This week, a primary care Alabama doctor, Dr. Valentine, received both acclaim and criticism for sending a message to his patients. It stated, “No vaccination, no treatment”. Dr. Jason Valentine is a family medicine specialist at the Infirmary Health Diagnostic and Medical Clinic in Saraland, Alabama. He shared a photo on Facebook of himself posing next to a sign informing patients of his new policy. It will be effective from October 1, 2021.
“Dr. Valentine will no longer see patients that are not vaccinated against COVID-19,” said the sign. The message was stuck on a door. AL.com saw the post before it was down. He stated he was mailing letters to patients advising them of his decision.
The letters reportedly said: “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.”
“If you wish to choose another physician, we will be happy to transfer your records,” the Alabama doctor ended the note.
“Time to start blaming the unvaccinated folks”
Alabama hospitals ran out of ICU beds this week, according to the Alabama Department of Public Health, after a COVID-19 outbreak fueled by the extremely contagious delta strain hit the state’s mainly unvaccinated populace. Alabama has one of the lowest immunization rates in the country, with only 36% of eligible residents fully immunized. Only 47% of Alabamans who are eligible have received even one dosage.
Alabama Gov. Kay Ivey (R) declared in July that it was “time to start blaming the unvaccinated folks” for the state’s failure. Alabama doctor Valentine’s post represents a problem that doctors across the country are dealing with.
In the interest of public health, a family physician in New York recently inquired if it was ethical to confine vaccine-refusing patients to telehealth appointments. Many other front-line health care workers have expressed anger with a California infectious disease doctor who blogged this week that she was “running out of compassion” for the unvaccinated.
Should Texas run out of ICU beds, doctors are reportedly considering taking vaccination status into account when making triage choices.
The users that swamped the sections of the evaluation of Valentine’s online medical profiles had various feelings about his move, albeit they were mostly positive.
“Encouraging patients to take care of themselves and mind their health is absolutely what all doctors should be doing!!” one person wrote.
“Why should anyone be forced to put their health at risk to treat patients too selfish to do the right thing to protect others. Good for you for taking a stand,” a second person commented.
Another reviewer debated, however, that Valentine was letting “his views interfere with his professional oath.”
Dr. Valentine and his Hippocratic Oath questioned
“On the one hand, modern versions of the Hippocratic Oath [require] doctors to treat patients to the best of their ability with compassion. On the other hand, doctors are free to make principled decisions based on their personal ethics.” – Susan Pace Hamill, University of Alabama
According to Danielle Weatherby, associate professor of law at the University of Arkansas, private doctors can legally refuse to treat patients in non-emergency situations for a variety of reasons, as long as the denial is not based on the person’s sex, religion, or national origin.
“The analysis becomes more nuanced when the patient’s refusal to vaccinate is rooted in their alleged deeply held religious beliefs,” she said.
Doctors can also end patient relationships if they take additional procedures such as giving notice and referring the patient to another care, according to Susan Pace Hamill, a law professor and honors professor at the University of Alabama who specializes in ethics.
However, the “medical ethics issue is not as cut and dry,” she said. “I can see both sides.”
“On the one hand, modern versions of the Hippocratic Oath [require] doctors to treat patients to the best of their ability with compassion. On the other hand, doctors are free to make principled decisions based on their personal ethics.”
Doctor Valentine is seemingly taking an ethical stance as a doctor but it still raises issues
Hamill gave the example of doctors deciding whether or not to conduct abortions depending on their own beliefs.
“Refusing the COVID vaccination raises significant ethical issues,” she said. “We have people getting sick and dying because they refused this simple prevention.”
Furthermore, she claims, those same people are driving outbreaks among the vaccinated, endangering children under the age of 12 who cannot be vaccinated and straining the medical system, putting the community at risk in additional ways. This could be unethical.
Doctor Valentine is seemingly taking an ethical stance as a doctor. She added by also stating that all individuals have a personal obligation to get the vaccine if they are able.
“Because the vaccine is free and safe, Dr. Valentine seems to be taking an ethical stand that he will only dedicate his talent and training (which is a limited resource) to those patients who have upheld their ethical responsibilities.”
Hamill believes the decision is within acceptable ethical parameters. However, she recognizes the merit of the argument. It violates medical responsibilities to treat the sick with compassion; even if the illness is a result of the patient’s own choices.
“From a medical perspective, many, many people in some way contribute to their own health issues,” she noted.
‘We do not blame the sick for their plight.’
Valentine’s decision, according to Aaron Kheriaty, a professor of psychiatry at the University of California Irvine and director of the medical ethics program at UCI Health, shows a loss of professional and ethical bearings as well as desertion of his patients.
“The logic employed here would never be applied elsewhere in medicine,” he said. Referring to examples like discharging obese patients for failing to lose weight or declining to treat people with addiction who haven’t achieved serenity.
“Doctors try to help patients be responsible for their health; and we try to persuade them to make healthy decisions, to be sure; but we don’t abandon them when they make medical or health-related decisions that we don’t condone,” he said. “Doctors treat the sick because they are sick, and simply because they are fellow human beings in need of care; we do not blame the sick for their plight.”
He also pointed out that there are a variety of acceptable medical reasons why someone would refuse the COVID-19 vaccine.
“A blanket condemnation of all the unvaccinated is unwarranted and unworthy of the profession of medicine,” he concluded.
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