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Several ethicists have argued that clinicians have obligations to treat such patients, yet providing care\u00a0to these patients has distressed clinicians, who have at times declined to do so. Critical questions thus emerge regarding how best to proceed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main body<\/jats:title><jats:p>Providers face moral tensions: whether to place the benefits to\u00a0an unvaccinated patient over their duties to protect themselves and their families, staff and other patients, and goals of working collaboratively with patients. Clinicians\u2019 duties to treat such patients arguably outweigh claims otherwise, but these obligations are creating moral conflict and distress for providers. Moral distress has been associated with burnout, post-traumatic stress disorder, and interpersonal and work difficulties. Given ongoing vaccine refusals, these problems are unlikely to disappear in the foreseeable future. Society has obligations to address this moral distress due to principles of reciprocity, and implicit social contracts, as part of which physicians risk their lives in caring for patients for the good of society as a whole. Responses are thus urgently needed at several levels: by hospitals, medical schools, professional societies, governments, media, providers and patients. Medical training on professionalism should address these stresses, probing why doctors have duties to treat these patients, but also how moral conflicts can ensue, and how best to address these tensions. Governments and institutions should thus alter relevant policies and devote more resources to addressing clinicians\u2019 psychological strains. Institutions should also improve organizational culture. Public health organizations and the media described clinicians, earlier in the pandemic, as heroes, committed to treating COVID patients. This narrative should now be changed to highlight the strains that unvaccinated patients cause\u2014endangering hospital staff and others.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Unvaccinated COVID patients should receive care, but multi-level strategies, involving enhanced policies, education and practice are vital to alleviate ensuing moral distress, and thus aid these clinicians and their patients. Ethical arguments that providers must treat these patients have not considered these obligations\u2019 effects on clinicians, but should do so.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12910-022-00859-9","type":"journal-article","created":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T15:02:58Z","timestamp":1668438178000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Needs to address clinicians\u2019 moral distress in treating unvaccinated COVID-19 patients"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6827-8063","authenticated-orcid":false,"given":"Robert","family":"Klitzman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,11,14]]},"reference":[{"key":"859_CR1","unstructured":"Jewett C. 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