Considering oneself exposed to the virus would be a logical conclusion, upon entering medical facilities and practices that do not require vaccination or reject it altogether. Here I will also include any other practices where body-work and close physical contact is made with a client, such as massages, spa treatments, Reiki, etc.
Unlike Pagosa Springs Medical Center and possibly many others, a number of hospitals nationwide are currently mandating the COVID-19 vaccine to all their employees. Among these, RWJBarnabas Health System with 11 affiliated hospitals and 35,000 employees in New Jersey has taken this measure given that health care workers continued to get sick and even die at a time when the pandemic seems to be receding. Health care workers are at higher risk for exposure to the virus that causes COVID-19 because of their close interactions with patients. Vaccination “protects them and their patients against COVID and ensures continuation of critical health care services,” according to the federal Centers for Disease Control (RWJBarnabas Health mandates COVID vaccine for staff.)
Other examples include Philadelphia’s six-hospital University of Pennsylvania Health System, which also extended vaccine requirements to its 44,000 employees and clinical staff. In April, Houston Methodist, was one of the first hospital systems to announce a vaccine mandate, stating that it would require its 26,000 employees to receive a COVID-19 vaccine by June 7, MedPage reports. For reference, read: More hospitals require health care workers to get COVID vaccine.
In terms of vaccination requirements within health care settings, we can look at the issue from different angles. The most common concern appears to be legal liability: the fear that employees might sue for discrimination based on their personal or religious beliefs about vaccines. It seems quite incongruent to observe that individuals who appear adamant about resisting public health measures, whether it is a mask or a vaccine, would want to work in any medical setting or even become board members in our Public Health Departments. A review of these issues appeared recently in this article: What is and isn’t allowed in Colorado when it comes to compelling people to get a coronavirus vaccine. Apparently, the Emergency Use Authorization of the COVID 19 vaccines is the main reason why there are no state or federal mandates requiring vaccination at this time.
In my understanding, once the vaccine receives its full license, hospitals and medical facilities can then mandate its administration to all employees without fearing a discrimination law suit, just like they can do so with other vaccines or tests (flu shot, hepatitis test, etc.) There are a number of creative reasons as to why a particular person might reject the COVID vaccine. Yet, a common reason seems to point to the potential adverse effects of the vaccine in the distant future, given that it has only been in the market for a few months. I understand the logic. Yet, there is a different logic I can think of, in the form of a question. What other vaccine, or any other medication, has ever been administered to almost 2 billion people globally in only five or six months and produced a clinically or statistically insignificant number of deaths? I do not know yet I imagine none, or not many. In this way, the massive global vaccination becomes the factual scientific and social test.
Yet, likely the least common liability concern might be the most important: Ethics. Consider the liability of health care facilities, should any patient be placed at risk or harm or death due to COVID-19 if the resulting contact tracing points back at them. I imagine that this type of liability would most likely surpass by far any liability resulting from any employees’ discrimination claims.
I am not implying that all individuals should be mandated to receive the COVID vaccine. It is, indeed, a personal choice and in line with the ethical principle of ‘autonomy’. I would be ecstatic, however, if all individuals would do their part to end this pandemic. Individuals who don’t work in health care settings or body-work practices rely on their ideas, theories and moral values to decide what choices to make. Using moral perspectives alone, we are encouraged to reflect on what is more important, the individual “liberty”, “beliefs”, etc., or the common good?
Can we put our own individual beliefs ahead and above all group considerations that protect human health and life?
I have observed in the last few years how the word “community” is used in common language so often that has become a high frequency word. Ironically, in the last few years too, we are observing very high levels of anti-social attitudes and behaviors (self-centered, anti-community) and extreme violence. It made me think of evolution theory. Does Darwin’s notion of the “survival of the fittest” imply that there is a higher chance for individual survival in the self or in group survival? An interesting discussion is offered here: Survival of the Fittest: Groups versus Individuals. In my humble opinion, extreme self -reliance and individualism can eventually signify the demise of any culture or society.
This second layer of Ethics is one which health care professionals are required to integrate in their daily practices. Health care professionals simply cannot function at the same level; much more is expected of them. They all have a duty to follow their Ethics Codes even when these may conflict with their personal beliefs, ideas, morals, values or desires. Doctors, nurses, medical and dental assistants, psychologists, dentists, chiropractors, and even massage therapists all have ethical codes and ethical duties to abide to. There are clear limits and legal consequences to forcing one’s personal beliefs, theories and liberties onto their clients, as well as neglecting to provide informed consent. Personal values and ideas must be put to the side to amplify and fully focus on the clients or patients’ well-being.
Health care professionals’ Ethical Codes are based on centuries-old ethical principles. In the 4th century BC, Hippocrates, a physician-philosopher, directed physicians to “help and do no harm.” Such directive is known today as the principle of “Non Maleficence” (Do no harm), and is an essential piece in all health care professionals’ codes of ethics. Non Maleficence is likely more important than the principle of Beneficence “do good.” Thus, taking appropriate public health measures such as implementing vaccine mandates for all health care workers will reduce the risk of harm (and death) and will significantly contribute to ending this global pandemic. For a review of these ethical principles, here is a summary from Beauchamp & Childress, “Principles of Medical Bioethics”.
Another principle embedded in our professional ethics codes and mentioned already, is that of “informed consent.” As stated in the above mentioned article, “Further, before implementing the medical care plan, it is now commonly accepted that the patient must be given an opportunity to make an informed choice about his or her care.” Informed consent is based on the ethical principle of ‘autonomy’ to empower patients and clients to make their own decisions with regards to medical care upon given full informed consent. Autonomy directs providers to provide information and disclosures to the patient, and to answer all his/her questions. It simply reflects the need for full transparency in all medical or health care settings to allow any individual seeking care to make health care decisions.
In the absence of state or federal mandates requiring vaccination in health care facilities, what can consumers do to protect their health and life, during this pandemic? It may be obvious to the reader by now that asking pertinent questions concerning vaccination is a consumer’s right and this question is not protected as confidential information.
Getting answers is also a consumer’s right. Furthermore, any and all health care providers and facilities have an ethical duty to provide informed consent to all his/her patients. This now includes who and how many are vaccinated at any given medical practice. I can’t imagine a better marketing tool than making public an announcement such as “all staff at this facility are vaccinated. We take your health and life seriously.” Since this is not happening in our rural town, any health care facility not requiring a vaccine mandate has an ethical duty to provide consumers with complete information concerning vaccination status.
One simple yet effective suggestion is to hang a large banner at the entrance of any facility or practice who does not require vaccine mandates, that reads: “Only ____ percent of employees have received the full COVID-19 vaccine. Enter at your own risk.” This or anything similar yet perfectly clear to consumers is be added to their websites, phone holding times, and registration forms. An addition, information to consumers disclosing safe and unsafe facilities needs to be provided to consumers via local media, the public health department and the Chamber of Commerce.
Consumers have the right to know and can demand transparency due to the fact that COVID is a public health threat. Take for example, the message published by Thingamajig Theater to our readers to announce their season opening on June 25. Clearly, our local professional theater is not a health-care facility. Yet, notice their transparency during this pandemic and vested interest in consumer protection. Their message reads:
COVID guidelines in Black Box
All of the summer events will take place in the theater’s Black Box under whatever COVID health guidelines are in effect at the time – for example, relating to masks, social distancing and audience size. Because the logistics may be subject to change, the Moores will remain flexible and nimble regarding various seating configurations and other requirements, given the ever-changing COVID environment. As of this writing, it is expected that everyone in the audience will be required to wear masks, and each party will be seated six feet apart from their nearest audience members. The actors will not be wearing masks, but they all will be vaccinated.
There are a number of businesses in town which, fortunately to all, have behaved in this manner and have kept the best interests of a community — the common good — above all personal and financial concerns. I truly admire, respect and appreciate these individuals and professionals. Among these thoughtful businesses are the UPS office, and Elizabeth Davenport, dental hygienist. Thank you for your care and sensitivity to public health.
I encourage and call upon all health care professionals and affiliated wellness occupations to disclose your vaccine status for consumer information and protection.
And above all, Do No Harm.
Ana M. Sancho Sama, PhD, Licensed Psychologist, lives in Spain.