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.
The 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)