Doctor refusing to see unvaccinated patients risks facing ethics charge

A doctor’s decision to stop seeing patients who have not been vaccinated against Covid-19 might have earned him some praise for taking a stand against those obstinately refusing to get vaccinated, but his peers believe his actions are not only unethical, but also premature.

This week patients arrived at Dr Tafara Machiri’s consulting rooms in Mbombela, Mpumalanga, to be greeted with a note that he “will not be seeing patients who are not vaccinated against Covid-19”.

This found its way to me via WhatsApp. I support what Dr Machiri is doing. pic.twitter.com/p3dOCxubRA

— Kananelo (@kaysexwale) September 6, 2021

The physician complained of “compassion fatigue” saying he was tired of losing people to Covid, and boasts that 43 of the 51 patients who had previously refused to get vaccinated had since received their jabs after he put up the notice.

Unethical

Machiri’s stance does not sit well with all his peers though, with the SA Medical Association (SAMA) saying he risked getting into trouble with the Health Professions Council of South Africa.

“As much as SAMA understands the frustration of doctors dealing with unvaccinated patients and COVID 19 severe cases, you as a Doctor cannot put your own interests above that of patients. It is unethical and you might run the risk of getting a complaint against you from the HPCSA,” SAMA Chairperson, Dr Angelique Coetzee, said.

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Christopher Tsatsawane, HPCSA’s head of corporate affairs, is yet to respond to questions about the ethics of Dr Machiri’s topical move.

Independent public health practitioner Dr Shakira Choonara said Machiri’s stance involved various rights, including a patient’s right to freedom of choice, as well as a health practitioner’s right to a safe work environment, and those of their other patients and staff.

“It is interesting and makes me think of practitioners who do not want to perform abortions also, then there is the Hippocratic Oath which holds personnel to fulfil duties and obligations around patients. So there are rights on all sides, which are clashing in these cases,” she said.

Choonara said personally she was against vaccination being compulsory, as she believed in patients being able to decide for themselves.

“We need to push the right information, build trust, tackle misinformation and invest in health promotion, awareness and education. Anything compulsory or forced for me personally, does not sit well,” she added.

Premature actions

According to public health and human rights lawyer Safura Abdool Karim, a doctor can legally choose whether to see a patient or not, provided they are not discriminating on the basis of race and gender.

“So it is totally within the doctor’s rights to choose whether or not to see a patient who is unvaccinated. His position is further boosted by the fact that because he is a frontline health worker, he is at risk of contracting Covid, and he works in a high risk environment,” she said.

Karim said, in her view, other doctors could adopt Machiri’s approach and decide not see unvaccinated patients, provided that vaccines were freely available to their patients.

She said though vaccination has been rolled out to anyone that is 18 years old and above, people from rural areas may be struggling to get appointments as fast.

Karim said it would be great if Machiri or other doctors considering this approach first checked if their patients were truly unvaccinated because they do not believe in vaccinations, or they were simply unable to access vaccines.

“It is tricky. There have been debates on whether or not somebody who is unvaccinated should have access to limited intensive care unit (ICU) capacity, because it is their choice. To be honest it is a bit premature at this stage to be thinking about those issues, because we have less than 20% of our population vaccinated,” she said.

According to Karim, it is going to take some time before the majority of the population was inoculated and the rollout has been slow, prompting her to warn against discriminating against people who are struggling to access healthcare services.

“So, in theory, yes, doctors can refuse to see unvaccinated patients, but we should be careful that we do not discriminate against people who have been unable to take the vaccine because they have been unable to access the services versus dealing with people who have chosen not to take the vaccine. Those are two different groups of people,” she added.