Since the start of the pandemic, scientists around the world have been busy developing a vaccine against COVID-19. After its creation, many people expressed concerns about its relevance and possible serious health consequences. At the same time, one could notice a division of opinion regarding the medical staff, especially nurses, many of whom worked in the red zone with the infected. The autonomy of nurses who refuse vaccinations has become a widespread precedent throughout the medical community. First of all, the health advice was an urgent request for vaccination and a corresponding certificate. However, this violated the essence of human rights, having free choice. In addition, ethical values regarding conflict management and patient care were included in the confrontation. Medical personnel asserted their right to autonomy, which came into conflict with the value of taking care of the sick first. Nevertheless, nurses should not be forced to vaccinate, as shown in the case of Missouri v. Biden.
Description
The case study is about the clash of ethical issues and government requirements to vaccinate healthcare workers. This included workers in Medicare and Medicaid programs that provide essential health insurance for low-income, disabled, and elderly people. The main direction of these organizations comes from the Minister of Health and Human Services of the United States. In the fall of 2021, they made an official announcement in which it was said that in order to continue funding, organizations must vaccinate all workers and provide an appropriate report (Biden v. Missouri, 2022). Many employees were against this decision and expressed their disagreement. However, the secretary pointed out that only those employees who are prevented by religion or certain medical conditions can refuse mandatory vaccination (Biden v. Missouri, 2022). Thus, many nurses were forced to get vaccinated or voluntarily write a letter of resignation from organizations.
The vaccination mandate was presented as an amendment to the current conditions for Medicare and Medicaid workers. After that, the case was taken to court and proceedings began on the legality of the applications. The result was that the Supreme Court reneged on the conditions put forward and the mandate remained in force (Biden v. Missouri, 2022). First, the decision was explained by the fact that the secretary has the legal authority to introduce such rules. They are necessary for the most effective performance of those functions and responsibilities assigned to the official.
The primary obligation of Medicare and Medicaid health care providers is to ensure the safety and health of every patient. Consequently, Congress delegated authority to the secretary to agree on a vaccination mandate (Biden v. Missouri, 2022). This meets the requirements that are established in the interests of the users of medical services. The commitment is based on the fact that within the walls of healthcare facilities, COVID-19 can quickly spread among workers and be transmitted to patients. In addition, if the staff falls ill and there is a shortage of staff, it can endanger people’s health.
Thus, the opinion of the Secretary was based on the stated facts. The court noted that these requirements are in accordance with the law of the country and will not be challenged. Moreover, the Court held that there was an appropriate reason for this decision regarding the global pandemic and the percentage of deaths from the virus (Biden v. Missouri, 2022). However, the opinion of the judges regarding the question posed was not unanimous. One of the justices explained his disagreement with the fact that the secretary is not endowed with legal authority in matters of creating rules on the vaccination of an entire organization (Biden v. Missouri, 2022). The statement was based on the fact that the authorities cannot exceed their powers under the regulations on sanitary procedures and increase their power over health care workers.
The assertion of disagreement with the mandate was supported by some other judges in the process. Justice Alito has argued that the federal government does not have enough power to force vaccination of workers in the peremptory manner in which it has been done (Biden v. Missouri, 2022). According to the secretary, the mandate was to be urgent, while the traditional system involves the introduction of notifications within 10 months (Biden v. Missouri, 2022). In such a case, medical professionals can weigh their opinion and make a decision. However, most of the participants found the terms of the mandate to be appropriate, and the federal administration prevailed in the process.
Evidence
The one side of the conflict has evidence that points to the need for a mandate and vaccination of Medicare and Medicaid workers. First and foremost, the federal government is committed to providing the population with the highest level of security possible as one of the mandatory points of law. This is due to the fact that the state seeks to protect the population from a potential threat (Barrett et al., 2016). Human rights imply the existence of health care, the main purpose of which is to protect people from diseases. Thus, on the part of the federal government, this justifies the possibility of introducing a mandate.
In addition, in the case of evidence of improvements in the application of mandatory vaccination, paternalism appears as one of the principles of the public health ethics. Therefore, the government has the power to determine the behavior of the population in return for properly providing for the basic needs of the citizens of the country (Maltezou et al., 2019). Accordingly, to reduce possible cases of infection, preventive measures are being introduced to contain the spread of the virus.
At the same time, the mandate is important for community as a whole. People want to be sure that the vaccine will work, and above all, they trust healthcare professionals and their recommendations (Gualano et al., 2021) If they see the nurse being protected, they may be more conscious about their health and COVID-19 vaccinations. Thus, it can contribute to raising public awareness and attitudes towards the decision to immunize.
However, when conflict and contentious issues arise, it is important to understand the problem from both sides and highlight potential interventions to resolve it. The decision to retain the mandate has raised ethical concerns among Medicare and Medicaid workers and staff across the country. The essence of this phenomenon lies in the fact that the staff, after critical reflection, will be able to make their decision regarding various issues that relate to the safety of the patient. In this case, they do not need the approval of anyone on the healthcare team. Thus, the mandate violated their right to autonomy and independent decision-making.
In addition, the ethical problem was the clash between compulsory vaccination and freedom of choice. Medical personnel are free to choose the relevance of the vaccination for them and the time when it is worth doing it (Chadwick & Gallagher, 2020). Medicare and Medicaid workers have been placed between the only option of being vaccinated or being fired from their jobs for non-compliance. The lowercase ruled that nurses could refuse to comply with the ordinance for religious or medical reasons. Accordingly, most of the staff faced a serious ethical dilemma.
Moreover, in the decision of the court and the issuance of a mandate, partial discrimination of medical workers can be traced. First of all, this is due to the fact that employees who do not comply with the established requirement must be fired. At the same time, their work experience, the desire to help the sick and the knowledge that they possess are not considered (Butts & Rich, 2022). This means that a less conscientious worker can take the place of a highly qualified specialist due to the refusal of compulsory vaccination. This kind of discrimination can negatively affect not only the nurses themselves, but also the patients for whom they provide their services.
Among other things, in the case of mandatory vaccination of medical workers, the question of ethics regarding the common good is raised. On the one hand, it can be argued that this will protect customers to some extent. Their level of confidence will grow and they will be more aware that they are safe (Butts & Rich, 2022). On the other hand, the vaccine does not provide a full guarantee of protection and nurses can still get sick. For the most part, its action is aimed at making the symptoms and effects of the virus easier to bear (Butts & Rich, 2022). Thus, the virus can spread further, with severe consequences, if patients do not get vaccinated. This will double the risk of infection and then the clients will be as protected as possible.
However, the other side of the conflict has evidence that points to the need for a mandate and vaccination of Medicare and Medicaid workers. First and foremost, the federal government is committed to providing the population with the highest level of security possible as one of the mandatory points of law. This is due to the fact that the state seeks to protect the population from a potential threat (Barrett et al., 2016). Human rights imply the existence of health care, the main purpose of which is to protect people from diseases. Thus, on the part of the federal government, this justifies the possibility of introducing a mandate.
In addition, in the case of evidence of improvements in the application of mandatory vaccination, paternalism appears as one of the principles of the public health ethics. Therefore, the government has the power to determine the behavior of the population in return for properly providing for the basic needs of the citizens of the country (Maltezou et al., 2019). Accordingly, to reduce possible cases of infection, preventive measures are being introduced to contain the spread of the virus.
At the same time, the mandate is important for community as a whole. People want to be sure that the vaccine will work, and above all, they trust healthcare professionals and their recommendations (Gualano et al., 2021) If they see the nurse being protected, they may be more conscious about their health and COVID-19 vaccinations. Thus, it can contribute to raising public awareness and attitudes towards the decision to immunize.
Analysis
When analyzing the evidence, it is important to consider the fact that both sides provide significant evidence of their case. In terms of nurses’ resentment, a strong assertion is a sharp encroachment on their autonomy as health professionals (Maltezou et al., 2019). In the first place, the ruling violated their autonomy as nurses, who can refuse to be vaccinated (Pursio, 2021). According to ethical principles, medical staff can think critically and draw conclusions about which option is most beneficial for them. In addition, when a large number of employees are laid off, a serious failure in the performance of the organization can occur.
With the layoff of 50 employees, management could face serious consequences for patients. First of all, due to lack of staff, organizations will not be able to provide services quickly. Work will slow down significantly and the remaining staff will be doing more work than before the mandatory vaccination mandate. In some cases, delay can have a critical impact on the patients’ health (Martino et al., 2020). At the same time, the search for new employees can take a long time and not lead to the desired result. Organizations are not always able to replace highly qualified personnel with people with equivalent experience and skills. In addition, it is vital to consider that new employees must be vaccinated and submit official documents, which further narrows the pool of potential nurses.
However, the weak point is the issue of discrimination due to the negative mandate. The Government’s goal is to protect the public from the spread of the virus, which is the defining point of the Secretary of State’s decision. This implies that the nurse works closely with the federal government for the benefit of the population (Schumacher, 2021). In the case of the mandate, it is not about belittling employees, but about caring for the population.
From the perspective of the federal government, strong evidence is paternalism, in which the state can dictate certain rules. In particular, this concerns respect for the opinion of society and ways to protect health.However, the weak side implies the immediate entry into force of the mandate. Normally, the state gives people the opportunity to think and make an informed decision. In the case of vaccination, nurses do not have much time to think and must choose a path in the shortest possible time (Van Hooste & Bekaert, 2019). In addition, the Secretary of State’s mandate lacks more precise explanations on how to take into account religious norms and medical indications when refusing vaccinations.
I think that the autonomy of medical professionals should be maintained for several reasons. First of all, it is respect for human rights, including the possibility of choice. Citizens of other professions may refuse to be vaccinated for a variety of reasons, from religious to lack of desire. Nurses should be given this opportunity, since they are first and foremost residents of a free country and people with an allied opinion. Another reason is that the virus continues to spread regardless of whether nurses are vaccinated. Since a large part of the population has refused to be vaccinated against COVID-19, medical professionals cannot significantly improve this situation. Accordingly, with their growing perturbation, they will not make a significant contribution. In addition, this can lead to a shortage of staff due to layoffs. Accordingly, medical centers will not be able to serve visitors to a significant extent.
Conclusion
In conclusion, I should say about my own opinion regarding the current situation. I believe that the autonomy of nurses should be protected and they remain in the workplace, regardless of their opinion. Medical personnel are able to think critically and be aware of the possible consequences. The main ethical principle that guides me is freedom of choice and lack of stratification among the staff (Van Hooste & Bekaert, 2019). Clinics are experiencing a shortage of staff, which could be exacerbated by the layoffs of those who refused the vaccine. Thus, I believe that the restrictive measures within the framework of COVID should be strictly observed, but the mandate should not be mandatory.
References
Barrett, D. H., Ortmann, L. W., Dawson, A., Saenz, C., Reis, A., & Bolan, G. (2016). Public health ethics: cases spanning the globe. SpringerOpen.
Biden v. Missouri, 595 U.S. 1 (2022). Web.
Butts, J. B., & Rich, K. L. (2022). Nursing ethics: Across the curriculum and into practice. Jones & Bartlett Learning.
Chadwick, R., & Gallagher, A. (2020). Ethics and nursing practice: a case study approach. Bloomsbury Publishing.
Di Martino, G., Di Giovanni, P., Di Girolamo, A., Scampoli, P., Cedrone, F., D’Addezio, M., Meo, F., Romano, F., Di Sciascio, M. B. & Staniscia, T. (2020). Knowledge and attitude towards vaccination among healthcare workers: a multicenter cross-sectional study in a Southern Italian Region. Vaccines, 8(2), 1-10. Web.
Gualano, M. R., Corradi, A., Voglino, G., Catozzi, D., Olivero, E., Corezzi, M., Bert, F. & Siliquini, R. (2021). Healthcare Workers’(HCWs) attitudes towards mandatory influenza vaccination: A systematic review and meta-analysis. Vaccine, 39(6), 901-914. Web.
Maltezou, H. C., Theodoridou, K., Ledda, C., Rapisarda, V., & Theodoridou, M. (2019). Vaccination of healthcare workers: is mandatory vaccination needed?. Expert review of vaccines, 18(1), 5-13. Web.
Pursio, K., Kankkunen, P., Sanner‐Stiehr, E., & Kvist, T. (2021). Professional autonomy in nursing: An integrative review. Journal of nursing management, 29(6), 1565-1577. Web.
Schumacher, S., Salmanton-García, J., Cornely, O. A., & Mellinghoff, S. C. (2021). Increasing influenza vaccination coverage in healthcare workers: a review on campaign strategies and their effect. Infection, 49(3), 387-399. Web.
Van Hooste, W. L. C., & Bekaert, M. (2019). To be or not to be vaccinated? The ethical aspects of influenza vaccination among healthcare workers. International journal of environmental research and public health, 16(20), 1-10. Web.