COVID-19 No vaccination, no care?Why it’s the wrong way

Vaccine hesitation is a long-standing phenomenon, but some doctors refuse to care for patients who have stopped SARS-CoV-2 vaccination due to new and highly frustrating manifestations during the COVID-19 pandemic. ..

However, treating patients who reject the safe and highly effective COVID-19 vaccine, which is widely available in the United States, is as annoying as possible, but doctors keep their professional ethical obligations in mind. Must be placed in. It turns out that there is extensive guidance for just such a situation.

“Ethics in our profession is about making difficult choices in the face of conflicting values,” said AMA President. Gerald E. Harmon, MD.. “Important value to me — and this is inherent in our AMA Code of Medical Ethics— It is the duty of the physician to provide patient care, even if the choice is difficult. “

Elliott Crigger, PhD, is the Director of AMA’s Ethics Policy and Secretary of the AMA’s Council on Ethics and Judicial Affairs. He expanded Dr. Harmon’s powerful view.

“In general, no, doctors shouldn’t reject patients because they aren’t vaccinated or refused to be vaccinated,” Kriger said.

Doctors have a clear obligation to provide care in an emergency, Kriger said. Principle VI In AMA Code of Medical Ethics, This states that doctors have to do, except in emergencies, “You are free to choose the environment in which you want to serve, partner with, and provide medical care.”

However, the physician’s commitment to caring for a sick or injured person has an obligation to treat other situations, including public health crises. Opinion 8.3, “Physicians’ Responsibility for Disaster Response and Preparation”, Physicians “May Face Greater Risks Than Usual” [their] Your safety, health, or life. “

Moreover, Opinion 1.1.2, “Future Patients” prohibit doctors from refusing to care for patients based solely on their infectious disease status or because they constitute discrimination against a patient’s class or category.

AMA recognizes that scientific integrity, transparency, and public confidence are crucial in the fight to contain the global spread of COVID-19.Get the latest information on AMA above COVID-19 and vaccine development..

Learn more at AMA on how to answer your questions.Can a doctor refuse an unvaccinated patient?“

However, doctors’ treatment obligations can vary depending on their condition, Kriger said.

“In certain cases, it takes careful consideration to determine if a doctor can ethically reject a patient,” he said.

For example, in a highly contagious disease situation where a safe and effective vaccine is available that poses a significant risk of serious illness, the decision to accept or reject a patient balances three factors: is needed.

• The urgency of the needs of individual patients.
• Risks that a patient may pose to other patients in a doctor’s practice.
• The need to make it available to doctors and other staff to provide care in the future.

These are one of the questions to consider.

What are the medical needs of unvaccinated patients, and how urgent are those needs? In an emergency, doctors cannot ethically refuse to provide care, regardless of the patient’s vaccination status. However, in other respects it may be justified to refuse to provide “daily care” such as annual physical examinations to healthy patients.

What is the nature of the doctor’s practice and patient population? “If meeting an individual’s medical needs” seriously undermines “a doctor’s ability to provide the care that other patients need, they may decline the patient,” Kriger recites. bottom. Opinion 1.1.2..

“Similarly, if an unvaccinated patient poses a significant risk to other patients in practice, for example, if the other patient in the doctor has weakened immunity, or if vaccination is not possible for medical reasons. Rejecting unvaccinated patients can be ethically justified. The higher the risk of serious illness to other patients in the clinic, the more so. “

Can adjustments be made to minimize the risks that unvaccinated patients may pose to other patients and staff? For example, is it possible to see an unvaccinated and potentially infected patient in a dedicated office or at a dedicated time? Or can I test for COVID-19 negative before receiving care? Can you reasonably provide care through telemedicine? Opinion 1.2.12, “Ethical Practices in Telemedicine” provides additional guidance.

Can the clinic provide appropriate personal protective equipment to minimize the risk of exposure to doctors and other staff? “This was a thorny issue in the context of the COVID-19 pandemic when the initial supply of PPE was extremely limited by some practices,” Crigger said. “As PPE becomes more accessible, physicians and healthcare organizations are increasingly responsible for ensuring an adequate supply of PPE so that even unvaccinated patients can be accepted.”

Can I convince a patient to accept vaccination? When an unvaccinated patient is treated, a doctor or other appropriate staff will work with the patient to investigate why they are not vaccinated and will respect and recognize and address their concerns. , You have the opportunity to persuade yourself to accept vaccinations to protect yourself and others.

In summary, Crigger said, “Patient vaccination status alone is not an ethical reason to keep an individual away.”

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