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Balancing health care worker immunization and patient safety

Recently, I heard a news report regarding several states’ attorneys general suing the federal government to eliminate the requirement that health care providers be immunized against COVID. They argued that as fully immunized individuals still contract COVID, and that allowing unimmunized people to be rehired would relieve provider shortages, the regulation was unhelpful.

Initially, I agreed that rehiring these individuals would generate some relief for those staff members who have worked overtime for many months; and would help reduce burnout, depression, resignations, and suicide – all laudable goals.

Subsequently, several questions came to mind: If I were hospitalized for a non-COVID condition, would I want to be cared for by an unimmunized nurse? Would the hospital have a fiduciary duty to inform me of the caregiver’s vaccination status and allow me to request an immunized caregiver? If I contracted COVID from an unimmunized employee and required intensive care or died, could the hospital be liable? Does the employee’s right to non-immunization supersede my right to a safe hospital environment? From these thoughts, I concluded that re-employing the unimmunized would be a questionable practice.

As an adolescent, my favorite author was Robert Heinlein. Most of his writings were from the 1930s to the 1950s, and he was a product of his times, being both racist and misogynistic, favoring white European men. He was also a strong individualist, and his concept of an ideal society was one in which the government was as minimal as possible, protecting the weak and ill, and in which everyone had a responsibility up to and including sacrificing their life to maintain and protect this government.

Major colonization of North America began with those who wished to be free of royal caprice and religious persecution. After the Revolutionary War, the Articles of Confederation attempted to balance individual autonomy and government control by creating a weak central authority but strong state governments, believing that by giving more power to the latter, individuals would be accorded the greatest liberty.

This approach to administration was not new, but was borrowed from the Greeks, who formed a cooperative of independent city-states over two millennia earlier, with much the same goal. The Greek system proved unworkable and collapsed. The states were more prescient and convened a committee to develop a more functional form of governing.

The Constitutional Convention sought to strengthen the federal government while maintaining maximal rights for states and individuals. The meetings were exceedingly contentious and resulted in a document constructed of compromises and defects, but that was most likely to be ratified by sufficient states to become the country’s foundation.

Examining national history, there have been necessary but temporary instances when individual rights have been limited. However, overall, these rights have been expanded. Nonetheless, there has been a shrinkage of these rights over the last 10-15 years. Part of this has resulted from the Supreme Court awarding a select group of people rights exceeding those supported by the Constitution, while diminishing rights constitutionally provided to others. The Court and the individuals who had their rights expanded perceive a society different from the present one: a society that supports them without requiring corresponding social responsibilities, thereby molding the nation into an oligarchy rather than maintaining a republic.

People who fulfill specialized roles in society often, and by choice, forgo specific individual rights – a concept Mr. Heinlein heartily supported. Ministers cannot endorse specific candidates from the pulpit or as church representatives. Those who enter the military cannot selectively obey orders. Most children, unless specific criteria are met by their parents, must be inoculated against specific contagious diseases to enter public school (recent minor relaxations of these regulations have caused outbreaks of measles and polio among uninoculated children). Those who work in health care cannot decline most infectious disease precautions (e.g., washing hands or sterilizing reusable instruments), a point recently reinforced by NIH when they reemphasized in-patient safety.

Multiple analyses of today’s vaccine refusers differentiate them from vaccine acceptors. Refusers have a greater level of generalized suspicion/mistrust, interpret others’ actions more negatively, are more likely to accept information from biased sources, are resistant/fearful of change, are more likely to use emotion in decision-making, and have a low opinion of science and scientists. These factors are not related to intelligence, financial status, or education level.

It would be reasonable to assume that individuals who enter patient-care professions wish, on some level, to help those who are ailing. If so, why would uninoculated professionals want to care for patients they could possibly infect with COVID, adding to their disease burden and possibly killing them? Does their right to be unvaccinated confer on them a right to potentially spread contagion? We are left with a conundrum, as individuals who, in desiring to protect their own rights, propose a government that reduces the rights of ailing others!

Of course, a remedy to protect non-COVID patients and employ non-inoculated caregivers would be to limit these caregivers to working with COVID patients. In this manner, these professionals would only risk exposing themselves (and their families) but not their patients to infection.

M. Bennet Broner is a medical ethicist.

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