An Alabama doctor refuses to see patients not vaccinated against COVID-19. Can he?

An Alabama primary care physician has caused praise and outrage this week after sending a letter to patients: neither vaccine nor treatment.

Dr. Jason Valentine, a family medicine physician at the Health Diagnostic and Nursing Clinic in Saraland, Alabama, posted an image on Facebook showing him posing next to a sign informing patients of his new policy, which will be effective on 1.

“Dr. Valentine will no longer see patients who are not vaccinated against COVID-19, ”said the sign that was engraved on a door.

He said he sent letters to patients informing them of his decision, according to AL.com, which saw the publication before it was withdrawn.

According to the letters, it was said, “I cannot and will not force anyone to get the vaccine, but I also cannot continue to see how my patients suffer and die from an eminently preventable disease.”

“If you want to choose another doctor, we will be happy to transfer your records,” the note concluded.

According to the Alabama Department of Public Health, Alabama hospitals ran out of ICU beds this week, as a rise in COVID-19 driven by the highly contagious delta variant affects the largely unvaccinated population of the state.

With only 36% of eligible Alabamans fully vaccinated, the state has one of the lowest vaccination rates in the country. Only 47% of eligible Alabamans have even received a dose.

In July, Alabama Gov. Kay Ivey (R) said it was “time to start blaming unvaccinated people” for failing the state.

The Valentine’s Day publication reflects a dilemma facing medical professionals across the country.

Last month, a New York family physician asked if it was ethical to restrict patients who reject vaccines to telecare appointments in the interest of public health. A California infectious disease doctor wrote this week that she was “running out of compassion” for the unvaccinated, a frustration that echoed many other front-line health workers. According to reports, Texas doctors consider taking the status of vaccination into account when making triage decisions, in case the state runs out of ICU beds.

Valentine’s decision provoked mixed, albeit largely positive, reactions from commentators who flooded the review sections of her online medical profiles.

“Encouraging patients to take care of themselves and take their health into account is absolutely what all doctors should do!” wrote one person.

“Why should someone be forced to risk their health to treat patients too selfish to do the right thing to protect others? It’s good to take a stand,” a second person commented.

Another reviewer argued, however, that Valentine let “her opinions interfere with her professional oath.”

The medical and diagnostic clinic declined to comment on HuffPost and HuffPost was unable to reach Valentine directly.

Two legal experts told HuffPost that a doctor has the legal right to refuse treatment to unvaccinated patients. However, from an ethical point of view, the issue is more complex.

Private physicians can legally refuse to treat patients in non-emergency situations for a variety of reasons, as long as that refusal is not based on factors such as the person’s sex, religion, or national origin, said Danielle Weatherby, a professor. law associate at the University of Arkansas. .

“The analysis becomes more nuanced when the patient’s refusal to vaccinate is based on their supposedly deeply held religious beliefs,” he said.

Doctors can also end relationships with patients as long as they follow additional steps, such as notifying them and referring them to another provider, said Susan Pace Hamill, a law professor and honorary professor at the University of Alabama. , with experience in ethics.

However, “the issue of medical ethics is not so dry,” he said. “I can see both parts.”

“On the one hand, the modern versions of the Hippocratic Oath [require] doctors to treat patients to the best of their abilities with compassion. On the other hand, doctors are free to make decisions based on their personal ethics. “

Hamill used the example of health care providers who chose or refused to perform abortions based on personal opinions.

“The refusal to vaccinate against COVID poses significant ethical issues,” he said. “We have people who get sick and die for rejecting this simple prevention.”

In addition, these same people feed advanced infections among vaccinated people, endanger children under 12 who cannot be vaccinated themselves and strain the medical system, putting the community at risk in other ways, he said. This could be considered unethical.

Valentine is ostensibly taking an ethical stance as a doctor so that all citizens have a personal responsibility to get vaccinated if they can, he said.

“Because the vaccine is free and safe, Dr. Valentine appears to be adopting an ethical stance that will only dedicate his talent and training (which is a limited resource) to those patients who have maintained their ethical responsibilities.”

Hamill said he believed the decision falls within the acceptable limits of general ethical principles, although he may also see validity in the argument that it violates medical responsibilities to treat patients with compassion, even if the disease is the result of the patient’s own decisions.

“From a medical perspective, a lot, a lot of people contribute in some way to their own health problems,” he noted.

Aaron Kheriaty, a professor of psychiatry at the University of California Irvine and director of UCI Health’s medical ethics program, says Valentine’s decision indicates a loss of professional and ethical relationships and constitutes the abandonment of his patients.

“The logic used here would never be applied anywhere else in medicine,” he said, citing examples such as discharging obese patients from losing weight or refusing to treat people with addiction who do not. they have achieved sobriety.

“Doctors try to help patients be responsible for their health and we certainly try to persuade them to make healthy decisions; but we don’t abandon them when they make medical or health-related decisions that we don’t accept. “He said. .

He also noted that there are many reasons why someone may refuse a vaccine against COVID-19, including legitimate medical reasons.

“A general condemnation of all unvaccinated is unjustified and unworthy of the medical profession,” he concluded.