Medical workers at Morton Plant Hospital in Clearwater, Fla., work to stabilize a COVID-19 patient.

 year and a half into the pandemic, the long-feared specter of rationed health care — that is, the delay or denial of medical treatment to some patients who need it because there simply aren’t enough resources to go around — is perilously close to becoming reality. As unvaccinated coronavirus victims overwhelm hospitals, some states are edging toward allowing doctors to decide which patients get immediate care and which don’t. It could affect not just coronavirus patients but medical care across the board.

Frustrated calls to put the willfully unvaccinated at the end of the medical line are understandable, but medical ethics don’t allow that kind of comeuppance. That means some who refuse vaccination (thus contributing to the crisis) could end up getting lifesaving treatment before those who behaved more responsibly but who are deemed less likely to survive. The anti-vaccination holdouts should think hard about whether this is a scenario they’re prepared to live with.

It’s ironic that misguided conservatives are largely the ones driving hospitals toward the rationed-care cliff. These are many of the same folks who falsely alleged a decade ago that the Affordable Care Act would lead to “death panels” and other forms of rationing. That danger was never real, but this time it is.

As The Washington Post reported last week in a sobering roundup, hospitals in Alaska, Idaho and Montana were recently given latitude to move to what are called crisis standards of care. It’s not an official declaration of rationing. but the granting of flexibility to doctors if it comes to that. Think of it as the Defcon 4 of health care: a state of readiness that could portend the worst of worst-case scenarios.

The severe shortage of hospital beds and equipment is the direct result of the current national surge in coronavirus deaths, which in turn are the direct result of vaccination resistance. About 62% of eligible Americans have received at least one dose of the vaccine. That’s one of the worst vaccination rates in the industrialized world. Virtually all those sick or dying today are unvaccinated, by choice. If and when rationed care comes, these people will be taking down others with them. Anyone who needs medical care for any reason could find it unavailable.

It’s infuriating that those who have worsened this pandemic might ultimately benefit from dwindling medical resources while others die from lack of them — but medical standards leave little room to mitigate that. Rationing must be based primarily on which patients are most likely to be helped by the available resources. Using rationing to punish unwise behavior is a path down which society must not go.

Which leaves it to the vaccine resisters to decide, in consultation with their consciences, just how many lives they’re willing to risk for their misplaced notions of “freedom.”