Sunday, July 25, 2021

Should COVID-19 Vaccines be Mandatory?

 I think we’re headed in that direction.  There are various angles and positions to consider.  But, as in so many disputes, it’s not a matter of right and wrong but an issue of which side has the better argument. When a judge rules for one party in a dispute, this does not mean that the other side had no legitimate position.  If means that the judge concluded that an analysis of the facts and the law tilted toward one side.

We must acknowledge that an individual has a right not to be forced to accept a vaccine or any medical treatment.  The doctrines of informed consent and patient autonomy are bedrock pillars in American medical care.  If, for example, I recommend a colonoscopy to a patient with symptoms highly suggestive of a serious colon condition, the patient is free to decline my advice.  While I may feel strongly that this decision – referred to as informed refusal – is unwise, no medical practitioner or ethicist would argue that I should be able to compel compliance with my advice. 



Patient autonomy and the right to refuse medical treatment becomes murky when there is a public health dimension to the issue.  The patient cited above who declines a colonoscopy may be incurring personal risk but his decision does not threaten the community.  In contrast, an individual who refuses a vaccine threatens others and is a direct obstacle to public health efforts to protect the citizenry.  So, while the individual has rights so does the community.  The issue then become which side’s rights should prevail?

In America, there has been great reluctance to mandate COVID-19 vaccinations for various reasons.  The vaccines have still not been granted formal approval from the Food and Drug Administration. Initially, there was not sufficient vaccine supply to meet demand.  Employers were concerned over legal exposure to mandate the vaccine for employers.   And, just as we saw with face masks, the vaccines became highly politicized. 

The hope was that Americans would achieve the task voluntarily.  But we haven’t.  Even now, less than half of all Americans have been fully vaccinated.  Does this fact astonish you?

The calculus regarding mandating vaccines is changing.  The Equal Employment Opportunity Commission (EEOC) has concluded that employers may mandate vaccines providing that there are exceptions for medical disability and religious reasons.   This gives cover to businesses and organizations who are ready to take the next step. Increasingly Republican political leaders and conservative commentators – after months of silence or actual support for anti-vaxxers – are now advocating for the vaccine.  And most importantly, we are now seeing a sharp spike across the country with rising cases that are filling up hospital and intensive care unit beds in nearly all 50 states.  And it’s going to get worse.  And we know why it’s happening.  The vast majority of these cases are occurring in unvaccinated individuals.  All of this was preventable.

So, which side do you think has the better argument?

 

2 comments:

Elliot Davidson said...

Another thoughtful and timely piece. I favor a comprehensive, balanced approach with mandates for certain groups( health care workers, military, teachers) vaccination passports and giving private industry the option to protect their employees and customers the way they want ( i.e. mask or vaccine). I also would pull in leaders of all kinds including Trump led events touting his vaccination genius. Beat this pandemic by any means necessary!

Michael Kirsch, M.D. said...

Thx, Elliot, for your thoughtful comment. In retrospect, imagine where we would be if we had reached herd immunity a few months ago, either by voluntary cooperation or mandate? This saga had been marked by so much frustration, defiance and missed opportunities.

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