Unpleasant pandemic questions: should everyone pay for the unvaccinated?

The coronavirus brings people to hospitals, livelihoods and a lot of money. This leads to difficult debates that are held at the regulars’ table or the Internet counterpart Twitter. Why should the general public pay for the treatment of the unvaccinated? And what does that mean for mandatory vaccination?

The pandemic is a matter of life and death – this is exactly the reason why everything is being done, not only in Germany, to prevent people from dying of Covid-19. In particular, the aim is to prevent the health system from becoming overloaded. So that all sick people get the best possible treatment and nobody loses their life, although it could have been saved. There is a basic consensus on this in Germany. But in the fourth wave it is put to the test: While a good two thirds of the population or around 80 percent of adults have themselves vaccinated, there is a minority who refuse to do so. And which provides the majority of those who are now in intensive care units.

Professor Mark Schweda teaches and researches ethics in medicine at the University of Oldenburg.

(Photo: Mirian Merkel / Uni Oldenburg)

Many caregivers are frustrated by this as they toil to save those who did not want to protect themselves. But not only they get angry. In other respects, too, many are annoyed that there is talk of a lockdown again, although one actually thought that the vaccination would make all of this superfluous. The more people get vaccinated, the smaller the problem. But how can you motivate the skeptical and hesitant? Free sausages and free coffee have had limited success. That would be the well-known carrot from the proverb. And then the question arises: what about the whip?

Some are now calling for this, for example the Berlin Association of Statutory Health Insurance Physicians: that those who end up unvaccinated and with Covid in the intensive care unit should pay their own treatment costs. The prospect of having to pay thousands of euros out of pocket should be motivation enough to get the injection. What might intuitively seem a good idea to some, would, however, be a serious step, as the Oldenburg professor and medical ethicist Mark Schweda says in an interview with ntv.de. Because where does that lead? It would not necessarily be enough to share the costs. “It is sometimes even requested that people who have not been vaccinated voluntarily should be deferred if they need a ventilator as a result of Covid 19 disease. This would make it more difficult for them to have access to life-saving medical care. I consider that to be unacceptable.”

It’s about a fundamental right

The question is where to start and where to stop. Because once you start to make the medical treatment dependent on the previous behavior, further questions arise. “What about the smokers and the overweight? What about the reckless drivers or the fans of risk sports?” Asks Schweda. “I find it difficult to open this discussion and say: Your access to health care or the level of your costs depends on how you have acted and how much you have contributed to your health.”

On the other hand, it is not true that health insurance companies pay for every medical treatment. This applies to follow-up costs for certain aesthetic measures or if a navel piercing becomes infected. At this point, the solidarity of the insured has a limit. Solidarity is not the only factor, according to Schweda. “The right to be supported in maintaining and restoring one’s own health is even more fundamental. We cannot just make that dependent on solidarity, which may be stronger or weaker, but that is, I would say , a fundamental right of everyone to adequate health care. Regardless of whether we now feel solidarity with the people – or they are with us. ”

But if health is a basic right, then the sick are to be treated as best as possible – period. Then it doesn’t matter whether you showed solidarity yourself or not. This also avoids the difficult to solve question of what appropriate behavior would have been before you fell ill. When it comes to the question “vaccination – yes or no”, it may still look simple. But from how many cigarettes, how many beers and how many steaks do you feel disaffected? There would have to be a kind of tribunal about one’s own way of life that would decide on treatment. Did you want to expose yourself to it? There is still the freedom to live the way you want, even if it doesn’t always end in the best of health.

Moral Responsibility to Vaccination

Nonetheless, Schweda also sees a moral obligation to get vaccinated. “It’s not just about being smart enough to protect yourself. It’s also about protecting others from infection. Ultimately, it is also about the common good, for example about such far-reaching restrictions on public life as it might be necessary again in winter to avoid it. Therefore I assume that there is a moral responsibility to get vaccinated. ”

However, Schweda does not advocate a general compulsory vaccination: “A moral responsibility does not automatically result in a legal obligation. We live in a liberal, democratic constitutional state and fortunately it does not impose on us to constantly act morally.” He also fears that compulsory vaccination will tend to harden the fronts and the willingness to vaccinate will decrease. He also believes that vaccinations can be advertised much more intensely – as in the 80s and 90s, when AIDS-awareness posters were everywhere and TV and radio spots were running. And: “First of all, suitable infrastructures should be provided so that the – by the way, very large – majority of those who get vaccinated wantto get vaccinated too can. “

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