians Will and Ariel Durant dying the same day. I'm not into mystic fantasizing and still wonder if there wasn't more than coincidence to it.

Past time for my husband and I to make advance directives like your father, definitely no intubation, and not a responsibility I want to place on our children even if it was obviously right.

[MineralMan]

26. Yes.

[PoindexterOglethorpe]

5. Bottom of the list for any in hospital treatment.

[Arazi]

6. You can't get on the transplant list if you're drinking

You have to be dry for 6 months before you'll get on.

Once you're listed, it doesn't matter what caused your liver failure. Your placement on the list will be "scored" using factors including your overall health and survivability. The lists are compiled by blood type and region.

The medical condition that caused the liver failure isn't a factor on how you're scored or your place

[KentuckyWoman]

7. Standard of care

Medicine is worst is first. But already we do our best to use some common sense when it comes to heroic measures to save life. I never envied the ones making those decisions but even more so now.

There aren't unlimited resources or staff. Even before all this we were having discussions about "death panels" ... because we all know a 90 yr old chain smoker with a failing heart should not be on a transplant list no matter what they think their "rights" are.

When all this started the whole point of stay home and wear masks was for the main purpose of saving the medical folks from being broken. Those days are gone. American doesn't give a shit anymore. Now it's just a litany of excuses from the "I was gonna" crowd and outright temper tantrums from the "you ain't the boss of me" crowd.

Asking people sworn to save human life to turn people away is just heartbreaking ... no matter what the reason.

[Backseat Driver]

12. In the end, LW&Ts, DNRs, Advanced Directives are the patient's choice

or, at best, those charged with the patient's medical-only POA. They decide an incapacitated patient's diagnoses made known by testing (other than the daily vitals) and/or imaging at whatever costs; the procedures done, the type of terminal care and venue; anyone else's opinion is irrelevant.

How to be kindest to those that have decided not to continue fighting or deciding the patient should/should not have a NOT TODAY! attitude to everything left behind, is my problem as a long-estranged but now reconciled sibling whose doctors told that sibling there was NO hope of any miracles: no surgery, chemo, surgical transplant nor clinical trial, that could be recommended, though that patient has not yet encountered many "uncomfortable" symptoms that point to the reaper being soon on its way. That's always tragic and sad when you know there are regrets that dreams were never fulfilled: no remembrances of travel; no bucket lists of activities, no partner chosen, no children, no home one could really be called "my place;" yet with such a drive to be so private and unknown that one refused the tools of technology to communicate with the greater world because..."I promised dad."

Yes, how to be kindest and protective of that loved one's final life choices, decisions, actions or denials...SMH with my own moral, ethical frames and judgments is sure tough, a heavy burden when considering they got a pass on their past "better angel" not showing up for me the better part of 30 years. What a thorny issue human autonomous mortality is presented; what empathy demands of love, and to whom can be!

[marble falls]

8. Great point.

[cstanleytech]

9. Giving them oxygen is fine as all you need for that is a cannula and a canister of oxygen.

The problem is that there are limited number of ventilators so the question is what should be done since they made the choice not to get vaccinated and choices come with consequences in life.

[citizen blues]

11. The willfully unvaccinated simply don't care

They don't care about their country.
They don't care about their state.
They don't care about their communities.
They don't care about their churches.
They don't care about their schools.
They don't care about friends and neighbors dying.
They don't care about family members dying.
They don't care about getting put on a ventilator.
They don't care about leaving orphans behind.
They don't even care about their own children's health.

All they care about is "owning the libs," but the only thing they're owning is the funeral industry.

When people are dying from treatable medical conditions because the hospitals are overflowing with the willfully unvaccinated, it's time for us to set some priorities.

[Hekate]

15. This is a 90% truly ugly thread

[Raine]

17. It certainly is and it's disgusting. 👎 nt

[Crunchy Frog]

23. It's a 100% ugly situation our county's stuck in right now.

[Raine]

16. It's not to punish alcoholics, it's because they're unlikely to survive

what you're advocating is punishment. 👎 What next, people who smoke, people who eat meat people who drive too fast and get in an accident, geesh!

[Ms. Toad]

18. No, they are not.

Alcoholics must generally remain sober for 6 monhs to be eligible (although there is some movement to remove even that restriction).

BUT - once eligible, their place on the list depends on how close they are to dying (largely based on their MELD score - Model for End Stage Liver Disease, and proximity to an available liver). In other words, they aren't put at the bottom of the list. Their placement is based on how long they can survive if they dont get a liver, and geography.

[ismnotwasm]

20. This is not true

I am a Transplant RN. We require 6 months of sobriety, demonstrable commitment to a healthy lifestyle, (with a psych evaluation) along with good social support.

That said, hospitals are filling with regular patients right now, covid patients are taking up a lot of resources. I’m in Seattle, so it’s not as bad as other places, but it’s still bad. We are watching Idaho, where Eastern Washington is taking overflow—except those hospitals are full.

I don’t know about parceling our oxygen, but anti-vaxxers have a lot to answer for, dying or not.

[BoycottTimHortons]

21. Here is the problem with your proposal

How do you put that into practice? As much as I agree that unvaccinated people do not deserve to be rescued from the consequences of their own actions at the expense of another patient who requires emergency care through absolutely no fault of their own, in reality how do you make that determination without being unethical or outright breaking any laws? Do you demand proof of vaccination? Do you run vaccine antibody tests before deciding to place gravely ill person on a ventilator? Doing either of these things takes time, time that is running out on a patient’s life that is hanging in the balance.


I am asking you to reconsider this stance not from a moral perspective, but a pragmatic one. If you were hospitalized for any reason, would you like it if critical care was delayed because you could not produce proof of vaccination quickly enough?

[Crunchy Frog]

22. Why aren't they at the bottom of the list for lung transplants?

[StarfishSaver]

27. The fact that a.person is an alcoholic doesn't put them at the bottom of the list

If they are alcoholics who are actively drinking, that will affect their place on the list. as others have noted, if they aren't actively drinking, they are placed on the list the same as others.

Their status as an alcoholic - and alcoholics are alcoholics whether they're drinking or not - is not the determining factor.