While there are individual and systemic ethical concerns for healthcare workers with respect to whether to take a vaccine , there are also ethical considerations for healthcare employers . These considerations are largely based on the responsibility to the individual patients and the responsibility to the broader public health .”
we ’ ve used to protect each other and our healthcare providers , like wearing masks . We may need to continue to do those things for a very long time . We ’ ve experienced paradigm shifts in the past ; back in the 1970s , we drew blood without wearing gloves . Then HIV came along , and everyone wore gloves . I think maybe we need a new paradigm shift , but it ’ s wishful thinking to say this is all going to just disappear at some point in the future .”
Examining Exemptions and Ethics-Related Concerns
Some healthcare workers say they have been bribed by bonuses or coerced into accepting vaccines as a last resort before implementing vaccination as a condition of employment ( CoE ). Late in 2020 , long before the vaccine mandate , Lazarus , et al . advised , “ A careful balance is required between educating the public about the necessity for universal vaccine coverage and avoiding any suggestion of coercion .” Another concern is “ a discrepancy between reported acceptance of a COVID-19 vaccine and acceptance if vaccination was mandated by one ’ s employer .”
In their survey around global COVID019 vaccine acceptance , Lazarus , et al . ( 2020 ) found that all respondents reported they would be less likely to accept a COVID-19 vaccine if it were mandated by employers : “ This finding across all countries with both high and low reported vaccine acceptance proportions , suggests that promoting voluntary acceptance is a better option for employers . It might seem easier to monitor compliance among adults in the working age group if employers required it , but this could fail if it is perceived as limiting employees ’ freedom of choice or a manifestation of employers ’ self-interest .”
As the multi-society consensus statement ( 2021 ) observes , “ Some healthcare facilities have achieved high rates of HCP compliance with routinely recommended vaccines in the absence of vaccination as a CoE … Notably , most programs reporting immunization rates of 90 percent or higher used one or more soft mandates , including mandatory declination forms or the requirement for use of face masks by unvaccinated HCP during close contact with patients .”
Incentives also have proliferated . As the consensus statement notes , “ Many healthcare facilities and systems , with and without vaccination as a CoE , have used incentives to encourage staff to receive recommended vaccines . According to EEOC guidance , employers may offer non-coercive incentives for voluntarily providing proof of vaccination or for receiving the vaccination itself .”
Habib and Penan ( 2021 ) outline other ethical concerns of vaccination : “ While there are individual and systemic ethical concerns for healthcare workers with respect to whether to take a vaccine , there are also ethical considerations for healthcare employers . These considerations are largely based on the responsibility to the individual patients and the responsibility to the broader public health . Employers also have an additional ethical duty to their employees , including the duty to create a safe environment for both the individual employee , and the coworkers of each individual employee , while also respecting the individual autonomy of all their employees to the extent practicable . In thinking about these duties and the broader public health , it ’ s important to consider the impact that a vaccine mandate would have on the number of employees receiving the vaccine . With respect to the influenza vaccine , studies have shown that if an employer requires the vaccine , 85 percent of employees get vaccinated , compared to 43 percent that get vaccinated in the absence of a vaccine requirement .”
But civil liberties exist . Habib and Penan ( 2021 ) explain that Title VII of the Civil Rights Act of 1964 protects an employee who refuses to receive a vaccine due to a sincerely held religious or moral belief , observance , or practice : “ This would apply to a healthcare employee who refuses to get the COVID-19 vaccine due to a sincerely held religious or moral objection to receiving it . If a healthcare employee refuses to be vaccinated due to a religious or moral objection , the employer must provide a ‘ reasonable accommodation ’ for the religious or moral belief unless it would cause an undue hardship on the employer , which courts have defined as ‘ more than a de minimis cost or burden on the employer .’ EEOC guidance explains that a religious or moral belief is interpreted broadly and that ‘ the employer should ordinarily assume that an employee ’ s request for religious accommodation is based on a sincerely held religious belief ’ unless the employer has an ‘ objective basis ’ for questioning the belief ’ s sincerity , in which case the employer may ask for supporting information . Federal regulations based on Supreme Court precedent provide that what qualifies as a religious practice includes ‘ moral or ethical beliefs as to what is right and wrong which are sincerely held with the strength of traditional religious views .’”
In interpreting this standard , courts have found that what qualifies as a religious belief for these purposes is fairly broad . In Chenzira v . Cincinnati Children ’ s Hospital , a federal court in Ohio denied a hospital employer ’ s motion to dismiss a case brought by a hospital employee who claimed an exemption on religious grounds from the hospital ’ s flu vaccine requirement on the basis that the vaccine was made from animal byproducts and the employee was vegan . In denying the employer ’ s motion , the court noted that it was “ plausible the [ plaintiff employee ] could subscribe to veganism with a sincerity equating that of traditional religious views ,” and thus the employee ’ s veganism could qualify as a sincerely held religious belief under Title VII of the Civil Rights Act .”
In some cases , termination may be acceptable . In Robinson v . Children ’ s Hospital of Boston , a Massachusetts federal district court granted a hospital employer ’ s motion for summary judgment on a claim by a former hospital employee who was terminated for failure to take the flu vaccine , in violation of the hospital ’ s mandatory flu vaccination policy for all patient-facing employees . The employee was a patient-facing employee working in the hospital ’ s emergency department who objected to being vaccinated on religious grounds ( because of pork byproducts used in creating the vaccine ) and then later , objected based on a medical exemption based on a past vaccine reaction . The hospital gave the employee time to gather required medical documentation and offered to provide the employee with an alternative version of the vaccine that did not contain pork byproducts , but the