ETHICS MADE REAL

Gordon Self

April 28, 2014

Reports of new confirmed cases of measles in Alberta are a sober reminder that the effort to stop the transmission of highly contagious illness is everyone's responsibility. Non-immunized persons are at risk of contracting and spreading measles, and are encouraged to get vaccinated.

Health care workers who are not immune and are exposed can put not only themselves at risk, but also vulnerable patients or residents. Thus, they may be excluded from work if exposed. Some schools in Calgary have taken similar precautionary measures to contain the risk of spread by sending non-immunized students home.

Some argue that every reasonable effort to curb the spread of measles, seasonal flu or any other communicable break should be employed, but stop short of mandating vaccinations out of respect for individual rights and freedoms. There is, however, a growing call for such measures.

One way to engage this debate is to consider the necessity of airport screening. Safety measures intended to protect all airline passengers requires their lining up, emptying pockets, taking off belts and shoes, and walking through metal detectors.

Some travelers have the added indignity of standing with arms and hands held over head in full-body scanners. We grudgingly accept these affronts to our civil liberties for a greater good. Ethically, such measures are justifiable even though they are unpleasant.

Any mandatory measure that restricts the rights and autonomy of individuals should never be imposed lightly, and never without a proportionate reason. There has to be good argument to justify the imposition, always taking the least restrictive steps to achieve the desired good.

For example, I described in a recent column during the height of flu season about the need to voluntarily roll up our sleeves to protect not only ourselves, but others too.

Lingering questions around the safety and the efficacy of the vaccine may be a barrier to getting a flu shot, thus it is important that the best available scientific evidence be consistently communicated to help address people's concerns. This is the voluntary approach we have taken with our staff and physicians to date.

But what if year after year, voluntary influenza campaigns among health care workers result in the same modest uptake, and the response is typically comprised of the faithful who are motivated to get their flu shot regardless of educational appeals? What if, after examining all our creative efforts to engage staff, based on the least restrictive measures, we are left asking what more can be done?

HIGH STAKES

The stakes are high for it is not just people at risk of infection through contact with non-immunized staff. Other non-flu patients may be negatively impacted as well if that ICU bed or surgery slate is not available to them during an influenza outbreak.

To this end, some jurisdictions have implemented mandatory flu vaccination for health care workers who have contact with patients and residents as a condition of employment. Even Alberta's health minister intimated looking into this possibility when commenting about low staff immunization rates.

While controversial, there seems to be growing ethical and legal support for mandatory immunization. This was reflected in the arbitrator's ruling in British Columbia late last year where mandatory vaccination measures were upheld as reasonable and valid, despite an unsuccessful union grievance.

Upholding mandatory vaccination as a condition of employment will set a precedent for other jurisdictions, and it may well be time to put this option on the table in Alberta.

EXTENSIVE CONSULTATION

If mandatory vaccination is to be implemented, how it is done is as important as the policy itself. People are more apt to accept a decision if they have input in the decision-making process and are given a rationale for it.

Few enjoy undergoing airport screening but most understand why it is required, and the safety benefit it achieves for the traveling public. In like fashion, implementing mandatory vaccination for the safety of self and others would require extensive consultation, providing sufficient time for stakeholder feedback.

ENCOURAGE VOLUNTARY RESPONSE

It would still require consistent messaging regarding the best available scientific evidence to continue to encourage a voluntary response.

And it would also require identifying appropriate options to accommodate a worker who, for medical or other conscientious beliefs, could not comply. For example, in B.C., health care workers who come into contact with patients who have not had a flu shot are required to wear a hospital mask.

Mandatory flu vaccination for health care workers may be the next reasonable step forward to protect the health of Albertans.

(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached at mes@covenanthealth.ca.)