Health practitioner vaccination (Melb) May13

Vaccination of healthcare workers: A legal and ethical duty of care?

International Nursing Congress 2013Melbourne, AustraliaDr Marie Bismark LLB MBChB MPH MBHL

@mbismark

MELBOURNE SCHOOL of POPULATION AND GLOBAL HEALTH

Page Title / heading goes hereVaccination of health practitioners

Patients protected from harm

Individual rights of health practitioners

Legal & ethical responsibilities

Patients exposed to risk of harm

Page Title / heading goes here Risk of harm


Page Title / heading goes hereRisk of harm.


Page Title / heading goes here Protecting patients


Page Title / heading goes here Protecting patients


Other interventions are also important:•hand washing•personal protective equipment e.g. masks, gloves•early detection•staying home when unwell

Page Title / heading goes here Rights and responsibilities


One of the core moral challenges of public health is balancing individual liberties with the advancement of good health outcomes.


Page Title / heading goes here Individual rights


Both the common law and international human rights laws protect the right of a competent adult to refuse medical treatment, including vaccination.

“Everyone has the right to refuse to undergo any medical treatment.”

Section 11 New Zealand Bill of Rights Act 1990



However, unvaccinated health practitioners do not have a legal right to work in settings where they may expose patients to harm.-newborns-pregnant women-immunocompromised patients

(NB: need to consider terms of individual employment agreements)

Page Title / heading goes here Legal & ethical duty of care

“The law imposes on a [health] practitioner a duty to exercise reasonable care and skill in the provision of professional advice and treatment.”

- Rogers v Whitaker (1992) 175 CLR 479

Healthcare providers must "exercise that degree of care and skill which could reasonably be expected of a normal, prudent practitioner.”

- Crits v Sylvester [1956] SCR. 991



“Every consumer has the right to have services provided in a manner that minimises the potential harm to that consumer.”

- NZ Code of Health Consumers Rights



http://www.scientificamerican.com/article.cfm?id=health-care-workers-flu-shot



Breach of duty of care may lead to:•Illness and complications among patients and their families•Loss of trust in health service•Patient complaint to commissioner or ombudsman•Action by employer or Medical Board•Medical malpractice litigation if breach causes patient harm


Page Title / heading goes here.

Young girl acquired smallpox after exposure at a Vancouver hospital:

“While it may be difficult to provide against unknown danger, … [the risk of disease transmission] suggests the need of rigorous precautions with the view, within reasonable limits, of closing every avenue from which danger might be apprehended."

McDaniel v. Vancouver General Hospital [1934] 1 D.L.R. 557

Legal & ethical duty of care


Page Title / heading goes here Voluntary vaccination

Vaccination rates <50% among health practitioners in many countries•Traditional strategies consistently fail•Some professions (eg midwives) even lower than others

Page Title / heading goes here Voluntary vaccination

Page Title / heading goes here Support and incentives

Vaccination rates 50 to 75% possible through:•Providing vaccines free of charge•Ensuring convenient times and places•Demonstrating strong leadership support•Offering incentives

Page Title / heading goes here Support and incentives

Babcock H M et al. Clin Infect Dis. 2010;50:459-464

Page Title / heading goes here Mandatory vaccination

Vaccination rates >95% achieved if mandatory•Very few adverse events (sore arm most common)•Exemption requests often reflect misconceptions e.g. influenza immunization during pregnancy

Page Title / heading goes here Mandatory vaccination

Page Title / heading goes hereFirst, do no harm

http://www.thedailybeast.com/articles/2013/03/30/why-rubella-s-scary-comeback-should-convince-vaccine-deniers.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+thedailybeast%2Farticles+%28The+Daily+Beast+-+Latest+Articles%29

Page Title / heading goes hereVaccination of health practitioners





Page Title / heading goes hereSummary

1) Unimmunised health practitioners expose patients to risk of harm

2) Vaccination of health practitioners reduces risk of harm

3) Health practitioners have a legal right to refuse vaccination (but no right to keep working with patients if unreasonable risk of harm)

4) Health practitioners owe patients a legal and ethical duty of care: must take all reasonable steps to protect patients from harm

5) Voluntary vaccination consistently fails to achieve adequate cover

6) Support and incentives can and should be widely implemented

7) In some situations mandatory vaccination policies (with ability to apply for exemption) may be legally and ethically justified

Health practitioner vaccination (Melb) May13

Health & Medicine

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