Nonmaleficence


Nonmaleficence is the obligation of a physician not to harm the patient.


This should scare you.



Over the weekend, I saw some disturbing headlines in which, physicians, hospitals, and political pundits, are considering and giving their opinions on whether they will or can deny care to the unvaccinated who contract Covid-19. If you don't believe me, google it. Attached are two examples, but there are many.


We don't owe the unvaccinated priority on hospital care

https://www.galvnews.com/opinion/editorials/free/article_218a58d6-9417-5731-ae60-c1010b819393.html


Here is the latest example: https://www.newsweek.com/florida-doctor-will-no-longer-treat-unvaccinated-person-denies-violating-hippocratic-oath-1626170


While I understand that nobody could have predicted this horrible and deadly pandemic, I must ask the question; didn't physicians take an #oath when they became a doctor of maxim primum non nocere (first do no harm)?


The #hippocraticoath, written by Hippocrates, has changed and or been amended over time as it is one of the oldest binding documents in history and held sacred by most physicians. The earliest known version of the Hippocratic oath dates back to the fifth century B.C. Many iterations exist, and in many U.S. medical schools, it has become customary for incoming medical students to write and even recite their own versions; many of the variants include language that prohibits discrimination or bias in the practice of medicine.


See an article in NPR

The new oath asks physicians to eliminate their personal biases, combat disinformation to improve health literacy and be an ally to minorities and other underserved groups in society. A New Hippocratic Oath Asks Doctors To Fight Racial Injustice And Misinformation


,


https://www.npr.org/sections/health-shots/2020/11/04/929233492/a-new-hippocratic-oath-asks-doctors-to-fight-racial-injustice-and-misinformation


Understand that I am not writing this as a conspiracy theorist, anti-vax, don't trust the government, #Karen, I'm writing to attempt to get my mind around a physicians right to pick and choose their patients based on whether they have taken a vaccination that there is a lot of fear surrounding its efficacy, side effects, RISK, and speed to market. So let's begin.


 

If you have a private practice or are in a large medical umbrella (lower medical malpractice costs), you can choose not to take patients with health insurance that you determine unacceptable. Yes, doctors aren't required to accept health insurance plans or accept the rates that insurance companies decide to pay doctors. If you chose to see one of these providers, it is considered out of network, and you as the patient will have to agree upon a price or be treated as uninsured and be responsible for the entire bill. So this is one example of a physician's right not to accept you.


From a personal experience, I had a very ill relative in end-stage renal failure. She moved out of state and took with her binders full of medical records. At least 75 percent of the general practitioners she tried to get into denied her insurance, which left her to go to the emergency room more times than necessary and get inconsistent, blind, and faulty care. This was both due to her medical history (#preexistingconditions) and #insurance. It really sucked, and she did not have many options.


In March of 2010, the Affordable Care Act was signed into law by former President Barack Obama. . Its full name is the Patient Protection and Affordable Care Act. This complex act has changed the playing field for insurance companies, physicians, hospitals, and patient access to healthcare. It has its pros and cons; however, it is also a political football due to too many issues (I'll table that for another day).


I mention it ONLY because within this ACA; insurance companies are not allowed to deny you health insurance because of preexisting conditions — that is, a health problem you had before the date that new health coverage starts. These rules went into effect for plan years beginning on or after March 23, 2010. For the most updated changes made by the government to the ACA, see the link below:

https://www.healthaffairs.org/do/10.1377/hblog20210316.222833/full/#:~:text=The%20new%20law%20extends%20ACA,2021)%3B%20and%20prevents%20individuals


So typical of me, I got off-topic for a minute, but you will see that it all does relate to a doctor's or hospital's right to refuse the treatment of #nonvaccinated patients. Please stay with me. I live in New York state, not far from NYC. During 2020 I had Covid-19 in my face every day, all day. I had family members working in hospitals in the city, saw loss, and personally have been diagnosed with Covid-19 twice. I guess you would call me lucky because it didn't kill me, and I have many preexisting conditions that place me at high risk. Here is my problem with what I hear in the press and in the links I have provided; it is a conflict of interest and unethical. There is no way around it.


One person’s rights do not end where they are perceived to impede the rights of others.


In 2020 many non-emergency and/or elective procedures were put off because an all-hands-on-deck approach was needed in many hospitals across the United States. Having doctor's appointments via smartphone has become the new norm or at least a preferred option. Unfortunately, proactive wellness checkups were also put off. The jury is out on the effect these delays will have on newly diagnosed patients with diseases such as cancer, where early detection is key to survival.


How are these same doctors, hospitals, groups, influencers, mainstream media, social media, big tech, and any other group I forgot to mention going to determine whether or not to treat a lifelong smoker who develops lung cancer? What will they say to the person newly diagnosed with liver cirrhosis because they drank too much? What about the morbidly obese patient diagnosed with type II diabetes and or heart disease because they lived an unhealthy lifestyle and had a terrible diet? What about the developmentally delayed person who doesn't have the means or support to go to a place or make an appointment to get vaccinated? I honestly could go on forever with examples that the patient may create illness due to lifestyle choices, bad luck, poor access to healthcare, poverty, and/or disability.


No medical therapy comes without risk, but informed consent – another foundational principle of medicine – demands that any risk be related accurately to the patient. I think that #operationwarpspeed demonstrated that #healthcare, #science, and #pharmacology could come together quickly and create possible treatments for disease or, in this case, a global #pandemic. That is fantastic because if you have ever been on the other side of waiting to be on a life-saving drug trial that is not FDA approved or in clinical trials, this pace to market and availability is unprecedented.


So we now are finding ourselves in the world of variants. It seems like a bad movie is going to be on the television for the foreseeable future. The headlines and daily ticker feeds are coming back of Covid-19 positive cases and deaths by state and county. We see the government mandating vaccinations for federal employees and the President encouraging the private business sector to require vaccinations or else. The "else" seems to be several things including, termination, mandating weekly testing of the unvaccinated, increasing health insurance premiums for the unvaccinated, offering "employee incentives" such as days off, free donuts, and the best I have read is free marijuana to the vaccine-hesitant. I know you don't believe me. See below:

https://www.forbes.com/sites/ajherrington/2021/05/07/free-marijuana-for-covid-19-vaccines-proves-to-be-a-popular-perk/?sh=4be887c724ab


Bribery, termination, and employee coercion are a slippery slope for employment practice law. It is in the infancy stage as the EEOC, OSHA, and CDC all have different positions on it, and it also varies by state. But, and this is a big but, if doctors or hospitals begin to pick and choose who they will treat out of anger and frustration of what they perceive as their patient not doing their duty as a patient, thereby out of luck if they do get Covid-19 and need care, that is against any version of the #oath that they took when they became physicians. Patient autonomy is one of the founding principles of the doctor/patient relationship. The right of patients to make decisions about their medical care without their health care provider trying to influence the decision.


Stress in the system can and will stress all involved and those in the frontline in this pandemic are tired. I get it. It is a dilemma of ethics. Is the treatment worse than the disease? Do the benefits outway the risks associated with the vaccine? What is the mortality rate of an otherwise healthy patient that gets the virus or variant? What long-term effects does the vaccine have over time? All I can say is that if we begin to allow physicians or hospitals to pick and choose patients they will accept based on their vaccine status, we have lost our way. It should also scare the shit out of you because where will it end?


This is a great oped written by a physician

As a doctor, here’s my message to anyone who thinks it’s OK to deny medical treatment to those unvaccinated against Covid

https://www.rt.com/op-ed/533903-medical-treatment-denial-unvaccinated-covid/



 

In late July 2021, the CDC published a report evaluating outbreaks of SARS-CoV-2 that were associated with large public gatherings in Barnstable County, Massachusetts. Out of the 469 identified cases of COVID-19, 346 or 74% of them were breakthrough infections that occurred in people who were fully vaccinated with 2 doses of Pfizer or Moderna or 1 dose of the J&J vaccine. Genomic analysis revealed that Delta was responsible for 90% of the 133 sequenced breakthrough infections. This information prompted the CDC to recommend the use of masks in indoor public spaces, regardless of vaccination status, in areas where COVID-19 transmission is high. Further research into breakthrough infections that occur after COVID-19 vaccination is needed.


Source: https://asm.org/Articles/2021/July/How-Dangerous-is-the-Delta-Variant-B-1-617-2


Stay healthy.


#notinvainapromisekept #patientadvocacy #medicalmalpractice



















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