COMMENTARY

Why Hospital Workers Should Be Forced to Get Flu Shots

Arthur L. Caplan, PhD

Disclosures

September 13, 2012

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Hi. I am Art Caplan from the New York University Langone Medical Center in New York City where I head the Division of Medical Ethics. Today I want to talk to you about an ethical issue that I think pertains to doctors, nurses, and other healthcare workers but not so much their patients.

It is about to be flu season, and we are starting to see the signs go up at pharmacies, drugstores, and other retail outlets: They have the flu shot, so come get one. I think that doctors responsibly tell their patients to get a flu shot. The problem is that we don't get our flu shots, and I am talking about doctors, nurses, nurses' aides, pharmacists, and other people who work in healthcare settings.

The average rate of flu shots among the workforce in American hospitals varies from about 80% in physicians down to 60% in nurses. In nursing homes, you are often looking at rates that are 30% or lower. Who is likely to get harmed by the flu? Who is at great risk? It is not the healthy 30-year-old. They may get sick and they may have some time in which they cannot go to work. It's not a good thing and I think they should get a flu shot, but they are not going to die.

The elderly are at high risk, babies are at high risk, and people who are immune-comprised due to HIV or transplants are at high risk too. Where are they going to be? In nursing homes, hospitals, and healthcare settings.

Therefore, it is of crucial importance that doctors, nurses, nurses' aides, and people who work in healthcare settings get their shots. I know that a lot of people have said that it ought to be voluntary, that it ought to be something that I choose to do. I do not lose my right as a doctor or a nurse to say that I don't want to do that.

Well, I think you do. Ethically, your first obligation is to do no harm. If you are there to do no harm and that is your primary obligation, then you cannot put your personal choice or your personal reluctance to get that shot above doing harm. And you are likely to do harm to others if you do not get that shot.

Also, every code of ethics that I have seen -- medical, nursing, and others -- says that we put patient interests first. It is not in the patient's interest for you to not get a flu shot. If we are putting patient interests first, if that rhetoric is what we believe in our codes of ethics, what we teach in our medical and nursing schools, there is no excuse for not getting a flu shot.

I think the obligation is there to do it, and I will go further. I think that every hospital and every nursing home should require as a condition of employment that you show that you got a flu shot every year. I think it is also important, if you are talking with families or patients who might have a relative in a high-risk category, that you remind them to ask their healthcare providers whether they have had a flu shot. When you go to visit Grandmom in the nursing home or if you are going to see the newborn baby, is everybody vaccinated there? That is a question that they need to be asking, and you need to remind them.

At the end of the day, it's flu season and we can do something about this. We can protect the weakest and most vulnerable that are among us, but we have to set the right example. Our moral duty is to get our flu shots and prevent harm to others who can't protect themselves or who are especially at risk for the flu. It's the time of the year to do it. I think it is important that we set the right example.

I am Art Caplan at the Division of Medical Ethics at NYU Langone Medical Center. Thanks for listening.

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