100. UNVACCINATED NEED NOT APPLY - Ethics, Healthcare Jobs and Mandatory Vaccination

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Wow - we made it to 100 posts! I probably should have done something amazing to celebrate but instead I’m just going to write a post as normal. Technically “I” haven’t written 100 posts, as some are written by other contributors (but still not nearly enough - write for us!) so maybe I’ll do something special when it gets to the actual hundredth post I have written. In the meantime, here’s post 100: UNVACCINATED NEED NOT APPLY:

I keep seeing headlines about care-workers and NHS staff who will be leaving the profession when Covid vaccinations become mandatory for them.  The headlines seem accusing.  It is as if this unfair ruling is pushing good people of their jobs.  These wilfully unvaccinated health-workers, the pull of the headline suggests, should be allowed the liberty and freedom to both choose to stay unvaccinated and maintain the current way they earn a living. 

The anarchist in me naturally balks at any enforcement of mandatory rules from on high.  But the ethicist in me can see the moral reasons why those people either looking after the most at risk of dying from Covid-19, or most likely to come into intimate contact with large numbers of members of the public, specifically for health-related reasons, should want to do what they can to protect both themselves and others.   

Consider someone working in a biological lab, studying contagious diseases.  It may be defensible to say that it is their own free choice if they decide not to wear protective gear when studying a new virus.  Freedom, one could say, perhaps dictates that an individual can choose to take their own lives into their hands and put themselves at risk if they want to.  I do so every time I wilfully choose to eat artery-clogging foods.  But, if there was any danger that such behaviour might not only infect the freedom-loving lab-worker, but all other innocent people who may come into contact with them for the next ten days, we can see that the argument from individual freedom hits a brick wall.  The consequences of such freedom are not limited to the individual an they put other people at risk who have not equally chosen freely to be put at such risk.  Indeed, some might have explicitly asked not to be put at such risk.  I have a friend who sky-dives as a hobby.  I wish him all the best with it and am glad he enjoys it.  But I don't want to sky-dive.  If one day the friend took me up in a plane against my will and forced me to take a leap with him, regardless of whether I happen to survive the dive or not, it is a risk I am forced to take without consent and it feels clear that some moral wrong has been committed against me. 

If our freedom-loving lab-worker therefore is truly a lover of freedom, that their free actions limit or even directly impose upon the freedom of others should concern them.  If it does concern them then one might imagine that the very love of freedom that motivated them to eschew protective gear for themselves might now entice them to put some on.  Freely.  Out of their own fully-informed choice.  After all, they remain free to find dangerous work elsewhere that puts only themselves at risk if such risk is what they want, but so long as their free choices impact on the freedoms of others to stay safe they need to consider how all parties can maintain as much freedom for all as is possible.   

If it doesn't concern them that their actions limit or even directly impose upon the freedom of others then perhaps our freedom-loving lab-worker doesn't actually love freedom at all?  Perhaps they just love their freedom.  In other words, they are selfish. The argument from freedom reduces instead to an argument from egoism, and can be rejected on terms of the interconnectedness of people and any ethical theory which believes it is important to consider the effects of our actions on others. 

If we transplant the principles from the fictitious lab-worker to the real-life example of the NHS worker or care-worker who doesn't want to get vaccinated but still wants to keep their job, we might consider why they do not want the vaccine.  I can think of three possible motivations: 

  1. They believe the vaccine is unsafe and may harm them (this includes the general idea that they don't want to put unknown substances into their body)

  2. They have some sort of known health condition which they know, and have been told by medical professionals, means the vaccine would be unsafe for them

  3. They just don't want to have it because they can't see the need.

If 1) then, to not be merely a selfish principle, we can see that the argument that a person has a right to protect themselves from potential harm must follow also to the patients or clients of such a worker, who might be harmed from their going unvaccinated.  If they are free to not have the vaccine and put themselves at risk, the NHS and the care-homes are equally free to only hire people who will not put their vulnerable patients and clients at risk. 

If 2), 1) still follows.  While their own protection here is out of necessity not choice, so too is the protection of vulnerable NHS patients or care-home residents who have no choice but to come into contact with the various staff they encounter while in need of healthcare services.  Eliminating the unvaccinated from that equation ensures no patient or resident is put at unnecessary risk. 

If 3), then we have to accept the consequences of our choices.  If I choose not to want to work around heights, I have to accept that I shouldn't be able to work as a tree surgeon.  If I am worried about my hearing and want to protect my ear-drums, I have to accept that work in a noisy nightclub is probably not for me.  If I choose not to learn to drive, jobs with Uber, or driving a bus, are not going to come my way. 

I mention driving because it is also worth mentioning that many jobs require additional conditions of employment beyond academic qualifications or an interview.  If I want to drive a bus I need to have a driver's license.  If I want to be a surgeon, I will have to have gone through a rigorous medical school.  If I want to be a teacher I need my criminal record checked on top of any generic academic qualifications which might be needed.  Dependent on the type of job being done it is often considered reasonable for certain extra requirements to be made a condition of employment.  Or of unemployment.  Those prone to narcolepsy or seizures should likely not be employed to use potentially dangerous, heavy machinery, for example. 

As it is not novel or outrageous, in our current employment model, to ask certain additional qualifications of people - even certain medical qualifications - and the particular jobs in question (working with vulnerable people in close, intimate contact, or alongside others who will be working intimately with such people) are ones in which transmission of this highly transmissible and potentially deadly virus could cause a significant amount of suffering for people who have not asked for it (not to mention the knock-on effects on all healthcare services stemming from the further prolonged duration of the pandemic), it therefore seems a reasonable requirement in healthcare settings to ask that people who work there are fully vaccinated.  I had to get three vaccinations just to be able to travel to Cambodia a few years ago.  It seemed a reasonable price to pay for the experience.  If I want to work in a healthcare setting, I should want to protect the health of those in my care.  And when we add the libertarian appeal to freedom to the issue we find only more reason to enforce a policy of vaccination, not less: it is only by protecting patients and residents to the best of our ability by being vaccinated that we can ensure their freedom from the risk of covid-19. 

Freedom, after all, is not the only value, and does not exist in isolation from all other goods we might consider to be important as a society.  If we value safety too, and ensuring others enjoy the same freedoms we do, if we value science, and if we value selflessness, there are many good reasons to let some freedoms take a back-seat to allow other, equally important, goals to be achieved. 

As the covid vaccine is free and available to all in the UK whose job may be at risk, the only obstacle to one receiving it and remaining employed is the personal choice not to have it.  Which is absolutely fine.  Gamble away with your own wellbeing.  You may even end up being right and have the last laugh.  But in the meantime, given all that we do know about the vaccine's safety and efficacy, such a personal choice does not take place in a vacuum and cannot come at the expense of the equal need to give others in our care the choice to stay healthy and uninfected.  And that means recognising that if you don't want to take a vaccine which has been deemed safe and effective by all medical bodies which oversee such things, though it may be your right to do so, perhaps a job in healthcare or medicine is probably not right for you anyway.

Author: DaN McKee

My book - AUTHENTIC DEMOCRACY: An Ethical Justification of Anarchism - is available HERE  and from all good booksellers.  Read my Anarchist Studies journal paper on Anarchism and Character Education here.