A 50-year-old, moderately obese patient walks into a medium-sized medical practice in New York and asks to see a doctor. He’s been having nagging chest pains and is concerned, naturally so, about a heart attack. He never reaches the inner sanctum of a consulting room or gets to see a doctor. He is refused access to the clinic, despite a heated argument with the receptionist, as he is unvaccinated against Covid-19.
The receptionists have clear orders from the practice managers. Without conclusive proof of vaccination against Covid, patients are to be denied access to a doctor.
The patient makes his way back to the parking lot but never makes it home. Sitting in his hot car in the lot, trying to catch his breath, that chest pain returns and he suffers a fatal heart attack.
A patient, let’s call her Gail, suffering from Covid symptoms and respiratory distress is taken to a hospital in a small town in Texas. There is a wave of Covid sweeping the town and only one bed remains open in ICU. Gail and another Covid patient wait on gurneys in the entrance hall, desperate to be admitted. Nurses evaluate the two individually and discover Gail has not been vaccinated, despite being over 60, obese, and suffering from a heart condition.
The other patient, also in respiratory distress, has been vaccinated. Hospital guidelines are clear and the nurses respond accordingly. Survival rates are far higher for vaccinated Covid patients. Gail is told she will need to return home and the bed is allocated to the vaccinated patient. The odds of him recovering are stacked in his favor, the outlook for Gail is poor. She dies at her home, 48 hours later.
The complexities of care
I’ve provided you with these two fictitious, yet practical examples of how care may be denied to Covid patients based solely on their Covid vaccination status. The reasons for the examples are twofold. Firstly to highlight the possible consequences of decisions made to withhold care and secondly, to highlight the complexities and nuances of the topic.
What if, in scenario 1, the patient had experienced his heart attack in the waiting room rather than in his vehicle? Would the medical staff simply have stood by idly and watched the patient die or would they have administered care, in contravention of their own policy? I tend to think the latter and most doctors would support this view.
There is a vast difference between emergent care and someone simply shopping for a doctor.
When, for example, ICU beds in hospitals are in short supply, unofficial triage protocols dictate that care be prioritized for those who display the greatest potential for survival. Sadly for the unvaccinated, their survival rates for severe Covid are terrible when compared to the vaccinated.
Most of us assume doctors are oath-bound and ethically obliged to provide care to any and all patients, but the truth is, as always, a little more complex than that.
In August of this year, the debate went public when an Alabama family doctor posted a sign on his office door that stated, as of October 1, he “will no longer see patients that are not vaccinated against COVID-19.” The doctor then sent letters to his current patients saying, “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 topic of refusing care has become so contentious in pandemic afflicted America that in September the American Medical Association (AMA) intervened, issuing a strongly worded statement on the matter.
In general…a physician should not refuse a patient simply because the individual is not vaccinated or declines to be vaccinated. The commitment to care for those who are sick or injured carries with it a duty to treat in other circumstances as well, including public health crises when a physician may face “greater than usual risks to [their] own safety, health or life…” Nor may a physician ethically turn a patient away based solely on the individual’s infectious disease status, or for any reason that would constitute discrimination against a class or category of patients.
Oaths, Duties, and Guidelines
The AMA statement was however qualified by the inclusion of the following extenuating conditions that the Association suggested may be considered when assigning care.
- It may be ethical for a physician to refuse to treat an unvaccinated patient if accepting him or her “would pose a significant risk to other patients in the practice”.
- If meeting the individual’s medical needs would ‘seriously compromise’ the physician’s ability to provide the care needed by their other patients.”
The American Medical Association Code of Ethics further muddies the water, creating contradictions when it comes to guidelines regulating the provision of care. Section VI of its code reads,
“A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.”
So that part encourages the physician’s right to choose. Then, in section IX of the code, it says the following,
“A physician shall support access to medical care for all people.” [emphasis added]
So which one is it, and how do individual doctors decide which sections are applicable, given the ambiguity? Another recent opinion by the AMA states that,
“Physicians may not decline to accept a patient for reasons that would constitute discrimination against a class or category of patients.”
Again, it’s not a hugely specific statement and fails to provide a definition for either class or category. Is the AMA Code referring specifically to race, gender, sexual orientation, and similar demographic features? Could one argue that the unvaccinated constitute a class or category?
The Hippocratic oath, taken by all doctors, doesn’t help much to clarify things either, as it doesn’t specifically address the issue or provide a direct answer to the question. What Hippocrates does offer is a more generalized statement that many interpret to mean care for anyone.
“Into as many houses as I may enter, I will go for the benefit of the ill…”
Physician Steven H. Miles, the author of the classic The Hippocratic Oath and the Ethics of Medicine, notes that “…people from all walks of life sought out and paid Greek physicians for health care. Cobblers, vine tenders, shepherds…soldiers, potters, prostitutes…[and] slaves…”. It would therefore appear that Hippocrates was in favor of providing unconditional care to any and all.
The ‘doctors are just human beings’ aspect
It’s a part we often overlook and yet, it plays a huge role in this debate. Your provider is a person just like you, subject to all the emotions you experience. Emotions like anger, frustration, and recently, for many doctors, pandemic-induced exhaustion, are dealt with on a daily basis.
Most medical practitioners perceive the vaccines as their only effective tool to curb and control the spread of Covid-19 and they, unlike you, have to deal directly with the deaths of those who refuse it. They watch unvaccinated people die from severe Covid, over and over again. It’s like Groundhog Day for viruses.
They see their other patients refused beds in ICU and dying from non-Covid related emergencies simply because the unvaccinated are occupying the ICU beds. Many doctors see you, the unvaccinated, as having blood on your hands.
In short, these doctors are fed up, frustrated, and at the end of their tethers.
If, the doctors argue, you aren’t willing to do this one simple thing to protect yourself, why should they bother to help you and potentially expose their other at-risk patients to potential death? It’s an argument that ignores certain key issues surrounding vaccines, but it is a more than natural human reaction to our current situation and a key factor in the provision of care that cannot be ignored.
So where does that leave the unvaccinated?
Legally, your doctor can not be forced to provide you with care. There is no service offered anywhere, in any industry, that is not provided subject to certain terms, and medicine and health are no exception. Morality and ethics aside, any medical professional can choose to decline care and cite any number of reasons for it.
Add morals and ethics to the mix however and the situation changes. Doctors and caregivers who place their patient’s needs at the heart of their practice will be far less inclined to withhold treatment for their patients, irrespective of the patient’s vaccination status. As with HIV in its early days, some doctors will allow fears for their personal safety and human bias to affect their decision to provide care.
If you are unvaccinated, you will find certain providers, clinics, and practices less than receptive to accepting you as a patient. Luckily for you, a little shopping around will soon enable you to find a doctor who is more than happy to provide you with care. If the doctors place their faith in the vaccines, as most do, what risk then do you pose to them?
If however, you turn up unvaccinated at an overcrowded hospital in search of a bed and a vacant respirator in ICU, you’re probably going to be right out of luck.