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The ethics of mandating vaccinations in healthcare



Since its unwelcome arrival over a year ago, the COVID-19 pandemic has presented us with a range of moral and ethical quandaries — some hypothetical, some deeply pragmatic.

How should a limited number of respirators be allocated if demand outstrips supply? Who should get access to vaccines first? What does the Government owe those whose livelihoods have been disrupted by state-mandated health measures?

Right now, a critical debate is proceeding about the ethics of mandating vaccinations in the workplace. 

Employer groups have discussed mandatory and some employers, like the fruit canner SPC, have gone a step further and simply declared vaccines mandatory on site.

The government has understandably been asked to step in and provide clarity: is it right for employers to mandate vaccines or not?

No clear answer is forthcoming. Nor, I fear, should we expect one in the near future, because the government has to date failed to provide clarity on a much more straightforward ethical question — that of the vaccination of health care workers.

Catholic Health Australia represents 83 hospitals across the country, treating millions of patients each year. These hospitals employ tens of thousands of health workers, doctors, nurses, and allied health staff.

None are currently required, by Australian law, to be vaccinated against COVID-19.

People I speak to tend to be bemused by this. It seems utterly baffling that someone could feasibly contract COVID-19 from an unvaccinated healer in a hospital, as has happened on a number of occasions in the past week at some of the NSW’s largest hospitals. The situation is all the more unfathomable when one considers that healthcare workers in high-risk settings are already required to be vaccinated against a number of diseases including influenza, diphtheria, tetanus, pertussis and hepatitis B, among others.


'It seems utterly baffling that someone could feasibly contract COVID-19 from an unvaccinated healer in a hospital, as has happened on a number of occasions in the past week.' 


And yet, a year-and-half into the pandemic, here we are. Why the reticence from government? Surely health care workers who are treating the most vulnerable among us should be vaccinated.

Conservative critics of workplace-linked vaccines, like Senator Matt Canavan, suggest it is an issue of the individual rights of the worker and cite slippery slope arguments about the state or employers being able to ‘force’ people to undergo ‘medical procedures.’

Such concerns are misplaced.

When considering the ethics of requiring vaccines for hospital workers, it should be considered as part of the moral contract a hospital has with its patients.

A core condition of this moral contract is that the people who care for them will ‘do no harm’, by minimising their exposure to risk. Minimising risk is key to modern health care. It is seen in falls prevention programs, in management of hospital acquired complications, and the protection against infectious diseases.

As an employer, a hospital cannot fulfil its contract with its patients if it does not impose conditions on its employees insofar as they relate directly to its obligations toward patients.

We know vaccinating health care workers protects patients against infection by COVID-19. That is why it is right to require any person working within a hospital or aged care setting to be vaccinated against COVID-19.

Health workers may still exercise their conscience and choose what goes into their body, but that right is not free from consequence. In this case it remains the employer’s right to decide if that person still meets the conditions of employment.

Recently, one of CHA’s largest members in Queensland, the aged care and hospital operator Ozcare, dismissed a care assistant who refused on medical grounds to comply with the organisation’s mandate that all client-facing employees receive the influenza vaccine.

The Fair Work Commission upheld Ozcare’s decision saying it was both lawful and reasonable because its clients were susceptible to influenza and Ozcare had a duty to protect them.

So while CHA members will respect the rights of individuals not to be vaccinated, health care workers must realise that they are unlikely to meet an underlying condition of their employment: that is, to keep our vulnerable patients and residents safe from harm. Rather than see such cases go to court, we need the Government to step in and remove the ambiguity. And we need it to happen soon.

Catholic Health Australia has been lobbying vigorously on this point.

In a broad sense, the Government's current refusal to give employers legal cover to mandate vaccines leaves everyone in a difficult and uncertain spot. Unions and other industrial relations experts agree that the only way for an employer to feel confident to mandate vaccines is for the Government to issue a Public Health Order; in effect to extend the existing mandated vaccinations to COVID.

I do not claim to speak to the ethics of introducing such an order in other sectors. But for the hospitals I believe the moral case is clear: the Government must issue a directive to mandate vaccinations.



John WatkinsThe Honourable John Watkins AM is currently Chair of Catholic Health Australia, a Director of Caritas Australia, Director of Catholic Professional Standards Limited, Director of the Central Coast Local Health District Board and member of the Governing Council of NeuRA. In 2005 John was elected to the position of Deputy Premier of NSW, a role in which he served until 2008.

Main image: Doctor drawing up solution from vaccine bottle (Getty Images)

Topic tags: John Watkins, COVID-19, vaccine, mandate, ethics, healthcare



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Existing comments

In my opinion vaccinations should be compulsory for all.
We don't live in a vacuum. We have a duty to our neighbours...our neighbours are our community.

But with PM who is all spin what hope do we have in an emergency.
Great article John.

ROBERT COLQUHOUN | 19 August 2021  

According to the epidemiazzi, being vaccinated does reduce the risks of contracting, becoming infectious and passing on the virus...but it can present the complications that the vaccinated carer is unaware they have the virus or may be contagious because they are asymptomatic; rare (10%) but an outbreak in care is frequently devastating for the vulnerable. This "asymptomatic" anomaly puts regular worker testing as a necessity in various front line workers, including health care, vaccinated or not. At the moment Australia is very limited in test types, almost exclusively reliant on tests required to be examined by pathologists off site with 24 - 48 hour results; do tested workers stand down until results are confirmed? If they lose (say) one shift per week who's paying for their downtime? Rapid Antigen tests are commonly used overseas with 15 - 30 minute results but this testing is fairly expensive and becomes reliant on semi-skilled testers if used wide spread. I believe there's a case to mandate vaccinations in health care but there's an equivalent case to provide an epidemic pension to those who refuse the vaccine on valid medical grounds; the government providing a waiver to avoid legal complications by persons adversely affected by the vaccine didn't help alleviate worker's concerns.

ray | 19 August 2021  

Thank you, John.

This is well reasoned and carefully thought through.
Beyond the moral contract is the requirement that already exists in many health systems, including NSW, is a series of compulsory "shots" before employment that a mandatory. We are adding another important one.

I endorse John's view of a moral contract. I remember working in a hospital where we admitted two medical students who developed chickenpox and had failed to be immunized before they started their work. I felt quite scandalized - not so much for these students and their lack of insight but that our system did not have safeguards in place that would prevent this.

A foundation stone of ethical practice is "do no harm" These students had done harm. Those in health who fail to protect their clients certainly risk harming the patients in their care. This risk is real foreseeable and preventable. To fail to act to prevent that potential harm is ethically wrong.

Ross Bell | 19 August 2021  

Woud be nice to see such conclusion with at least a few mentions of current reported covid vaccine side effects, possible treatments, and of result in other countries such as Sweden, Denmark or Israel

Anthony | 19 August 2021  

This issue could turn up a number of curly questions. I would say that, in any public contact role, paricularly teaching, medical and caring, it should be compulsory. I don't think you can allow exceptions here.

Edward Fido | 20 August 2021  

This is a complicated issue. Ideally everyone should be fully vaccinated. I’m vaccinated. However 20% of fully vaccinated people can still get COVID and be infectious to others. The same sort of deal with influenza. Very few health authorities in Australia mandate influenza vaccination. Again although I agree all health workers should be vaccinated the problem is that mandating vaccinations is the very likely to exacerbate maintaining a full health workforce. In WA yesterday there was a demonstration by nurses outside the major maternity hospital in Perth because there is a chronic shortage of nursing staff. The health minister agreed there was an issue and they were trying to recruit staff. In the past many of these recruitment drives focused on overseas staff! I think politicians are right to proceed cautiously with this issue.

Corrado Minutillo | 20 August 2021  

'For the hospitals, I believe the moral case is clear: the Government must issue a directive to mandate vaccinations.' I would have thought that it's a no brainer'. So why is the government dragging its heels? Is this the Canavan/Christensen effect in operation again?

Ginger Meggs | 20 August 2021  

Ethics is always influenced by Belief, a curious lover prone to inexplicable and damaging unfaithfulness to both herself and all around her. Faithfulness to Belief can be so unshakable that her lovers, beguiled by her charm, will sometimes endure death even when salvation is offered. (Ref: the unshakable belief in Jehovah Witnesses who refuse life saving blood transfusion and die because Leviticus wrote that the ingestion of food containing animal blood was unclean and excluded the partaker from God's presence). Some would rather die than abandon their great love, Belief. It is a very sad story when it happens and is there for all to see in the feckless approach of the antivaxxers to vaccination - a matter of seriously flawed belief rather than ethics. Get the jab! It has nothing to do with ethics and everything to do with Belief - belief that in getting the jab we are caring about our fellow human beings.

john frawley | 25 August 2021  

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