Clinical ethicists hold near consensus on the view that healthcare should be provided regardless of patients’ past behaviors. In classic cases, the consensus can be explained by two key rationales—a lack of acute scarcity and the intractability of the facts around those behaviors, which make discrimination on past behavior gratuitous and infeasible to do fairly. Healthcare providers have a duty to help those who can be helped. In contrast, the COVID-19 pandemic suggests the possible recurrence of a very different situation, where a foreseeable acute shortage of healthcare resources means that some cannot be helped. And that shortage is exacerbated by the discrete decision of some to decline a free, safe, and highly effective vaccine, where the facts are clear. In such a future case, if healthcare must be denied to some patients, rationers who ignore vaccination status will become complicit in externalizing the consequences of refusing vaccination onto those who did not refuse. I argue that giving the unvaccinated person healthcare resources that would have otherwise gone to other patients is to wrongfully set back the interests of, or harm, those patients. The article considers rejoinders around the voluntariness of the vaccination choice, which impinges both access and information, and how to scale this criterion proportionally with other rationing criteria that serve utility. Ultimately, the article speculates on why there will be some cognitive dissonance under this approach, while upholding a more general solidarity with and concern for all those seeking healthcare.

中文翻译：

---

危害原则对疫苗接种和医疗保健配给的看法

临床伦理学家几乎一致认为，无论患者过去的行为如何，都应提供医疗保健。在经典案例中，这种共识可以用两个关键理由来解释——缺乏严重的稀缺性和围绕这些行为的事实难以处理，这使得对过去行为的歧视变得无端且不可行。医疗保健提供者有责任帮助那些可以得到帮助的人。相比之下，COVID-19 大流行表明可能会再次出现非常不同的情况，在这种情况下，可预见的医疗资源严重短缺意味着一些人无能为力。一些人在事实清楚的情况下拒绝免费、安全和高效的疫苗，这加剧了这种短缺。在这种未来的情况下，如果必须拒绝对某些患者进行医疗保健，忽视疫苗接种状况的配给者将成为同谋，将拒绝接种疫苗的后果外化到那些没有拒绝的人身上。我认为，向未接种疫苗的人提供本来会流向其他患者的医疗资源是错误地损害了这些患者的利益或伤害了这些患者。本文考虑了围绕疫苗选择自愿性的反驳，这会影响访问和信息，以及如何将该标准与其他服务于效用的配给标准按比例缩放。最后，文章推测了为什么在这种方法下会出现一些认知失调，同时对所有寻求医疗保健的人保持更普遍的团结和关注。