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Medical ethicists criticize doctors refusing to treat the unvaccinated

Yahoo! News logo Yahoo! News 9/24/2021 Marquise Francis

Linda Marraccini, a family medicine doctor in South Miami, Fla., is tired of patients who refuse to get vaccinated, endangering themselves and everyone they come into contact with ⁠— so she gave them an ultimatum: Get vaccinated or find another primary care physician. Marraccini sent out a letter to her patients last month, informing them that since the Food and Drug Administration had fully approved the Pfizer vaccine, she would no longer see those who were not fully vaccinated.

“This is a public health emergency — the health of the public takes priority over the rights of any given individual in this situation,” Marraccini wrote in the letter, according to NBC Miami. “It appears that there is a lack of selflessness and concern for the burden on the health and well-being of our society from our encounters.”

Marraccini is not alone. In the past month, as the Delta variant of COVID-19 has ripped across the country, an Alabama doctor also said he won’t treat unvaccinated adults.

That decision has caused backlash within the medical profession, with many critics saying doctors should not pick and choose who they treat.

“We have to find ways to take care of people, even if we don’t agree with their actions,” Dr. Jonathan Moreno, a professor of medical ethics at University of Pennsylvania, told Yahoo News.

a close up of a person wearing a hat: A woman in Indianapolis in April at a protest against COVID-19 vaccination outside Gov. Eric Holcomb’s mansion. (Photo by Jeremy Hogan/SOPA Images/LightRocket via Getty Images) © Provided by Yahoo! News A woman in Indianapolis in April at a protest against COVID-19 vaccination outside Gov. Eric Holcomb’s mansion. (Photo by Jeremy Hogan/SOPA Images/LightRocket via Getty Images)

But that responsibility has to be balanced with the need to protect their most vulnerable patients. Marraccini believes that by requiring all of her patients to be vaccinated, she reduces the chance that her immunocompromised patients are endangered by those who have not received the vaccine. For longtime patients of Marraccini who have not found a new provider as a result of her decision, she told Newsweek that she will continue to provide telehealth consultations until they do.

Sixty-four percent of the total U.S. population has had at least one dose of the COVID-19 vaccine, according to data from the Center for Disease Control and Prevention, and more than 182 million Americans are fully vaccinated. Yet many people, particularly in rural and minority-majority areas, remain skeptical of the vaccines, despite their effectiveness.

Overall, more than 680,000 Americans have died from COVID-19 since the pandemic began, and 1,500 Americans continue to die each day, according to the CDC. The rising number of deaths have left many medical professionals frustrated and others exhausted by those who remain unvaccinated.

Anti-vaccination protesters rally in Los Angeles near City Hall in August in opposition to the City Council vote to introduce an ordinance to require proof of vaccination to enter many public indoor spaces. (David McNew/AFP via Getty Images) © Provided by Yahoo! News Anti-vaccination protesters rally in Los Angeles near City Hall in August in opposition to the City Council vote to introduce an ordinance to require proof of vaccination to enter many public indoor spaces. (David McNew/AFP via Getty Images)

Another physician at Diagnostic and Medical Clinic Infirmary Health in Mobile, Ala., Dr. Jason Valentine, posted a Facebook message expressing a similar sentiment last month: refusing to watch people die from a “preventable disease.”

“We do not yet have any great treatments for severe disease, but we do have great prevention with vaccines,” he wrote in a letter posted online, according to the Washington Post. “Unfortunately, many have declined to take the vaccine, and some end up severely ill or dead. I cannot and will not force anyone to take the vaccine, but I also cannot continue to watch my patients suffer and die from an eminently preventable disease.”

The doctors refusing to treat the unvaccinated are in states with bad COVID-19 outbreaks. Alabama has seen a significant decline in COVID-19 hospitalization rates across the state in recent weeks, but according to State Health Officer Dr. Scott Harris, the drop can be partially attributed to a “really high rate” of daily deaths. With a state population just under 5 million, Alabama is averaging 135 COVID deaths per day, a dramatic 324 percent spike over the last 14 days. Florida currently averages more than 9,000 daily new infections, and nearly 52,000 Floridians have died from the virus.

“We still have more patients requiring critical care than critical beds,” Harris told the Montgomery Advertiser. “It’s better than it’s been, but it still means we don’t have any available ICU beds in Alabama. It’s a problem for people with non-COVID illnesses.”

Marraccini and Valentine did not respond to Yahoo News’ request for comment.

A Johnson & Johnson COVID-19 vaccine is prepared for a clinical trial in Aurora, Colo., in 2020. (Photo by Michael Ciaglo/Getty Images) © Provided by Yahoo! News A Johnson & Johnson COVID-19 vaccine is prepared for a clinical trial in Aurora, Colo., in 2020. (Photo by Michael Ciaglo/Getty Images)

They are not alone in wondering whether people who choose to overwhelm health care providers and create dangerously overcrowded hospitals by refusing vaccination should be deprioritized in the health care system. A leaked memo from the co-chair of the North Texas Mass Critical Care Guideline Task Force, a volunteer group that periodically updates medical guidelines for hospitals in the region, also indicated that the task force was considering whether to take vaccination status into account when deciding who gets an ICU bed when numbers get low. That decision has since been scrapped.

While it is legal for doctors to stop seeing a patient for any reason that doesn’t violate laws against discrimination on the basis of race, sex and gender, medical ethics standards can go beyond the letter of the law.

The law, according to Moreno, is not an effective barometer of right and wrong in the medical field, because it doesn’t have perfect guidance in every situation. He noted that, in the late 1980s, during the HIV AIDS epidemic, some doctors denied care to patients — who were more likely to be gay, Black or to belong to another marginalized group.

“This is very dangerous,” Moreno said. “Once the medical profession starts deciding, picking and choosing who can be cared for and who not for whatever reason, we’re in a really bad position.”

“The foundations of medicine require doctors to take care of patients,” he added. “If they stopped doing that, then we really have no profession.”

a hand holding a glass: A dose of the Pfizer-BioNTech vaccine is prepared for a mass COVID-19 vaccination event in Denver in January. (Michael Ciaglo/Getty Images) © Provided by Yahoo! News A dose of the Pfizer-BioNTech vaccine is prepared for a mass COVID-19 vaccination event in Denver in January. (Michael Ciaglo/Getty Images)

Yahoo News Medical Contributor Dr. Kavita Patel, a primary care physician in Washington, D.C., who also serves as a health policy fellow at the Brookings Institution, says that while she disagrees with not treating the unvaccinated, she understands the sentiment.

“I don’t blame health professionals who feel this way, because I think they are practicing self-preservation,” Patel told Yahoo News. “They are getting hammered … and they’re frustrated and tired. There are three vaccines, and we have people willfully not taking them.”

But Patel stresses the importance of being able to compartmentalize one’s personal feelings for the betterment of others.

“When you say no to anyone, it creates an incredible moral slippery slope,” she said. “I don’t think doctors should enter that. … Medicine is both art and science, but it’s also incredibly clear on being objective.”

It’s already common practice for some doctors to refuse treating children who don’t have childhood vaccines. A University of Colorado survey from 2020 found that more than 50 percent of pediatric offices have a policy that dismisses families that don’t vaccinate their children.

Moreno believes that is justified, but argues it is different from refusing to treat those unvaccinated from COVID-19.

“I surmise that these pediatricians regard themselves as protectors of children and don’t want to see their patients become ill with an easily preventable and serious disease,” he said. “And, of course, not receiving the usual childhood vaccinations may isolate children from school and other activities. I also think pediatricians worry that immunosuppressed kids could get diseases like measles in their offices from other kids who were not vaccinated.”

Protesters against masks, vaccines, and vaccine passports gather outside the headquarters of the Centers for Disease Control in Atlanta in March. (Elijah Nouvelage/Getty Images) © Provided by Yahoo! News Protesters against masks, vaccines, and vaccine passports gather outside the headquarters of the Centers for Disease Control in Atlanta in March. (Elijah Nouvelage/Getty Images)

With the exception of protecting children from their parents’ dangerous decisions, however, those reasons are not different from the ones given by doctors who won’t treat people who reject the COVID-19 vaccine: They don’t want their patients dying of a preventable disease, and they want to protect the immunosuppressed. Increasingly, work, school, travel and other social activities are requiring vaccination against COVID-19 as well.

A recent CNBC/Change Research poll revealed that of the 29 percent of Americans who are unvaccinated, 83 percent never plan on getting the COVID-19 vaccine, largely based on mistrust of the government and fears of the vaccine’s side effects, which have been vastly overstated or even invented in online misinformation campaigns and some right-wing media outlets, such as Fox News.

Vaccine hesitancy has also come within the medical field. More than 100 staff members at Houston Methodist Hospital, including many nurses, were fired in June for refusing to comply with the company’s vaccine mandate.

For Dr. Alyssa Burgart, a bioethicist and pediatric anesthesiologist at Stanford University, when it comes to health professionals deciding whether to treat the unvaccinated, not everything that feels right is actually good.

“I think the important thing to recognize is that sometimes something feels right, but actually is morally misguided,” she said.

Cover thumbnail photo illustration: Yahoo News; Photos: Angela Weiss/AFP via Getty Images, Stephen Zenner/SOPA Images/LightRocket via Getty Images

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