Can doctors and hospitals deny treatment for unvaccinated COVID-19 patients?

This article has been updated with a response from the Tennessee Department of Health. 

 Across the South, hospital systems are in distress, and many administration officials have said facilities will soon have to start triaging scarce healthcare resources based on a patient's likelihood of survival. 

This has led some healthcare officials to consider whether vaccination status ought to be a factor when deciding who gets care and who doesn't when hospitals are operating under so much strain. 

The Dallas Morning News published an internal memo, circulated among Dallas physicians, that raised the question of whether a person's vaccination status should figure into a patient's chances of survival, and by extension, treatment access.  

In Alabama, one doctor made the decision to no longer treat unvaccinated patients, explaining to the Birmingham News, "If they asked why, I told them COVID is a miserable way to die and I can’t watch them die like that."

And while social media commentary is hardly a scientific poll, scroll through the comment sections that follow articles about scarce hospital capacity, and it becomes clear that some Americans are wondering: Why should precious lifesaving resources go to those who refuse to protect themselves against COVID-19?

So, what does a person's vaccination status mean for individuals severely ill? 

Memphis-area health officials: COVID vaccination status doesn't matter

Recently, more than a dozen hospital officials signed a letter warning city and county leaders that hospitals would soon have to start allocating resources based on a person's chances of survival. 

"To be clear," the letter read, "We may be unable to provide timely care to everyone and will have to make choices about delivering care to patients based on their probability of survival." 

Methodist Le Bonheur Healthcare, the area's largest hospital system, has said vaccination status would not factor into decisions around who would be treated. 

"While we strongly encourage everyone who is eligible to get vaccinated against COVID-19, all Methodist Le Bonheur Healthcare patients receive the same quality of care regardless of vaccination status," the hospital system said in a statement.         

The hospital system warned its census of admitted patients with COVID-9 was nearing 300, saying, "This is a record no one wants. Vaccines are our only hope of stopping this insidious pandemic. We are pleading with the community to get vaccinated."

Tennessee Hospital Association: All will be treated

When asked if a patient's vaccination status would be considered under a scenario that calls for evaluating a patient's likelihood for survival, the Tennessee Hospital Association said vaccination status would not be a determining factor. 

"Hospitals have a mission to serve their communities and provide life-saving care to anyone in need. Moreover, hospitals are bound by the Emergency Medical Treatment and Labor Act, a federal law intended to ensure all have access to care in an emergency. Tennessee hospitals will continue to treat patients regardless of their vaccination status but urge everyone to do their part and get vaccinated for COVID-19 if eligible," wrote Andrea Turner, a spokesperson for the hospital association. 

The organization is a non-profit that advocates for hospital systems and their patients on issues like policy and state laws. But, they do not govern hospitals systems.

The Tennessee Department of Health said while the state has published guidelines for ethical allocation of scarce healthcare resources, it is up to each individual hospital or hospital system to make their own choices.

Mississippi and Arkansas hospitals on unvaccinated patients

Both the Mississippi Hospital Association and the Arkansas Hospital Association were asked if a person's vaccination status would have any bearing on whether they were allocated scarce treatment options. 

Shawn Rossi, a spokesperson for Mississippi's association said he was unaware of any such discussion; the state hospitals are treating individuals with severe cases of COVID-19 regardless of vaccination status.

The Arkansas Hospital Association did not address the question directly but offered a statement that said the state's hospitals were doing everything possible to expand treatment capacity. 

"So far, hospitals of all sizes throughout the state have been willing and able to incrementally increase capacity in the face of surging demand for hospital care. The largest obstacle they have faced and continue to face in doing so is staffing shortages," said Arkansas Hospital Association spokesperson Ashley Warren. 

The National Hospital Association's answer is mixed 

At the national level, however, the answer of whether a person's vaccination status could affect their chances of receiving scarce care, is more nuanced. 

The short answer, according to the American Hospital Association is yes, with a caveat. 

For emergencies or pregnant patients that arrive in labor, their vaccination status has no bearing on their ability to receive care. But, if a patient is not in acute distress, and needs a procedure that can be delayed for a bit of time, then hospitals could wait until the patient is healthy enough to be vaccinated. 

The full statement from the American Hospital Association is as follows: 

"During an emergency situation or if the patient is in labor, the Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to stabilize and initiate treatment. If a patient is in need of non-emergency surgery, or other care that might leave the patient with a weakened immune system or the inability to mount a strong response to the vaccination, doctors may want to delay services long enough for the patient to get vaccinated so that they are as safe as possible." 

Ultimately, ethics could ensure the unvaccinated receive care 

Daniel Wikler, a medical ethicist at the Harvard T.H. Chan School of Public Health recently penned a column for The Washington Post that argues a patient's access to care should not be contingent on whether they have received the COVID-19 vaccine. 

The same ethics that guarantee a life-long smoker will be treated for lung cancer should also apply to the unvaccinated, Wikler argues. 

Wikler's stance contradicts that of Trish Zorino, a scientist and expert in behavioral neuroscience for the University of Colorado - Denver.

In a piece for NC Policy Watch, Zorino opined, "As controversial as it may be, we should deprioritize the eligible unvaccinated patients during medical triage. It’s a free country, and you can absolutely choose not to get the vaccine. But choices have consequences, and the willingly unvaccinated have made this consequence necessary."          

For now, hospitals in the South will likely continue to allocate scarce resources in order to treat patients who are unvaccinated. But the question of whether it is fair or ethical to do so is being debated.

Micaela Watts is a reporter for The Commercial Appeal, and can be reached at micaela.watts@commercialappeal.com.