An Alabama physician will not treat any patients who are not vaccinated against COVID-19.

Dr. Jason Valentine recently informed patients this policy will begin on October 1, 2021.

He’s not alone.

In Vancouver, a walk-in clinic sent a 13-year-old to the emergency room to receive treatment for a sore wrist because he was unvaccinated.

In Texas, a medical task force has been considering COVID-19 vaccination status as one possible criteria for allocating intensive care unit beds, as the state’s health system has once again been strained by Delta-variant-related hospitalizations.

Many are shocked by these reports. Some have asked if this was legal. Others are concerned about the morality of declining unvaccinated patients.

Yes, this is legal. Private practice physicians in private clinics can, and have, declined to treat unvaccinated patients. Pediatricians have been dismissing patients whose parents refuse vaccinations for years.

The morality component is a little more complicated and is context dependent.

Let’s begin with the physician’s legal obligation. Physicians have been held liable for failing or refusing to treat a patient.

They cannot abandon patients, but this obligation is not without limits. A physician can stop providing services to a patient with just cause and appropriate notice.

For example, it is completely legal for a private practice physician to decline services to a patient who refuses to follow medical advice (non-compliance), refuses to pay for services, disrupts the medical practice or threatens harm.

The stipulation is that the physician must provide the patient an appropriate amount of time to secure services at another provider.

While a physician should not terminate a therapeutic relationship without just cause, it is often forgotten that private practice physicians are not legally required to take a patient or establish a therapeutic relationship.

So, a physician could decline to take a new patient, or retain an existing one, if they determine that refusing to get vaccinated is a rejection of medical advice or that doing so could be harmful to the physician, staff and other patients involved in the practice.

Granted, when considering which patients to accept into their practice, physicians must avoid discrimination.

For example, if a patient declines vaccination due to a medical condition which is associated with a disability that is covered by the Americans with Disabilities Act, then the provider would need another reason for declining the patient.

In addition, hospital emergency rooms, not private clinics, are required to treat patients facing a medical emergency.

The question of morality is far more complicated.

Many will point to the Hippocratic Oath’s axiom, “Do no harm,” as a condemnation of physicians who refuse to see the unvaccinated.

Yet, physicians whose offices are not set up to safely handle potential COVID-19 patients are not only justified in refusing to treat the unvaccinated but also may have a moral obligation to do so in order to protect themselves, their staff and other patients.

The clinical context also matters. For example, an oncologist might refuse to take new unvaccinated patients out of concern for putting their highly vulnerable patient population at risk.

While there are justifications for not accepting unvaccinated patients into a specific clinic setting, providers should explore alternate options like telehealth.

Some communities may lack resources and more appropriate treatment options.

As stated above, this is all context dependent and requires considering what is best for all parties involved, including the unvaccinated patient.

At first glance, the consideration in Texas sounds cruel and spiteful, but it makes perfect sense.

If resources are limited during a public health crisis, then the goal is to save as many people as possible. It becomes about successfully allocating limited resources.

If there is only one ICU available for two COVID-19 patients who have the same general level of health, but one is vaccinated and the other is not, using vaccination status would make perfect sense in making a determination of who receives the available bed.

The vaccinated patient has a better chance of survival and, on average, will spend less time in the ICU, freeing up resources more quickly for another patient.

The reasoning here is not about punishing the non-vaccinated patient or out of anger towards the unvaccinated. It is about maximizing resources for the best outcome based on good science and data.

Refusing to treat an unvaccinated patient simply because they are unvaccinated is inappropriate. Like all real ethical questions, context is important.

It should be noted that the north Texas group decided not to make vaccination status part of their criteria for triage care allocation.

So yes, in some circumstances, it is legal for physicians to decline to accept unvaccinated patients, and there might be a moral obligation to do so.

It is important to note that declining unvaccinated patients is not a decision that should be made out of spite or anger. It is also one that should not be made out of fear.

Part of being in health care is taking on some degree of personal risk. We treat the sick, the injured and, yes, the infected, but we need to do so in the safest way possible.

Like most moral questions, this is not a simple yes or no. Any decision to limit patient access is a weighty decision and determination cannot be universal; they must be context dependent.

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