Walking the Talk

Arthur Caplan

The Code of Ethics of the American Nursing Association contains some stirring language when it comes to you and me. Provision 2.1 of the Code, entitled “Primacy of Patient’s Interests,” states unequivocally that the nurse’s “primary commitment is to the recipient of nursing and healthcare services.” The American Medical Association and other medical groups invoke much the same “patients first” moral stance. Yet when push has come to shove, the flu and swine-flu viruses have shown sadly—but all too clearly—that for many health-care workers and organizations, a patient-centered ethic is more rhetoric than reality.

Each year, the flu kills at least thirty thousand people in the United States. Swine flu has killed over four thousand people in North America in 2009, many of them babies and young children. Receiving the flu and swine-flu vaccines prevents 70 to 90 percent of working-age healthy adults from getting either disease. It is a known fact that flu rates in hospitals fall in direct proportion to the percentage of health-care workers who get vaccinated.

So the bottom line is that the flu and swine flu are deadly to patients. It is also true that both flu and swine flu result in thousands of hospitalizations, to say nothing of the sickening of many caregivers who are then unavailable to work during flu season or a swine-flu outbreak. Safe and effective vaccines exist for both diseases, but voluntary vaccination rates among health-care workers in the vast majority of American hospitals have never gotten much above 50 percent. Often, vaccination rates hover around a deplorable 30 percent, even when vaccinations are available in the hospital workplace.

Obviously, health-care workers have the duty, proclaimed in their own professional associations’ ethical codes, to put patient interest and safety first and get vaccinated. There is also, clearly, an unarguable foundation for insisting that all health-care workers who have regular patient contact get vaccinated as a job requirement. Those who don’t should either have no patient contact or find another job.

So why is it that when hospitals and health departments have proposed vaccination mandates for health-care workers, they have almost invariably been met with lawsuits demanding the right to choose? In October 2009, when the New York State Department of Health announced such a mandate, the first response was thousands of nurses crowding a plaza in Albany yelling about liberty and freedom of choice—followed by state and federal lawsuits to overturn the mandate. Lawsuits against flu mandates were also just about the only response of the nursing profession in Washington state and California.

Fighting health-care worker vaccination mandates not only represents dipsy public-health thinking, it also adds fuel to the anti-vaccination fires that kooks and ignoramuses have been stoking for decades in the United States. If the only voices the public hears loud and clear are health-care workers fighting mandates because of fears or uncertainties, then what is the average mom to think about vaccinating herself or her children? Those filing suits are driving the public directly into the arms of advocates who urge us to “combat” deadly viruses by gobbling immune-boosting vitamins, sticking rubbing alcohol up our noses, and drinking Chinese herbal teas of uncertain composition.

Americans deeply respect choice. But when one becomes a doctor, nurse, pharmacist, physician assistant, or other health-care worker, one’s right to choose must yield to the protection of the vulnerable, weak, frail, and defenseless whom you have chosen to serve. That is why the ethical codes of the various health professions read as they do.

Nineteen children died from swine flu in the United States during the first week of November 2009. A few hundred other Americans died from ordinary flu. No vaccine in recent times has ever caused anything like that death toll. It is long past time to get our ethics and public policy aligned before the next pandemic or bioterror attack reaches our shores.

It is also way past time for organized medicine, nursing, and pharmacy to stop signing on to legal actions against mandates. Leaders must weigh in on the side of safety and science. So should our public health officials, congressional leaders, and the president himself.

Arthur Caplan

Arthur Caplan is director of the University of Pennsylvania’s Center for Bioethics and a nationally prominent voice in the debates over cloning and other bioethical concerns.


The Code of Ethics of the American Nursing Association contains some stirring language when it comes to you and me. Provision 2.1 of the Code, entitled “Primacy of Patient’s Interests,” states unequivocally that the nurse’s “primary commitment is to the recipient of nursing and healthcare services.” The American Medical Association and other medical groups invoke …

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