A primary care physician in Alabama has sparked both praise and furor this week after he sent a missive to patients: No vaccination, no treatment.
Dr. Jason Valentine, a doctor specializing in family medicine at the Infirmary Health Diagnostic and Medical Clinic in Saraland, Alabama, posted an image on Facebook that showed him posing next to a sign that advised patients of his new policy, which will be effective Oct. 1.
“Dr. Valentine will no longer see patients that are not vaccinated against COVID-19,” said the sign, which was taped to a door.
He said he was sending letters to patients informing them of his decision, according to AL.com, which viewed the post before it was removed.
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,” he ended the note.
According to the Alabama Department of Public Health, Alabama hospitals ran out of ICU beds this week as a COVID-19 surge driven by the highly contagious delta variant hits the state’s largely unvaccinated population.
With just 36% of eligible Alabamans fully vaccinated, the state has one of the lowest vaccination rates in the country. Only 47% of eligible Alabamans have received even one dose.
In July, Alabama Gov. Kay Ivey (R) said it was “time to start blaming the unvaccinated folks” for letting the state down.
Valentine’s post reflects a dilemma that medical professionals around the country are facing.
A family physician in New York last month asked if it was ethical to restrict vaccine-refusing patients to telehealth 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 echoed by many other front-line health care workers. Doctors in Texas are reportedly considering taking vaccination status into account when making triage decisions, should the state run out of ICU beds.
Valentine’s decision prompted mixed, though largely positive, reactions from the commenters who flooded the reviews sections of his online medical profiles.
“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 argued, however, that Valentine was letting “his views interfere with his professional oath.”
Diagnostic and Medical Clinic declined to comment to HuffPost, and HuffPost was not able to reach Valentine directly.
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
Two legal experts told HuffPost a doctor has a legal right to refuse treatment to unvaccinated patients. However, from an ethical standpoint, the issue is more complex.
Private doctors can legally refuse to treat patients in nonemergency situations for a variety of reasons, as long as that refusal is not based on factors like the person’s sex, religion or national origin, said Danielle Weatherby, associate professor of law at the University of Arkansas.
“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 terminate patient relationships as long as they follow additional steps like providing notice and a referral to another provider, said Susan Pace Hamill, a professor of law and honors professor at the University of Alabama with expertise 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.”
‘Refusing the COVID vaccination raises significant ethical issues.’
Hamill used the example of health care providers choosing or refusing to perform abortions based on personal views.
“Refusing the COVID vaccination raises significant ethical issues,” she said. “We have people getting sick and dying because they refused this simple prevention.”
Moreover, those same people are fueling breakthrough infections among vaccinated people, endangering children under 12 who cannot be vaccinated themselves, and straining the medical system, thus putting the community at risk in other ways, she said. That could be considered unethical.
Valentine is ostensibly taking an ethical stand as a doctor that all citizens have a personal responsibility to get vaccinated if they can, she said.
“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 said she believed the decision falls within acceptable boundaries of general ethics principles, though she can also see validity in the argument that it violates medical responsibilities to treat the sick with compassion, even if the sickness 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.’
Aaron Kheriaty, a professor of psychiatry at the University of California Irvine and director of the medical ethics program at UCI Health, says Valentine’s decision indicates a loss of professional and ethical bearings and constitutes abandonment of his patients.
“The logic employed here would never be applied elsewhere in medicine,” he said, citing examples like discharging obese patients for failing to lose weight or refusing to treat people with addiction who haven’t achieved sobriety.
“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 a fellow human being in need of care; we do not blame the sick for their plight.”
He also noted that there are many reasons why someone may decline a COVID-19 vaccine, including legitimate medical reasons.
“A blanket condemnation of all the unvaccinated is unwarranted, and unworthy of the profession of medicine,” he concluded.
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