COMMENTARY

It’s Okay for Docs to Refuse to Treat Unvaccinated Patients

Arthur L. Caplan, PhD

Disclosures

October 13, 2021

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I’m at the Division of Medical Ethics at the New York University Grossman School of Medicine in New York City.

A couple of weeks ago, a physician in Alabama said he'd had enough. He would not be seeing any more unvaccinated patients in his practice. Many other doctors are starting to think about following in his footsteps.

Is it ethical to say, “I'm not going to treat you if you're not vaccinated”? Well, it's a sticky issue and a complicated issue. Let me try and work through a little bit of the thinking.

The Alabama doctor said it was too hard on him. He suffered too much worrying about what was going to happen to his unvaccinated patients. I don't think that's a good reason.

I do think a better reason might be, “I have to protect my staff from unvaccinated people. I want to keep people safe in my waiting room, and I don't want to be exposed to people with COVID-19 for fear of a breakthrough infection.” It also may make some sense to say, “If you won't follow my medical advice and do what I tell you, there's no point in me taking you on as a patient.”

Under those terms, I think family doctors, nurses, and others in primary care could say, “I'm not taking on any patients who won't vaccinate.” This basically is justified by protection of the office, other patients, and the doctor as well as saying, “For us to work together and for me to be a good doctor to you, you've got to follow my advice. My advice is to vaccinate.”

Does that rule apply to the emergency room (ER) and hospital settings? I don't think so. When someone comes in very sick, or whatever the reason, I think we have to take care of them ethically, and legally we're bound to get them stable in the emergency room.

I do think different rules apply there. I don't think vaccination status can be used to tell someone to move on to another hospital unless, obviously, you're full, but that doesn't have anything to do with vaccination status.

Some physicians have started to ask me, “Well, okay, I can let people in, but should I put the unvaccinated at the end of the line if, as is true in Idaho, Texas, Louisiana, and other states, the intensive care units (ICUs) and ERs are starting to get full, there are no spare beds, and we have to start thinking about triaging?”

I wouldn't put someone at the end of the line simply because they're unvaccinated. I might put them at the end of the line if their lack of vaccination made it likely that they would not do well or that their disease had gotten so advanced that they wouldn't respond to the treatments that we have.

In other words, if you could use lack of vaccination as a predictor for failed treatment, then I think it might become relevant if it tells you something is futile or it tells you something failed. If you can't really do that in good conscience, then I don't think we can, using good ethical standards, shove that group to the back of the line.

However, we ought to publicize what happens and talk about what happens when you don't vaccinate. That, I think, is very important to do. I think one of the best arguments we have to get people to vaccinate is to say that 99% of people who are in our ICUs are unvaccinated and they're pushing other people aside who need ICU care but can't get in because it’s full.

The bottom line is that for primary care, if you're trying to protect yourself, your staff, or other patients, I think you do have the right to not take on somebody who won't vaccinate. This is somewhat similar to when pediatricians do not accept a family if they won't give their kids the state-required shots to go to school. That's been happening for many years now. I also think it is morally justified if they won't take your advice. If they won't follow what you think is the best healthcare for them, there's not much point in building that relationship.

In intensive care and emergency settings, the situation is different. It's a little harder to use unvaccinated status when someone really is at death's door. The way to use it, if it makes sense, is as a predictor. If someone unvaccinated with COVID-19, let's say, is less likely to do well than someone who's there because of a heart attack or some other ailment, maybe that can become relevant.

I’m Art Caplan at the Division of Medical Ethics at the New York University Grossman School of Medicine. Thank you very much for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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