Physicians’ obligations to protect patient autonomy during the pandemic are being complicated by vaccine hesitancy.
My patient cried violently, his face mask falling to his upper lip, as he sat only six feet away from me: “No, I’m not going to get vaccinated. That fact will not be altered by anything you do or say. ” He gave no justification for his opposition to the COVID-19 vaccination.
As a primary care resident physician practicing in an underprivileged region of Reading, Pennsylvania, I’ve witnessed patients of all ages refuse to follow COVID-19 rules like wearing a mask, social distance, or getting the vaccine.
A substantial number of illnesses have been linked to exposure in health-care settings. Early in the epidemic, one in every six patients admitted to the hospital with COVID-19 was a health care worker or their family member.
Vaccines significantly lowered this danger, and by August 2021, the risk of infection among health-care workers had been slashed in half. According to the Centers for Disease Control and Prevention, less than 70% of the vaccine-eligible population in the United States is fully vaccinated, even when the booster is included, though these figures are changing.
When a patient refuses to receive the vaccine, a healthcare worker is frequently called in to offer advice. This could take a long time, and the outcomes may not always be good.
Many doctors believe that it is the patient’s responsibility to get vaccinated, and that if they do not, they should be held responsible for developing COVID-19. One such argument is that people who are wilfully unvaccinated should have less priority for organ transplantation.
As new COVID-19 varieties develop, posing a threat to everyone’s health, doctors are torn between their duty to “do no harm” and their duty to respect patient autonomy. Some speculate that the two might even be incompatible.
“Do no harm,” as the saying goes
Refusing to get vaccinated endangers the lives of doctors and nurses. They also have a negative impact on other patients’ results. Whether done intentionally or not, this refusal shows a disrespect for human lives. Physicians must “do no damage” to everyone else just as much as they must “do no harm” to the patient.
A patient’s right to refuse treatment for their own illness may be difficult for physicians, but a patient’s right to refuse treatment for an illness that can spread may be even more difficult for physicians.
Ethical theories may aid in the understanding of a physician’s responsibilities.
Immanuel Kant, a German philosopher, introduced the concept of an absolute, universal reason to act out of obligation. According to this theory, doctors have a moral duty to tell their patients about vaccines. It’s not just an option.
Doctors have a responsibility to educate their patients about COVID-19, vaccination, and the necessity of protecting other patients and the general public, although they cannot force the patient to get vaccinated out of respect for the patient’s ability to make educated decisions.
This also brings up the topic of patient autonomy. One of the cornerstones of bioethics is autonomy, which is defined as the patient’s ultimate decision-making capacity. There’s no arguing that a patient’s ability to make decisions is crucial. In the end, the patients want what’s best for them, and respecting their choices means valuing their health.
Some academics, on the other hand, are debating the notion that the doctor is the most knowledgeable. The notion behind “paternalism” is that physicians should be the ones to make the final choice about what is ethically right for the patient because they know better.
People who have been intubated can get angry and try to get their breathing tube out, so soft materials can be used to tie their hands.
Last year, some doctors argued that healthcare employees should be required to receive COVID-19 immunizations. This argument from doctors is always met with opposition from anti-mandate activists, which separates the patient from the doctor even more.
Resources are limited
So who should get limited life-saving treatments? People who have been vaccinated or people who haven’t been vaccinated.
One example of this problem is the use of Paxlovid, a relatively new medicine that can be taken in the outpatient environment for the treatment of COVID-19. Those who had never been vaccinated were the first to be treated in the clinical trials.
According to those studies, Pfizer claims that Paxlovid is 89 percent effective in lowering the risk of hospitalization or death in study participants who received medication within three days of the onset of symptoms.
If doctors have one life-saving drug and two patients, one with COVID-19 and the other who doesn’t want to be vaccinated, which one should they choose?
From an insurance standpoint, there are further ethical concerns, such as who should cover the cost and whether the unvaccinated should pay a higher rate.
Through teaching and counseling, I have been effective in altering people’s opinions regarding the vaccine in my own practice.
But there are still unanswered concerns about what patient autonomy should look like as we learn to live with COVID-19 and how the doctor-patient relationship might alter. These larger issues are just beginning to be discussed.