DO GOOD AND AVOID HARM:
Why Health Care Providers Should Get a COVID-19 Vaccination Charles E. Binkley, MD The COVID-19 pandemic has taken a substantial toll on health care providers. In the early days of the pandemic, when personal protective equipment (PPE) was scarce, providers were putting themselves, and their families, at risk for contracting the virus. Providers then suffered the emotional effects of caring for so many sick and dying patients as surge after surge ripped across the world. Despite the trauma that COVID-19 has inflicted on many in health care, some providers are declining vaccination. The question that now arises is whether or not health care providers are ethically required to receive a vaccination. The primary ethical obligation that every health care provider has is to do good and avoid harm to patients. For most people that manifests as making the correct diagnosis, administering the right treatment, and ensuring that benefit exceeds risk. However, in the setting of an infectious pandemic, an important part of that ethical commitment to patients is to not unintentionally infect them with COVID-19. Providers often have to interact with patients in ways that do not always allow for implementation of contagion reduction strategies such as social distancing. This not only places the provider at risk of contracting the virus from a patient, it also places a patient at risk of contracting the virus from the provider. Because of the greater number of potentially infectious contacts that providers have, in many ways providers pose a greater risk to patients than do patients to providers. As well, patients may have medical conditions or comorbidities that make them more susceptible to infection and/or more likely to have a serious course should they be infected. Receiving a COVID-19 vaccine is the most medically and ethically sound way that providers can fulfill their commitment to do good and avoid harm to their patients. Besides the ethical obligation that providers have to their patients, providers have an additional obligation to protect the safety of the entire health care team. Requiring that all team members be vaccinated is a direct way of meeting this obligation to the team, as well as to the patients they serve. In some ways it may not only be ethical to require that all members of the health care team be vaccinated, it could also be seen as unethical not to require vaccination. Members of the health care team who are unvaccinated pose an unnecessary risk of harm to patients and colleagues alike. This avoidable risk of harm is contrary to the duty that the health care team owes to patients, as well as the duty that members of the team owe to one another. Some providers may object to being vaccinated, citing their right to make their own health care choices, including whether to get the vaccine. Patients reasonably expect that health care providers will respect their individual autonomy and right to self-governance, but there is no such reciprocal obligation owed to providers. In fact, providers already relinquish some of their 28
SAN FRANCISCO MARIN MEDICINE APRIL/MAY/JUNE 2021
autonomy over their own health as part of being in the profession. Providers have an ethical obligation to care for patients, even if there is some personal risk to the provider’s health. Providers are also required to maintain certain health standards, such as annual tuberculosis testing and potential treatment as a means of not harming patients or other members of their team. Some providers may seek medical exemptions. Indeed, there are legitimate medical exemptions, such as a history of severe allergic reaction to vaccines, medical comorbidities, and disabilities. Pregnant providers may be able to claim an exemption based on the limited data available in this population. However, the CDC is currently recommending that high risk pregnant people receive the vaccine since they are at greater risk of severe infection and are also likely to be at an increased risk of adverse pregnancy outcomes if they contract COVID-19. Exemptions based on philosophical and/or religious grounds are another consideration. Since many religious leaders argue that receiving the vaccine to prevent infecting other people is a moral obligation based on charity and love for one’s neighbor, these exemptions should be carefully considered. In addition, framed through the religious lens of preserving life, one could imagine that certain faith traditions may encourage their followers to be vaccinated. Providers may also seek a consciencebased exemption since all the currently approved vaccines have some association with stem cells from aborted fetuses. However, in the carefully reasoned judgment of the Roman Catholic Church, one of the most strident institutions to oppose abortion, the vaccines are all morally permissible. Health care providers should receive COVID-19 vaccinations not only for their own health, but also to protect their patients and other members of their teams. It is always preferable for ethical choices to be made based on individual agency. However, once vaccinations receive final Biologics License Approval, it could be ethical to require health care providers to receive a vaccine. The process would need to be transparent, and applied equitably and justly. Such a mandate would have to be guided by the obligation to do good and avoid harm. Mandating that health care providers receive a vaccine would also need to be a last resort. It’s time to end the collective trauma caused by COVID-19. Charles Binkley, MD is Director of Bioethics, Markkula Center for Applied Ethics at Santa Clara University.
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