Healthcare Executive - November/December 2013 - 42

Healthcare Management Ethics

The Ethics of Mandatory
Flu Shots
William A. Nelson,
PhD, HFACHE

Tim Lahey, MD

Influenza is a common, life-threatening
and vaccine-preventable infection.
The transmission of influenza in
hospitals and other healthcare facilities is a major safety issue, particularly for hospitalized patients.
Influenza vaccination is effective at
preventing the spread of influenza, so
the U.S. Advisory Committee on
Immunization Practices recommends
influenza immunization for everyone
older than 6 months. More specifically, according to a February 2011
article in the American Journal of
Public Health by Abigale L. Ottenberg
et al., influenza immunization of
healthcare workers is recommended to
1) prevent transmission to patients; 2)
reduce the risk of healthcare workers
becoming infected; 3) maintain a societal workforce of healthcare workers;
and 4) create an example of the need
and importance of vaccination.
Despite the clear indications for influenza immunization among healthcare
workers, a 2010 position paper
authored by Thomas Talbot, MD, et
al., for the Society for Healthcare
Epidemiology of America, notes that
“despite tremendous efforts to promote
HCP [healthcare personnel] influenza
vaccinations by government agencies,
regulatory groups, professional societies, and visible vaccination champions,

Healthcare Executive
nOv/DEC 2013

Balancing patient protection with healthcare
worker autonomy is essential.

influenza vaccination rates among
HCP remain unacceptably low.”
The discouragingly low influenza
vaccination rates among healthcare
workers have prompted some healthcare facilities to consider mandatory
influenza immunization for all staff.
Individual Rights and
Professionalism
Mandatory influenza immunization
has met resistance from some healthcare workers. Resistance arises primarily from three concerns. First,
some healthcare workers worry influenza vaccination could be harmful to
their health (e.g., in the case of
allergy to immunization). Second,
some healthcare workers belong to
faith groups that oppose medical
interventions such as immunization.
The third and perhaps most forceful
argument for resistance centers on
self-determination or autonomy—
healthcare workers may resent being
compelled to undergo immunization.
Each of these arguments prioritizes
the single healthcare worker’s individual rights. However, they do not take
into consideration other key priorities such as the prevention of influenza epidemics or the principles of
beneficence and nonmaleficence. Both
of these cardinal bioethical principles

suggest healthcare workers have a duty
to act in the patient’s interest and to
avoid undue harm to patients.

We believe an ethically
grounded policy of mandatory
influenza vaccination is
morally justified as long as
implementation of the policy
allows healthcare workers
with medical or religious
grounds to opt out.
While commonly applied to decision
making around the provision of
standard-of-care medical treatments,
these principles can be interpreted to
imply that healthcare workers have a
moral duty to not place patients or
colleagues at risk of preventable
influenza infection. As noted in a
September 2010 article by Andrew
Miller, MD, and David Ross, MD,
JD, in Virtual Mentor, the American
Medical Association’s ethics journal:
“Applied to influenza vaccinations,
this principle suggests that patients
have the right to expect that their
hospital will take every reasonable
precaution to protect them from
developing nosocomial illness.”

Healthcare Executive - November/December 2013

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