Is medical treatment just another business — or is treatment of all an ethical duty? One Florida doctor has drawn a line around her clinic and told the unvaccinated not to cross it. Linda Marraccini still offers telemedicine options for those who do not want to get inoculated against COVID-19, but has declared her in-person services open only to those who take the vaccine.

“This is a public health emergency,” Marraccini wrote to her patients, scolding the unvaccinated for their “lack of selflessness and concern” for others:

A Florida doctor says she will stop treating patients in person if they are not vaccinated against COVID-19, citing the risk of exposing immunocompromised patients and staffer to the virus that has killed over 46,000 people in the state and more than 648,000 nationwide.

“I understand that people are free to choose, but to me, it’s a problem when it affects other people,” Dr. Linda Marraccini said.

With the Delta variant fueling the latest COVID-19 surge, the Marraccini said she had to make a tough decision for her practice.

“When it comes to the safety of others, when it comes to the fact that it’s a global health problem and community health problem, at this point, I really say that this is where it draws the line in the sand for me,” Marraccini said.

Note that the chyron is actually inaccurate, at least to some extent. Marraccini is not refusing medical care; she’s just insisting on virtual meetings with the unvaccinated. It would be an ethical violation to refuse care entirely to any sick person. There’s an open debate as to how effective telemedicine has been, but some providers had begun offering it as an option even before the pandemic. And since it is an option, should Marraccini choose to prioritize safety for her staff and other patients ahead of potentially unnecessary in-person appointments with unvaccinated clients?

That raises a number of questions, though. Does this apply to other vaccinations, such as pneumonia, chicken pox, MMR, and so on? Most of those aren’t as transmissible as COVID-19’s Delta variant, but some of them are more deadly, and those have vaccine skeptics as well. If not, why treat patients differently for not choosing to get a brand-new vaccine while not making an issue of refusal to take well-established vaccines? If transmission is the issue, then have the patients and staff wear masks at all times — which most clinics already mandate.

Also, why now? It’s true that Florida has just had a wave of Delta-variant infections, hospitalizations, and deaths, it does appear that the wave may have already crested. Furthermore, state’s vaccination rate is a bit better than the national average:

Florida is still struggling with infections that have overwhelmed hospitals across the state, reporting more than 46,000 new cases of infection over the holiday weekend, according to data compiled by The Washington Post. While the state appears to be turning the corner, with a seven-day average for new infections that has dropped by 18 percent, Florida is still reporting a daily average of 17,570 coronavirus infections.

The state announced Monday that more than 1,000 covid deaths were reported over the weekend. Nearly 13,800 people are hospitalized for covid in the state, with 3,183 occupying beds in intensive care units — second in the nation behind Texas.

Nearly 54 percent of the state is fully vaccinated, which is now slightly higher than the nation’s vaccination rate.

The case rate in Florida is still astronomical, but it’s plunging at the moment, as are deaths — thankfully:

The trend for deaths started two weeks ago and has accelerated back to a post-vaccine low almost as rapidly as deaths hit a pandemic high. Marraccini appears to be closing a barn door after the horse has bolted.

Finally, just how does this square with the science on vaccination? It’s true that Delta can produce breakthrough infections, but the odds are incredibly low. For the most part, the risk presented by the unvaccinated falls on the unvaccinated themselves. If we are to live with COVID — and we really don’t have much choice — then we need to assume the same risks we do with other infectious diseases. Masking in doctor’s offices might be here to stay, but exile and vaccine-shaming are not likely to advance any cause, epidemiological or cultural.

Elizabeth Bruenig wrote about this kind of “death shaming” in the media and by institutional leaders last week, and its unintended consequences. Whatever happened to empathetic persuasion, Bruenig wondered:

But if persuasion is the target, then the aim seems off—a general problem in our democracy, where persuasion is a key method of self-governance but something we’re less and less amenable to. In that sense, the strange case of vaccine persuasion is just another entry in the annals of our disillusionment with our own liberal democracy. One receives the distinct impression from today’s discursive environment that persuasion in its traditional democratic form—wherein a great deal of value is placed upon shrewd and moving rhetoric that assumes listeners’ basic goodwill—is a useless venture, and that lower forms—insults, scolding, intra-group memeing, the dirty persuasion of disinformation campaigns—are all that’s left. Maybe those things are useless too, one gathers, but at least they’re fun and cathartic.

Still, it’s worth considering what an honest persuasion effort aimed at the unvaccinated or vaccine-hesitant would look like, even if we may never see the population-level vaccine uptake that we’d like to. Good-faith persuasion is a matter of discipline and habit; it’s not something that comes naturally. It also happens to be a practice that maintains the premise that liberal democratic politics can change, that they can respond to the shifting will of the people without violence or civil unrest. Perhaps we’ve already come near that point through lopsided, bitter polarization. But inasmuch as democracy is a shared vision—a collaborative dream about the kind of governance we’re capable of and the sort of future we could build—it’s crucial to keep its practices alive even when its functions have broken down. The dream is the last thing to go.

Marraccini fell into this trap with this declaration. She might have a defensible position here, but it’s certainly not empathetic — or, one can imagine, persuasive either.