Occupational Health Ethics by Jacques Tamin

Author:Jacques Tamin
Language: eng
Format: epub
ISBN: 9783030472832
Publisher: Springer International Publishing

(b)The next example is that of chickenpox (varicella) vaccination in HCWs. Chickenpox is typically a mild illness in healthy children but can be a severe one in adults. It can be even more serious in immunocompromised individuals, pregnant women and fetuses, and neonates. Therefore, HCWs working particularly with these groups of patients must be immune to varicella zoster virus (VZV), so that they cannot contract the infection and transmit it to patients. The primary purpose of a VZV vaccination program is for the benefit of patients, especially those at higher risk of severe illness and complications. There is also benefit to vaccinated HCWs, as they then become immune to VZV infections. Similar ethical (and practical) concerns arise if the HCW declines VZV vaccination, as we saw in the case of hepatitis B vaccination. The main ethical tensions are between HCW autonomy and patient protection. However, the group of HCWs may be wider in scope, as it involves all HCWs in clinical contact with patients, rather than the smaller group of HCWs involved in EPPs when we considered hepatitis B.

When a HCW declines VZV vaccination, we may question whether this is a fully informed choice, so we should explore concerns and beliefs, and provide appropriate information. This allows the HCW to exercise their more reflective or reasoned autonomy (see Chap. 3). HCWs also have a professional duty to protect patients, often reinforced by their professional bodies’ codes of conduct. This should also be part of their reflection. However, if they still refuse vaccination, then we should act in accordance with their choice. Nonetheless, it would not be ethical either to put patients at risk of potential severe infections. So, we would advise their manager that a risk assessment would be required, on the basis that the HCW is not immune to VZV. This should usually exclude them from clinical contact with the most vulnerable and high-risk groups of patients. However, there may be clinical settings where patient groups are variable, such as accident and emergency departments, so relocation to less acute areas with no high-risk patients might be required. On the issue of confidentiality, a “fitness certificate” with only the relevant information and advice, that is, the HCW lacking VZV immunity and the need for an appropriate risk assessment, addressed to the manager (possibly with a copy to HR) would not breach confidentiality in my view. It would still be preferable to have the HCW’s permission to disclose this, but if the HCW refused, then our duty to protect patients from a serious illness should take precedence.

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