Judge’s order requiring hospital to give COVID patient ivermectin called “unethical”

“If I were these doctors, I simply wouldn’t do it.”

Read the whole story

 

[Kesh]

IANAL, but I'm curious how the case played out. The judge's order is basically that the hospital has to follow the prescription by Wagshull, but no details on what the defense said. The linked Ohio Capital Journal also raises the question of why the hospital didn't object using conscience protection laws on the grounds of the medical staff viewing the treatment as "unethical," which is how I ultimately see it resulting. I'm assuming the details are vague because of it's breaking news nature and the fact that it involves health care.

I'd say the hospital hasn't responded because they're going to let their legal department craft an appeal. And that appeal will likely be "this quack hasn't got privileges at our hospital, you can't force us to accept legal liability for an outside doctor's orders." Which will likely succeed, because what the fuck was this judge thinking?

 

[Kesh]

I thought about this... If I and my wife were in the situation. She would want to help me, any way she can. I wouldn't want Ivermectin, and I wouldn't want her to pay any money to scammers. On the other hand, I would want her to know that she's done to help me.

So if she asks the hospital to treat me with Ivermectin, the best outcome would be that they tell her they are doing it, but not give me anything. It makes her happier, it doesn't hurt me, and it doesn't cost any money.

That would be completely unethical, and if it came to light risks the doctors getting their license revoked & the hospital getting sued. You do not get to lie to the patient and/or their decision maker about the treatment being given. Flat out.

 

[Kesh]

People, even scientists, go absolutely nuts when talking about drugs. How is it ok to consume dangerous drugs like alcohol and tobacco, but forbidden to take ivermectin? There are absolutely no studies that prove ivermectin does or does not work. Why is it your decision, that of the fda or anyone else to dictate whether this drug can be given? Sorry folks, but the fda has gotten it wrong many many times. Need I cite the opioid epidemic and the massive over-prescribing of narcotics in very recent times? It should be my decision, and mine alone, to decide what drugs I take in extremis. Although I concede ivermection is unproven, does that mean I should be forbidden to take it if there is any chance whatsoever that it might help?

There is no evidence ivermectin can help. Doctors aren't going to give you every random medicine you request just because you're desperate.

More to the point, this doctor is prescribing insane amounts of ivermectin, well beyond the accepted safe dosage.

 

[Kesh]

Tell me you know nothing about medicine without telling me you know nothing about medicine.0000000

Ivermectin is used to treat roundworm and river blindness (which is caused by a parasitic worm).

Yes. And so what? That doesn't mean it can just be lumped in as a "de-wormer" such that it has all the same side effects as any other de-wormer. Or do you not understand that about how drugs work?

It can have a of gastrointestinal side-effects (and other side effects as well), and certainly will at the ridiculous dosage that was prescribed. Do you even know anything about it?

It has nowhere near the side effects that you seem to be ascribing to it, and I've repeatedly pointed out that sure at 50x the dose it is certainly hazardous, but have pushed back against claims that somehow ivermectin is any kind of problem at its clinically indicated doses.

And yes, drug side effects CAN kill very sick patients or make their conditions worse. This is why sometimes it is better to do nothing than to toss on another drug.

Are you suggesting that because I've claimed ivermectin is a safe drug at indicated doses -- even for someone already sick with something else -- that I don't understand that some drugs can kill very sick patients or make their conditions worse? Or are you simply trying to claim that all drugs will kill very sick patients or make their conditions worse? Because I've said nothing to indicate the former and the latter would just be a ridiculous claim.

So now that you've successfully argued that some drugs are bad when you're already sick and that ivermectin is indeed used as a de-wormer, do you have anything to say in response to something I actually wrote?

(And as far as knowing nothing about medicine, I believe you're the one who claimed ivermectin has bad GI side effects by comparing it broadly to other de-wormers. De-wormers have a broad range of side effects. Some pretty harsh, some rarely resulting in any side effects. Guess which part of that range ivermectin falls in.)

I was basing it on looking up the side-effects:
https://www.rxlist.com/stromectol-side- ... center.htm

Apparently, you didn't do that. Just like you said it wasn't a dewormer and now have to admit that it is. Well, I guess now you'll admit it has gastrointestinal side effects too and then spin that.

No. I did look up the side effects. Only in a database that doesn’t just list them in one list, but also by prevalence and when used for which indication. Ivermectin only lists GI side effects when actually used with patients with GI worms, and even then only as “less common”. Since we’re not talking about a patient with GI worms, GI side effects would not be expected. I’m sorry, is it “spin” to exclude side effects that wouldn’t be expected in the patient population under discussion?

Congratulations, you just showed you have no idea what you're talking about.

The indication means "what we're treating them for." It does not mean "if they don't have that, they won't have the side effect." That's all you making up bullshit.

 

[Kesh]

Unless this ICU patient was vaccinated, the correct course of treatment is to send the patient home to die and free up an ICU bed for someone who truly deserves medical attention.

This is such a horrible take, I hate that it keeps coming up.

Even if they're someone who refused the vaccine out of ignorance, it's not ethical to just say "sorry, you get to die."

 

[Kesh]

Unless this ICU patient was vaccinated, the correct course of treatment is to send the patient home to die and free up an ICU bed for someone who truly deserves medical attention.

This is such a horrible take, I hate that it keeps coming up.

Even if they're someone who refused the vaccine out of ignorance, it's not ethical to just say "sorry, you get to die."

Is it ethical to turn away another patient who needs the ICU bed due to something that wasn't caused by their own stupidity?

For one thing, it's not as simple as you're making it. People are winding up in the hospital for other things and then testing positive for COVID. What do you do, kick them out of the ICU with a "sorry, we need the room for someone else"?

 

[Kesh]

Unless this ICU patient was vaccinated, the correct course of treatment is to send the patient home to die and free up an ICU bed for someone who truly deserves medical attention.

This is such a horrible take, I hate that it keeps coming up.

Even if they're someone who refused the vaccine out of ignorance, it's not ethical to just say "sorry, you get to die."

This depends.

In normal circumstances? You're absolutely right.

But in situations where medical beds are scare, which to be honest I don't think is the case here, there is solid reasoning to ration beds and deprioritize the unvaccinated.

Not to refuse treatment, but if there is an ICU waiting list/oxygen shortage/etc then prioritize those you can actually save with the resources available.

Consider that the person in this article has been hospitalized since July 15th. That's going on 45 days.

There are areas of the country right now where that hospital stay could have costs the lives of many simply by taking a needed bed.

Triage means you will condemn some to die, so that others may live.

Triage happens before they get assigned to a room. Once they're in there, you have to make the best, most ethical course of treatment for that patient. Throwing them out onto the street with "well, it's your fault for not getting vaccinated" is unethical.

 

[Kesh]

Unless this ICU patient was vaccinated, the correct course of treatment is to send the patient home to die and free up an ICU bed for someone who truly deserves medical attention.

This is such a horrible take, I hate that it keeps coming up.

Even if they're someone who refused the vaccine out of ignorance, it's not ethical to just say "sorry, you get to die."

This depends.

In normal circumstances? You're absolutely right.

But in situations where medical beds are scare, which to be honest I don't think is the case here, there is solid reasoning to ration beds and deprioritize the unvaccinated.

Not to refuse treatment, but if there is an ICU waiting list/oxygen shortage/etc then prioritize those you can actually save with the resources available.

Consider that the person in this article has been hospitalized since July 15th. That's going on 45 days.

There are areas of the country right now where that hospital stay could have costs the lives of many simply by taking a needed bed.

Triage means you will condemn some to die, so that others may live.

Triage happens before they get assigned to a room. Once they're in there, you have to make the best, most ethical course of treatment for that patient. Throwing them out onto the street with "well, it's your fault for not getting vaccinated" is unethical.

Not the argument being made.

Respond seriously or be disregarded.

I was responding seriously, directly to the statement being made. If you meant something else, feel free to clarify.

 

[Kesh]

Not the argument being made.

Respond seriously or be disregarded.

I was responding seriously, directly to the statement being made. If you meant something else, feel free to clarify.

You completely mischaracterized the statement in a way I can only take as bad faith or a lack of comprehension on your part.

Re-read, reply without disingenuousness and we can continue.

I mischaracterized nothing. We were discussing patients already admitted to the hospital, and you come up with "triage" as an excuse for condemning individuals to die. I corrected you. And now you're upset because you can't rely on your misuse of terminology to win an argument.

There was nothing disingenuous on my part, you were just flat wrong and now are doubling-down on it. Don't worry, I'll just block you so we don't have to annoy anyone else with this.

 

[Kesh]

Unless this ICU patient was vaccinated, the correct course of treatment is to send the patient home to die and free up an ICU bed for someone who truly deserves medical attention.

This is such a horrible take, I hate that it keeps coming up.

Even if they're someone who refused the vaccine out of ignorance, it's not ethical to just say "sorry, you get to die."

And so does the vaccinated patient who presents with another serious condition who can't get a ICU bed bed because this clown is in the one he needs?

That's the case if the ICU is full anyway. You don't get to say "Well, this person was stupid, so we'll pull the tube and let them die" in order to make room for someone you feel was smarter. That's not how medicine works.

Look, it pisses me off that we've got COVID anti-vaxxers taking up hospital beds on my floor. I utterly hate it. But that doesn't excuse people calling for them to just be killed to make room. They're still human beings, for fuck's sake.

 

[Kesh]

Unless this ICU patient was vaccinated, the correct course of treatment is to send the patient home to die and free up an ICU bed for someone who truly deserves medical attention.

This is such a horrible take, I hate that it keeps coming up.

Even if they're someone who refused the vaccine out of ignorance, it's not ethical to just say "sorry, you get to die."

And so does the vaccinated patient who presents with another serious condition who can't get a ICU [bed] because this clown is in the one he needs?

That's the case if the ICU is full anyway. You don't get to say "Well, this person was stupid, so we'll pull the tube and let them die" in order to make room for someone you feel was smarter. That's not how medicine works.

So I take it you missed "...free up an ICU bed for someone who truly deserves medical attention" in mikebikeswa's post? If the hospital isn't at capacity, i.e. full, there's no need to free up a bed.

I didn't miss it. It's a terrible argument, because you're not basing the decision on medical necessity, you're basing it on who "truly deserves" treatment, ie. "Who do I feel morally is a better person?" Which is just plain unethical.

Also, there's a valid medical reason to deny care to the unvaccinated over a vaccinated person, since the unvaccinated are more likely to die.

That's not how doctors make that decision. You're basically calling for a blanket "sucks to be you" rule where people get kicked out of the hospital for making a bad choice, rather than based on medical necessity.

I get it. It sucks that people are having their medical care delayed because of these idiots. That doesn't suddenly change the fact that doctors have to treat people as people, and not decide "Well, I don't like you, so you get to die."

 

[Kesh]

It's not a matter of not liking them, but of not having an effective treatment. Even the approved treatments for covid are not particularly effective. If somebody comes along with something significantly more treatable, it's more important to devote scarce resources to the treatable patient.

This applies to vaccinated people too... but there are not many of those in the ICU.

There's not a miracle cure, but there are treatments. And not everyone in the hospital with COVID is going to be a severe case. There's nothing ethical about a blanket "sorry, you weren't vaccinated, no treatment for you" policy.

 

[Kesh]

It's not a matter of not liking them, but of not having an effective treatment. Even the approved treatments for covid are not particularly effective. If somebody comes along with something significantly more treatable, it's more important to devote scarce resources to the treatable patient.

This applies to vaccinated people too... but there are not many of those in the ICU.

There's not a miracle cure, but there are treatments. And not everyone in the hospital with COVID is going to be a severe case. There's nothing ethical about a blanket "sorry, you weren't vaccinated, no treatment for you" policy.

You're ignoring the triage situation, which is implied in all of these discussions. If admitting, treating, and saving the life of an unvaccinated person for COVID means that >1 other person dies because care is denied (on average), you're improperly triaging the situation. Of course, everything is a judgement call since nobody can exactly predict the future, so they have to make these judgements based on experience, assessment of survivability, and how many days and other resources such treatment will take.

Sure, it would be good for people to keep their personal feelings out of it, but there will be a strong and understandable correlation between the negative feelings elicited by the unvaccinated and the amount of resources they are using. That is, if unvaccinated people weren't overwhelming our health care supply resources, health care workers wouldn't be so pissed off at them to begin with.

I'm not ignoring the triage situation. People are bouncing back and forth between different scenarios and painting them all the same. I'm tired of the bullshit equivalencies being thrown out by people who have zero experience in the medical field thinking that doctors can just arbitrarily decide "you live, you die" and calling that "triage."

 

[Kesh]

Patients have a right to refuse care but do not have a right to receive whatever the fuck they want.

If not a doctor or lawyer, but is that always true? If you refuse treatment, could not the doctor have you committed since you are not caring for yourself and could be deemed suicidal?

No, it's not that cut and dried. People are allowed to refuse treatment and, at that point, it becomes an evaluation of what is most appropriate for them. That's a conversation between the doctor & the patient / their legal medical decision maker, potentially with a psych consult if there's a question of their mental state.

Most of the time though, it becomes a conversation of "What do you want? Okay, here's how we can accommodate that."

Sometimes that's hospice. Sometimes it's a long-term care facility. Sometimes it's a transfer to a different medical facility. And sometimes it's a discharge home, and they take their chances.

 

[Kesh]

I'm not ignoring the triage situation. People are bouncing back and forth between different scenarios and painting them all the same. I'm tired of the bullshit equivalencies being thrown out by people who have zero experience in the medical field thinking that doctors can just arbitrarily decide "you live, you die" and calling that "triage."

Then ignore those people and focus on the discussion over triage since discussing denial of treatment in the absence of a triage situation is a waste of time as that's not happening and likely won't happen.

That is, unless it is your preference to deliberately merge the discussion and avoid the actually relevant issues about treating COVID patients in the presence of a triage condition.

Nevermind, fuck it. No one actually wants to explain where they're seeing these hypothetical triage situations, they're just screaming "triage!" and making up straw-man scenarios so they can mentally masturbate about punishing anti-vaxxers with death. It's like they've turned the word "triage" into a magic "anytime I want to kick an anti-vaxxer into the street" situation.

 

[Kesh]

I'm not ignoring the triage situation. People are bouncing back and forth between different scenarios and painting them all the same. I'm tired of the bullshit equivalencies being thrown out by people who have zero experience in the medical field thinking that doctors can just arbitrarily decide "you live, you die" and calling that "triage."

Then ignore those people and focus on the discussion over triage since discussing denial of treatment in the absence of a triage situation is a waste of time as that's not happening and likely won't happen.

That is, unless it is your preference to deliberately merge the discussion and avoid the actually relevant issues about treating COVID patients in the presence of a triage condition.

Nevermind, fuck it. No one actually wants to explain where they're seeing these hypothetical triage situations, they're just screaming "triage!" and making up straw-man scenarios so they can mentally masturbate about punishing anti-vaxxers with death. It's like they've turned the word "triage" into a magic "anytime I want to kick an anti-vaxxer into the street" situation.

Are you fucking serious?

https://abc13.com/us-army-veteran-danie ... /10983810/

https://www.nytimes.com/2021/08/19/us/a ... rtage.html

https://www.washingtonpost.com/health/2 ... covid-icu/

This has been reported on both in the news and here at Ars. Get your head out of your ass and take a look around maybe.

And there it is. You're conflating "triage situation" with "lack of beds." Those are not the same situations. But you don't want to actually learn about this, you just want to feel good about punishing anti-vaxxers.

Ah, but then you might have to confront the fucking FACT that anti-vaxxer COVIDiots have directly killed people waiting for hospital services, and maybe we don't want that to actually happen.

I fucking know that, and I fucking don't like it. I don't want it to happen either. But that doesn't mean we throw medical ethics out the window and declare some people just too stupid to live.

I'm done with this bullshit bloodlust you're wrapped up in.

 

[Kesh]

Are you fucking serious?

https://abc13.com/us-army-veteran-danie ... /10983810/

https://www.nytimes.com/2021/08/19/us/a ... rtage.html

https://www.washingtonpost.com/health/2 ... covid-icu/

This has been reported on both in the news and here at Ars. Get your head out of your ass and take a look around maybe.

And there it is. You're conflating "triage situation" with "lack of beds." Those are not the same situations.

I think an accurate summation of their position is that they'd rather run triage than have {for example} a simple fifo system when it comes to limited resources like ICU beds.

You may call it "bloodthirsty" if you'd like, but it's not a "conflation".

He's a lot confused. Every patient entering a hospital gets triaged. If they arrive by ambulance, they're triaged by the EMT or Paramedic. If the ER admitting nurse has time, they may re-assess. Then they're sent off to wherever they should be. An OR, the ER attending rooms, the ER waiting area, etc. After that they may be looking for an ICU bed for them, or they may be off to a recovery ward (or back on the street).

The triage process doesn't end, really, since an assessment needs to be made at every potential transfer of care.

As far as "hypotheticals" about ICU beds, we're past that and well into actually running short on ICU beds. Everywhere. Even places that aren't being overwhelmed by unvaccinated Covid patients; because the Covid patients represent unusually heavy load.

This is exactly what I was talking about earlier. No, deciding bed assignments isn't triage. You're taking the normal decision-making process of a hospital and conflating it with "we need to make a decision right now."

I've worked in healthcare over a decade, and this kind of confusion is what makes discussions like this frustrating. People don't know how it actually works, but are very happy to spout off.

 

[Kesh]

Are you fucking serious?

https://abc13.com/us-army-veteran-danie ... /10983810/

https://www.nytimes.com/2021/08/19/us/a ... rtage.html

https://www.washingtonpost.com/health/2 ... covid-icu/

This has been reported on both in the news and here at Ars. Get your head out of your ass and take a look around maybe.

And there it is. You're conflating "triage situation" with "lack of beds." Those are not the same situations.

I think an accurate summation of their position is that they'd rather run triage than have {for example} a simple fifo system when it comes to limited resources like ICU beds.

You may call it "bloodthirsty" if you'd like, but it's not a "conflation".

He's a lot confused. Every patient entering a hospital gets triaged. If they arrive by ambulance, they're triaged by the EMT or Paramedic. If the ER admitting nurse has time, they may re-assess. Then they're sent off to wherever they should be. An OR, the ER attending rooms, the ER waiting area, etc. After that they may be looking for an ICU bed for them, or they may be off to a recovery ward (or back on the street).

The triage process doesn't end, really, since an assessment needs to be made at every potential transfer of care.

As far as "hypotheticals" about ICU beds, we're past that and well into actually running short on ICU beds. Everywhere. Even places that aren't being overwhelmed by unvaccinated Covid patients; because the Covid patients represent unusually heavy load.

This is exactly what I was talking about earlier. No, deciding bed assignments isn't triage. You're taking the normal decision-making process of a hospital and conflating it with "we need to make a decision right now."

I've worked in healthcare over a decade, and this kind of confusion is what makes discussions like this frustrating. People don't know how it actually works, but are very happy to spout off.

No, you.

You're confusing mass cal triage with the regular process of triage that is done every day.

I'm a former paramedic and combat medic, and was at Ground Zero. Would you like the shut the fuck up now?

I'm confusing nothing, but sure, fuck off and I'll just ignore this thread full of people flexing shit they don't understand.