Medical Ethics is an important field because rarely are there easy answers to the questions posed throughout this thread. Discussions around ethics can be some of the most heated in medical training - there are only so many arguments to be made about reordering a differential diagnosis, but the who/when/why of treatment? - that shit can get personal, and everybody has an opinion.
Starting with the most straightforward - the Emergency Room.
He’s correct. The EMTALA law, passed in 1986 in response to for-profit hospitals in LA dumping indigent patients on skid row instead of treating them, ensures that anyone - regardless of the ability to pay - may be seen in an ER (if the hospital offers 24-hour emergency services and accepts federal payment, i.e. Medicare). No matter who you are, if you present to a qualifying ER (basically all of them), a provider there MUST perform a “Medical Screening Exam” to ensure no emergency exists. The providers have a lot of discretion as to the nature of the MSE, but usually it involves a pretty serious workup - defensive medicine and all that.
If an emergency does exist, the provider is obligated to stabilize the situation or to transfer you to a center that can. In fact, the hospital with more services MUST accept the patient referred as long as there is bed capacity. Tertiary care referral centers fill up fast in crises, which is exactly what’s happening now, with patients being stuck in the ER of hospitals that can’t provide all the services needed - no place to send anybody.
Primary care providers have a lot more discretion in treating, if they’re not employed by an outside hospital or larger healthcare organization (unfortunately, there are fewer and fewer independent practices - another discussion for another day). There may be a lot of different factors in the decision not to treat somebody. At least a couple of them have been mentioned already.
First, the willingness of a patient to follow the instructions given by the provider – you’re not gonna follow the advice I offer? Okay, maybe you get put at the bottom of the queue for additional advice & treatment. Of course, it’s rare to have a patient follow every detail of advice and prescribed treatment, so there’s something like a sliding scale here. Having trouble managing everything? Sure, let’s keep working on it - that’s more or less the bread and butter of primary care. But if you’re actively hostile to the doctors recommendations? Maybe you need to find another provider.
Second, the risk of harm to other patients from a potentially infected, non-vaccinated patient. Honestly, this may be a bit less of a concern at the moment. COVID is EVERYWHERE right now, and a medical practice trying to avoid infected patients is akin to visiting the beach and trying to keep sand out of the car on the way back - it might be possible, but it’s unlikely. To be sure, in a large patient population with unknown COVID status (infected vs not), the unvaccinated are more likely to be on the infected side of the fence; excluding them from your waiting room is one way to decrease the sand on the floor mat, but it doesn’t eliminate the risk altogether.