If they won't get the jab, they must go
Health care organizations need staff committed to reducing risk of harm, not contributing to it. Credit: Randee Daddona
Public commitments health care professionals make often explicitly address and condemn behaviors that can harm people. They are made publicly through sworn oaths, and through affiliations with professional organizations that also make public commitments through codes of ethics and sets of principles. Health care professionals who knowingly expose people to SARS-CoV-2 infection, who put their interests ahead of those in their care, are unworthy of their profession, and thus unworthy of patient care roles.
Health care professions translate their commitments into standards, norms, and expectations. They become the basis for their business objectives and marketing messages, all of which emphasize providing safe and effective care. Retaining patient care staff who will not agree to COVID vaccination contradicts this messaging and establishes a false sense of security among the people they serve. To live up to the expectations they create, these organizations cannot let their patients be exposed to unvaccinated staff — they should not be hired and should not be retained.
Western societies require many patient care professionals obtain licensure or certification ensuring minimum competency and commitment. These requirements give the public more reason to believe that health care professionals give their care and safety the highest priority. Licensure and certification also raise entry barriers into health care professions and create monopolies, which produce higher pay and provide more privileges. In return, societies can reasonably expect health care professionals will respond selflessly to the confidence placed in them.
The refusal of patient care staff to get vaccinated against COVID is a visible sign of harm the U.S. health system can inflict on people. A Johns Hopkins University analysis shows that U.S. health care system errors are the third leading cause of death. This startling and embarrassing finding should encourage patient care professionals to take every opportunity to reduce harm. Vaccination offers an easy way to help reduce the harm endemic in the U.S. health care system. Health care organizations need staff committed to reducing risk of harm, not contributing to it.
If patient care professionals regard patient safety requirements for vaccination as unimportant or unacceptable, then patients and organizational management staff can doubt they comply with other requirements addressing patient safety. Refusing vaccination could be seen as a proxy for a range of unsafe practices, which can serve as an alert to patients and to organizational safety officers in hospitals and nursing homes who have an interest in removing all hazards.
When health care organizations fire or suspend unvaccinated patient care professionals, they are doing what the patient care professionals would not do, and that is removing a source of harm to the people they serve.
This is not a punitive action. It follows from commitments health care professionals and organizations have made to patients. And, it’s common sense.
The U.S. health care system needs many bold actions to reduce harm. COVID vaccination is an easy one. Health care professionals promise to protect those in their care. If they won’t, they have to go.
This guest essay reflects the views of J. Russell Teagarden, member of the Working Group on Compassionate Use and Preapproval Access, and Arthur L. Caplan, founding director of the Division of Medical Ethics at the NYU School of Medicine.
