Ethicist argues for mandatory healthcare worker flu vaccinations

In an editorial in the July 23 issue of the journal Lancet, ethicist Arthur L. Caplan argues that to protect patients from infection, morbidity and death, influenza vaccination should be mandatory for healthcare workers.
Caplan, who is the Emmanuel and Robert Hart Professor of Bioethics and the director of the Center for Bioethics at the University of Pennsylvania, writes that there are three major ethical reasons why healthcare institutions and clinics should require vaccination, according to the Lancet.
"First, every code of ethics adopted by physicians, nurses, nurses aides, social workers, pharmacists and other healthcare professionals states very clearly, succinctly and loftily that the interests of patients must come ahead of anyone else's," Caplan writes, according to the Lancet. "Whatever one's views about personal rights to choose, unless a valid medical reason exists to not vaccinate, the best interests of the patient trumps personal choice in the hierarchy of self-imposed professional values."

In addition, Caplan says that all healthcare workers are obligated to honor the "First Do No Harm" core medical ethics requirement.

"Given the evidence that vaccination prevents disease transmission to the vulnerable and maintains the health of health-care providers which allows them to work, the most fundamental moral requirement in all of health care demands that those in care-giving roles treat influenza vaccination as obligatory," Caplan writes, the Lancet reports. "It also requires that those who run health-care institutions and programs act on and implement that principle in the form of making vaccination against influenza a mandatory condition of employment or volunteering."

Finally, Caplan says that healthcare workers must protect the vulnerable who cannot protect themselves, such as newborn babies, infants and the seriously immunocompromised. Since few people pick their healthcare providers or even know to ask if they have been vaccinated, Caplan writes that these providers have an absolute duty to ensure they do not transmit diseases to those who are unable to protect themselves.

"Vaccination against influenza and other communicable diseases is an important step in fulfilling this duty to protect the vulnerable," Caplan writes, according to The Lancet. "It takes obvious moral priority over one's personal choice not to be vaccinated or individual delusions about why vaccination is not necessary in dealing with patients who are of necessity highly vulnerable to influenza."

Caplan writes that for such a mandate to succeed, it is vital that healthcare workers fully understand the moral and empirical rationales for such a requirement. He suggests that each workplace mandate be preceded by a comprehensive educational program and that vaccination must become a condition of employment for these workers.

"Vaccination is a duty that one assumes in becoming a healthcare provider," Caplan writes, according to the Lancet. "Mandating vaccination is consistent with professional ethics, benefits many, including some of whom must rely on healthcare workers to protect them, maintains a stable workforce, and sets an example that permits honest engagement with others working in hospital settings and with the general public in educating them to do the right thing about vaccination."