Editor’s Note: Theresa Brown is a nurse and author of “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.” The views expressed here are hers. Read more opinion on CNN.
Covid-19 has killed over 600,000 Americans and sickened many more. It’s hard for me to understand why people would refuse a vaccine that could save their lives and those of their family. But as a nurse, what I find even harder to understand is why some health care workers choose not to get vaccinated and put patients at risk as a result.
In my view, personal choice must surrender to professional responsibility if someone’s choice endangers patients. That is why I support a national mandate requiring the Covid vaccine for all health care workers who work with patients, including nurses, doctors, dietary workers, home health aides and others.
On Monday, amid a disturbing rise in Covid-19 cases in the US, more than 50 health care groups – including the American Medical Association, the American Academy of Pediatrics, the American Academy of Nursing and the American Nurses Association – issued a joint statement calling for all health care and long-term care employers to mandate their employees be vaccinated against Covid 19.
A mandate that specifically requires front-line health care workers to be vaccinated against Covid is the right thing to do for patients.
In a recent viral Facebook post, Alabama physician Brytney Cobia described treating unvaccinated patients who ask for the Covid vaccine as they are dying. Her only choice is to tell them it’s too late, but she described in moving terms how she encourages their families to get vaccinated as a way of honoring their dying loved one.
It should be common sense that institutions caring for patients cannot have employees who, because they are unvaccinated, might find themselves in the same situation as Dr. Cobia’s patients: infected with Covid, contagious and deathly ill.
The four primary principles invoked by medical ethicists are beneficence (doing good), non-maleficence (not doing harm), justice and autonomy. It is easy to see that requiring the Covid vaccine for front-line workers meets the standards of beneficence and maleficence, but health care staff who refuse the vaccine often invoke their own autonomy as patients and insist they have the right not to be vaccinated.
They do have that right, but ethical due diligence requires weighing the most just course of action, which means that all patients must be treated equally and fairly. Looked at in terms of justice, it is clear that front-line staff who remain unvaccinated against Covid offer unequal care that is also unfair because it threatens patients.
Working as a nurse with bone-marrow transplant patients showed me how vulnerable hospitalized patients who are immune-suppressed are to disease. Dying patients with fungal infections had ugly black splotches marking their arms and legs. One patient caught pneumonia after chemotherapy killed all of his white blood cells, and the pneumonia killed him. Another developed a rare transplant complication that left him unaware of who he was and speaking nonsense.
These grim stories make a clear case for why at the very least, staff who work with cancer patients should be vaccinated against Covid.
But all hospital patients are more susceptible to sickness than the population at large because they are physiologically fragile. Being weak and physically and emotionally stressed reduces one’s ability to fight off all contagious illnesses. Hospital patients also tend to be sleep-deprived because they get woken up in the middle of the night for vital signs, lab draws and IV medications. Tiredness leads to a weakened immune response, too.
As Covid hit state after state last year, patients’ increased susceptibility to disease played out in real time in skilled nursing facilities across the US. Anyone in a nursing home is by definition fragile; admission to such a facility acknowledges a need for significant care. Upward of 184,000 staff and residents of various long-term care facilities died from Covid, according to the AARP dashboard.
The dashboard also shows that as of July 15, only 56.7% of nursing home staff were fully vaccinated against the coronavirus.
Comparing the number of people who died of Covid in long-term care facilities with the figure of 43.3% percent of staff who remain unvaccinated against Covid presents a conundrum. One would imagine that a sense of ethical responsibility toward patients would impel every member of those staffs to get vaccinated, especially as the Delta variant sweeps through the country and sickens the unvaccinated. But that hasn’t happened.
The issue of front-line health care workers refusing the Covid vaccine was brought into focus this past June by unvaccinated staff members from Houston Methodist Hospital in Texas. Houston Methodist required Covid vaccinations for all of its employees and around 150 workers who refused to be vaccinated resigned or were fired.
Hospitals ideally want to create the safest possible environment for patients vis-à-vis Covid, but so far, few hospital systems have mandated the Covid vaccine. The problem is, the Delta variant is much more contagious than earlier versions of the virus, and as it spreads, hospitals around the country are once again being overwhelmed with Covid patients.
Immediate, mandated vaccination of front-line health care workers protects present and future patients, including children and staff. Some vaccine-hostile Americans may never be persuaded to get the shot, but a mandate would guarantee that anyone entering a care facility will be as safe as possible from Covid.
And in my experience as a nurse, vaccine requirements are normal. Beginning nursing school required proof of childhood immunizations, an MMR booster, and two rounds of the hepatitis B vaccine. In fall of 2019 I supervised nursing students giving flu shots at a Pittsburgh hospital: the vaccine was required for all employees.
American resistance to vaccine mandates has over a 100-year history, according to Yale law professor John Fabian Witt’s recent book, “American Contagions,” but an individual’s right to refuse a vaccine is not absolute in health care, just as rules about hand-washing and sterile procedures cannot be ignored based on employee preference.
In fact, working in a hospital or skilled nursing facility requires following a myriad of rules put in place to protect patients, and vaccination against Covid easily falls into that category.
A vaccine mandate for health care workers could be implemented through the Centers for Medicare and Medicaid Services (CMS). CMS currently mandates all kinds of actions from health care staff. So why couldn’t they require that all front-line staff in health care facilities that accept payment from Medicare or Medicaid be fully vaccinated against Covid?
Facilities could pay a fine if staff remained unvaccinated, similar to the new rules from CMS that call for price transparency. Limiting the requirement to front-line staff gives facilities room to move vaccine-refusing employees to nonclinical jobs, but they could also require vaccination of all staff members.
In her book “On Immunity,” Eula Biss argues that “Debates over vaccination” can “be understood as conversations about power.” She’s right, and while it is unusual for me not to support health care workers taking a stand, it’s also even rarer for health care workers to fight for actions (or in this case, inactions) that could hurt their patients.
One year ago, my husband, who’s rarely ill, had a heart attack that would have killed him had he not gotten prompt care. After coming home from the hospital, he developed Covid-like symptoms of fever, chills and muscle aches. His Covid test was negative, but still, he had contracted a serious virus in the hospital even though everyone was masked, probably because he had been under severe physical strain and hospitals are full of sick people.
Unvaccinated health care workers have an ethical obligation not to add to the threats facing their already vulnerable patients.