It's not unethical for dentists to refuse care for unvaccinated patients in some situations, according to an updated version of the American Dental Association Principles of Ethics & Code of Professional Conduct.
Given the communicable nature of diseases such as measles and COVID-19, it is necessary to consider policies that accommodate those who choose not to be vaccinated, those who cannot be vaccinated and those who are actively ill, the update reads.
"For example, a practitioner who treats a population of highly vulnerable patients, perhaps including some for whom vaccination is contraindicated, may conclude that the ethical obligation to those patients outweighs the ethical obligation to those who willingly choose not to be vaccinated and therefore may present a higher risk to the other patients," said Robert Wilson, DDS, immediate past chair of the ADA Council on Ethics, Bylaws and Judicial Affairs. "Perhaps a doctor or staff person has a condition that precludes inoculation and renders them highly vulnerable to significant morbidity or mortality. Because of these very specific and unique circumstances a blanket statement to the effect that dismissing or refusing to care for an unvaccinated patient is unethical would not be appropriate."
Policies should respect the code's principles of autonomy, beneficence and nonmaleficence and be fair to all involved, according to the ADA.
"Refusal of care altogether or dismissing patients is not per se unethical, so long as necessary precautions are taken as may be dictated in your state and patient abandonment does not occur," the guidance reads. "However, this misses a teachable public health opportunity and an opportunity to build trust with patients and to 'use skills, knowledge, and experience for the improvement of the dental health of the public.'"
Additionally, to avoid contributing to the spread of disease, dental professionals have an ethical obligation to be vaccinated, unless they have a recognized medical contraindication, according to CDC and ADA guidelines. Personal negative feelings to vaccination don't outweigh a dentist's ethically and scientifically-based professional responsibility to limit the spread of harmful infectious diseases, the ADA says.