Say one person arrives at an emergency room suffering a massive heart attack. The other, defiantly unvaccinated, has come down with covid-19 and is struggling to breathe. ICU beds are scarce at this hospital; so are ventilators — the foreseeable result of the decision by this covid patient, and scores of others like him, not to live up to theirresponsibility to be vaccinated. It is not only ethical to discriminate against him, it would be morally wrong not to give priority care to the heart attack victim.

One argument against this position is that it puts health-care providers on a slippery slope toward becoming free-ranging moral arbiters. Nope, I don’t think the slope is unduly slippery. This is a unique setting that combines the availability of lifesaving treatment, the imperative of individual responsibility and the attendant, pandemic-created shortage of resources. Carving out a justifiable exception from ethical rules doesn’t mean risking that they will be routinely ignored…

Emergency physician Dan Hanfling has written extensively about how to triage care, and he agrees. “If you believe there’s a certain degree of accountability that we as citizens have to take for each other to protect our community, then that group of individuals who have willingly chosen not to vaccinate, for illegitimate reasons, it would be fair to place them at the back of the line. Not kick them out of line, just move them back,” he told me. “At the end of the day, if you have willingly chosen not to do something that benefits the public good in the setting of a national crisis, then there are certain consequences.”