Is it ethical to deny care to unvaccinated patients?

Doctors and other HCPs are aggravated with unvaccinated patients, according to an article published by Critical Care Explorations.^[] The frustration stems from the fact that in 2019, a large majority of ICU patients with COVID-19 had not received a vaccine.

As a result, some physicians are denying care to the unvaccinated. Should they? Some would argue that this decision breaks from the core of medical ethics.

Reasons to deny care

There are several reasons why a physician may choose to bar unvaccinated patients from their practice. For one, doing so could protect other patients.

Protecting other patients

In an article published by the American Academy of Family Physicians, Ryan Neuhofel, DO, MPH mentions that practices that implement vaccine requirements may do so to spare immunocompromised patients from exposure to the deadly virus.^[] Doctors may also wish to keep their waiting rooms as COVID-free as possible, relying on vaccine mandates to do the job.

Practice-specific considerations

The nature of a physician’s practice may also be crucial in the decision to implement vaccine mandates, according to the American Medical Association. For example, if a doctor’s patient population is primarily composed of immunocompromised individuals who are medically unable to receive a vaccine, banning medically able patients who choose to remain unvaccinated could be a sound decision.

Assessing patients' needs

Another factor to consider is the level of care a patient needs.^[] Doctors are justified in asking a patient to get vaccinated prior to entry into the practice if the patient is looking to establish a primary care physician for long-term, routine checkups. They might be less justified if the patient required emergency care, in which case, it’s seldom ethical to turn someone away based on vaccine status.

Emily Largent, JD, PhD, RN, is an assistant professor of medical ethics and health policy at the Perelman School of Medicine and a Senior Fellow at the Leonard Davis Institute of Health Economics.

In an exclusive MDLinx interview, Largent spoke about a circumstance in which it would make sense for unvaccinated patients to be denied a specific type of care: Organ transplants. Largent noted that organs are in short supply, and allocation decisions are based on who is most likely to reap the benefits of the procedure.

Discharge plan and strategies

“If an individual is unwilling to be vaccinated, there is a much higher risk of severe outcomes from COVID,” Largent said. “It’s always regrettable when patients don’t receive care, but when we have scarce resources like that, the decision not to list a patient is justified.”

Largent also made a point to say that doctors who discharge patients could benefit from this plan: Notify the patient that the treatment relationship is ending, refer them to a more suitable provider, and ensure that they continue to be cared for in your absence.

Even with a plan in place, the choice to regularly deny patients care based on vaccine status is debatable for a number of ethical and practical reasons.

The rebuttal—and strategies for treating the unvaccinated

Perhaps the most evident argument against terminating treatment of patients based on vaccine status lies in the very foundations of doctorhood.

Doctors enter healthcare to serve. The decision is outlined by the commitment to care for patients whose medical circumstances could pose risks to physicians’ well-being and safety. The AMA reminds doctors that while there may be circumstances in which denying care to patients who lack certain vaccinations could be justified, it certainly isn’t recommended.

Long-term effects

Terminating patients based on vaccine status may also prove to be ineffective.

For example, while Neuhofel recognizes the validity of some doctors’ decision to protect other patients via office vaccine requirements, he also notes that such requirements don’t account for the potential exposure patients may face outside of the office.

In essence, requiring vaccination to enter a practice can create an expectation that simply isn’t applicable to other environments like schools, libraries, or parks.

Not only do vaccine requirements promote a false sense of safety, but doctors who refuse unvaccinated patients may inadvertently contribute to lower vaccination rates in the long-term.

Strategies for care

If you’re a physician who feels frustrated with unvaccinated patients but doesn't wish to discharge them, there’s still hope. In our conversation, Largent mentioned that patients who have longstanding trust with personal physicians may come around to the vaccine after a conversation—or, more realistically, many conversations.

Terminating the treatment of patients who choose not to get vaccinated, on the other hand, could considerably harm the patient. Taking a more empathetic approach could be the more ethical and efficient option for many physicians.

“I worry that doctors who cut people off with an ultimatum approach might actually alienate them, either from the clinician relationship or from the healthcare system,” Largent said. “I tend to favor the idea of more compassionate persuasion, rather than ending the treatment relationship.”