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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Bioethicist makes case for mandatory flu shots

Is it unethical as a medical professional to refuse vaccination against influenza? One of the nation’s leading bioethicist says it is, outlining the key issues to be considered in a provocative commentary. Arthur Caplan, PhD, professor of medical ethics and health policy at the University of Pennsylvania Center for Bioethics in Philadelphia makes his case via the following arguments:

“It is time to make clear what the ethical reasons are for requiring vaccination and then to get a mandate in place in all health-care institutions and clinics. … First, every code of ethics adopted by physicians, nurses, nurses’ aides, social workers, pharmacists, and other health-care professionals states very clearly, succinctly, and loftily that the interests of patients must come ahead of anyone else's. … 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. “Second, all health-care workers are obligated to honor the core medical ethics requirement of ‘First Do No Harm.’ 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. 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. “Lastly, health-care workers have a special duty towards the vulnerable who cannot protect themselves. This is a duty that is widely acknowledged in professional codes of ethics. Newborn babies, infants, and the seriously immunocompromised can do little to protect themselves against acquiring diseases in hospitals, nursing homes, and home-care settings. Few people pick their health-care providers or even know to ask if they have been vaccinated. Health-care providers have an absolute duty to do what can be done to ensure they do not transmit diseases to those at grave risk who cannot protect themselves. Vaccination against influenza and other communicable diseases is an important step in fulfilling this duty to protect the vulnerable. 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."