One physician's case for refusing to treat unvaccinated patients in person

A family medicine physician has given the nearly 3,000 patients of her independent practice in South Miami a deadline of Sept. 15 to get vaccinated against COVID-19 or terminate their patient-physician relationship, the Miami Herald reports.

Patients who are unable to find a new physician before the deadline will receive teleconference consultations.

"I feel if I can't have a good doctor-patient relationship, I'm not going to be comfortable taking care of those patients, and they should find someone who's a better fit for them," Linda Marraccini, MD, told the Miami Herald. She shares the practice with her brother, John Marraccini, MD.

The physicians' website states: "At this time, we are no longer seeing medically eligible unvaccinated patients unless they have an exemption."

As of Sept. 9, 84 percent of the population in Miami-Dade County has received at least one dose of a COVID-19 vaccine, and 68.6 percent is fully vaccinated. 

The question of whether healthcare providers can ethically decline or treat unvaccinated COVID-19 patients differently than their vaccinated counterparts has been raised in recent weeks. 

Daniel Wikler, PhD, professor of ethics and population health at the Harvard T.H. Chan School of Public Health, wrote in an op-ed for The Washington Post that culpability, blame, sin, cluelessness, ignorance or other personal failings should not be factors in the evaluation of patients for healthcare.

"Doctors and hospitals are not in the blame and punishment business. Nor should they be," he argued. "That doctors treat sinners and responsible citizens alike is a noble tradition, an ethical feature and not a bug. And we shouldn't abandon it now."

When it comes to nonemergency situations, physicians are legally able to refuse patients for a variety of reasons, provided they are not doing so because of some aspect of the patient's race, gender, sexuality or religion, according to Timothy Hoff, PhD, professor of management, healthcare systems and health policy at Northeastern University in Boston. 

Northeastern experts convened their thoughts on the ethical implications of refusing to care for unvaccinated patients in an Aug. 25 article written by Tanner Stening. 

While physicians can legally dismiss patients who do not need urgent care because of their unvaccinated status, the decision to do so still raises ethical questions. 

If a physician who wants to reduce the spread of COVID-19 sees the care of unvaccinated patients as a risk to his safety or the safety of staff, the physician needs to explain the reasons for refusal of treatment and offer to connect patients with an alternative provider. Otherwise, it could be a breach of the duty of care doctrine, according to the article.

But if a physician refused to care for an unvaccinated patient as a tactic to incentivize receiving the COVID-19 vaccine, that would fall into the category of ethically problematic because it can "erode trust in the profession," according to Patricia Illingworth, a philosophy professor and ethics expert at Northeastern.  

Robert Baginski, MD, associate clinical professor and director of interdisciplinary affairs for the department of medical sciences at Northeastern, said it is vital for health authorities to continue urging the public to get vaccinated, but not at the expense of care.

"Healthcare professionals are frustrated and tired," Dr. Baginski said. "It's not that we want to deny patients care. We're tired, we're at risk, we're doing absolutely everything that we can."

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