Mandatory vaccinations? A brief primer on medical ethics | Aaron Wood
The push for the Covid-19 vaccinations to be mandatory has been gathering momentum over the past few months- with several major businesses including QANTAS requiring the vaccine for their airline staff, as well as the healthcare sector. I am a Registered Nurse and have worked in the field for five years in a variety of clinical environments including Aged Care, Orthopaedic Surgery and most recently Intensive Care in one of Australia’s largest and most high-acuity ICU wards. This push for mandatory vaccinations has disturbed me greatly and caused me to reflect on the nature of medical ethics around vaccines.
I would like to emphasise that I am not anti-vaccination. I know that vaccines are one the greatest inventions in the history of medical science, have saved countless millions of lives around the world and have transformed health care in an undeniably positive way. I have also had the Pfizer vaccine, suffered no negative consequences and would encourage all Australians to choose to vaccinate, especially if they or their loved ones are in a high-risk demographic regarding Covid-19.
In my first year of studying nursing at university there was a compulsory course that focused on the various legal and ethical issues within healthcare. One of the most important concepts I was taught was that of informed consent. Informed consent is legally required by any clinician in order to administer any medical treatment to a patient. The concept has three main requirements: first, the patient is entitled to full disclosure regarding the nature of their treatment and any potential risks or complications that could occur. Second, the patient must be mentally competent enough to make sound decisions about their own healthcare. Finally, the patient’s decision must be voluntary and free from any coercion. This last point was particularly important as any attempt to force a patient to undergo medical treatment against their will, I was taught, was legally considered assault and battery.
So, let us look at the recent push for mandatory vaccinations that has come down from both the government and the corporate world. Does the vaccine rollout abide by the principles of informed consent if vaccination is forced? To me the answer is simple- no. Forced vaccines quite clearly violate informed consent by removing the right of patients to make voluntary choices about their healthcare. If we look at the government, then state mandated vaccines are not exactly new. I myself had to provide proof of vaccination and received several vaccine boosters before being admitted to university, and within certain clinical environments- such as Intensive Care Units- the yearly flu shot is now compulsory for all staff (failure to get the flu shot would lead to staff being deployed to work in other units until they complied). For many years, I went along with this without really considering the ethics involved, but the recent push for compulsory Covid vaccines – and in particular the growing fear-mongering and demonisation of the unvaccinated – have led me to reflect on the meaning of informed consent and the inherent contradiction between advocating informed consent in the classroom while over-riding individual clinician’s autonomy in the name of public health.
Now let us take a look at vaccine pressure coming from the corporate world. Now some I know, even in more conservative circles, may have a more lenient view of private-sector vaccine pressure compared to pressure from the state. After all, I have heard it said in discussions with friends, there is no absolute right to work in this country and a private employee can simply choose to look for work elsewhere if they oppose being forced to vaccinate against the new medical boogeyman that is Covid-19. Further, an individual worker may refuse a vaccine, but they don’t have the right to put others at risk. However, what is legal is not necessarily synonymous with what is moral. Putting ourselves in the position of a worker who is vaccine-hesitant (whether it be from anti-vaccine convictions, concern over the Covid-19 vaccine side-effects or simply because they are not in a high-risk demographic) these workers nonetheless need a job in order to support themselves and their families. For many, employment security is becoming a rarity in an economy where frequent lockdowns have left many out of work for months at a time. In this situation, when an employer announces that the Covid-19 vaccines will be mandatory and with the tacit threat of unemployment looming over them, could an employee truly be said to be making an informed decision free from coercion? The coercion may not be coming from the medical profession, but the larger issue is that individuals have -and should maintain- the right to make decisions regarding their own health for themselves without interference from either state or employer.
As an experienced Nurse, I value the health of all Australians as well as the important role vaccines have played in improving public health and drastically reducing the number of deaths from infectious diseases over the past century. However, I also have respect for the freedom of all Australians to make their own choices regarding their health and medical care. Protection of this freedom comes from the principles of informed consent, and I worry an increasingly authoritarian government and health system are taking steps to sideline these basic ethical principles.