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Refusals to Treat the Unvaccinated Violate Health Care Ethics

Commentary: Some health care workers are forgetting their obligation to care.

Key points

  • Abandoning the unvaccinated risks worsening the nation’s physical and mental health.
  • Denying care to the unvaccinated violates the ethical principle of treating all patients justly.
  • Many unvaccinated patients will eventually wind up in the hospital, which can only worsen staffing and supply shortages.

Doctors are increasingly refusing to treat the unvaccinated. Physicians in Alabama, Florida, the District of Columbia, and Toronto have dismissed unvaccinated patients from their practices. A Texas task force has considered reserving beds in intensive care units solely for the vaccinated.

Calls to Punish Anti-Vaxxers

Among my fellow bioethicists, incredulity and anger run high against so-called anti-vaxxers. Behind closed doors, I’ve heard repeated calls to punish them by charging higher insurance premiums, withholding scarce medications, or refusing treatment.

Some argue it is ethical to decline to treat those who refuse the COVID jab. Prohibiting unvaccinated patients from entering clinics protects both health care workers and high-risk patients and can motivate patients to accept the vaccines.

It seems logical that refusing to treat the unvaccinated will reduce harm and promote good. But ethics is far more complicated than a simple calculation of risks and benefits.

As a physician and ethicist, I am a strong advocate of vaccination. Although the Omicron variant has evaded both vaccine-induced and infection-induced immunity, in my experience, the large majority of patients hospitalized with COVID-19 in intensive care units didn’t take the shot. Throughout the pandemic, the unvaccinated have faced a greater risk of severe illness, hospitalization, and death. They’ve also risked harming others by inadvertently spreading disease.

But refusing to care for the unvaccinated can itself inflict harm. Nearly one in five healthcare workers have left their jobs during the pandemic. Nursing shortages abound. There’s no guarantee that patients dismissed by one clinician will find another. Patients may not be able to fill prescriptions or manage chronic conditions. Many will eventually wind up in the hospital, which can only worsen staffing and supply shortages. Doctors who seek to punish the unvaccinated end up punishing their own colleagues.

What’s more, refusing to treat patients amplifies divisiveness at a time when cultural and ideological divisions seem stronger than ever. Researchers at Northeastern University have shown that people who perceive higher levels of partisan polarization are at greater risk for depression and anxiety. The pandemic has already taken years off our lives. Physicians who choose the partisan route of abandoning the unvaccinated risk worsening the nation’s physical and mental health.

The Ethical Principle of Treating All Patients Justly

Denying care to the unvaccinated also violates the ethical principle of treating all patients justly, regardless of their complicity in becoming sick. Almost no one exercises enough, eats perfectly, or takes medications exactly as prescribed. We doctors don’t dismiss patients for smoking or drinking too much. Why punish them for refusing the COVID-19 shot?

The earliest hospitals were sites of hospitality. These days, medical professionals are required to be neither saints nor martyrs. But they are obligated to care. The greatest hazard we face—vaccinated or not—is to have a generation of health care practitioners lose sight of that purpose.

This piece was first published online in the Wall Street Journal.

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