In Opposition of Mandatory COVID-19 Vaccination: The Continued Importance of Medical Autonomy in the Pandemic
As nurses, we often find ourselves in positions where we must advocate for our patients’ wishes and beliefs; we must do this even when we ourselves do not share the same belief systems and wishes. We refer to these actions—on behalf of and in support of patient preference—as advocacy. Advocacy is one of the most important responsibilities carried by healthcare providers. Historically, these rights have been embraced by both health care providers and by society. In fact, autonomy—along with beneficence, nonmaleficence, and justice—is one of the four main principles that comprise the Nursing Code of Ethics. According to Varkey’s summary of philosophers Immanuel Kant and John Stuart Mill, “all persons have intrinsic and unconditional worth, and therefore, should have the power to make rational decisions and moral choices, and each should be allowed to exercise his or her capacity for self-determination” (2021). According to this ethical code, individual patients maintain the right to make their own decisions regarding treatment pathways, medical and surgical intervention, pharmacologic options, and end of life care. Clearly then, the right to medical autonomy cannot and should not exempt vaccination policy.
Since the appearance of the novel coronavirus in spring of 2020, tracking disease spread has been moved to the forefront of public consciousness. The Center for Disease Control (CDC) began tracking data related to COVID-19 on December 20, 2020; this data includes number of total infections, number of new infections, number of deaths following infection, and number of patients recovered. This data can be further stratified by state, county, and city. For worldwide data, the World Health Organization (WHO) maintains a Coronavirus dashboard to track global data related to the pandemic. According to the data provided on that site, as of September 15, there have been 226,844,344 confirmed cases of COVID-19, resulting in 4,666,334 deaths. To curb the spread of infection, a vaccine was released that ideally will decrease the number and spread of the disease. In recent months, many employers have released statements threatening to terminate employment of any individual who does not receive all doses of the proscribed vaccine within a certain timeframe, a policy that is clearly problematic when it comes to both ethics and autonomy.
In his report on the value of autonomy in medical ethics, Jukka Varelius (2006) describes freedom that is “at minimum, self-rule that is free from both controlling interference by others and from limitations, such as inadequate understanding, that prevent meaningful choice [and that] ‘the autonomous individual acts freely in accordance with a self-chosen plan.” He further asserts that “a person of diminished autonomy, by contrast, is in some respect controlled by others or incapable of deliberating or acting on the basis of his or her desires and plans. For example, prisoners and mentally retarded individuals often have diminished autonomy (2006).” Without even touching upon the numerous individual freedoms that we appreciate in this country related to topics as broad as religion and sexual preference, we also have historically enjoyed freedoms related to the individualization of our personal health.
Practitioners of both medicine and nursing have been educated to provide information regarding health to both individuals and communities and to let them each choose, from that point, which care pathway best fits their own personal goals and attitudes toward health. These same providers are promoting the numerous guidelines that exist in our modern-day healthcare system, recommendations that were created in order to positively influence both individual and public health, describing all aspects of health promotion and maintenance, from which foods have the most nutritional value and what medications and treatments have been proven most efficacious in fighting various diseases, to which vaccinations our children should receive, optimally before attending public school. Despite this wealth of knowledge identifying the practices that are statistically most likely to positively influence health outcomes, a patient may still refuse to change their diet as part of their diabetes management, or to take medication for the treatment of hypertension. They may opt to continue smoking, despite education on the inherent risks of that practice, even to the detriment of themselves and/or others. Patients may even choose not to accept life-extending care at all.
By the same token, parents are free to either opt out of receiving vaccinations for their children or to alter the published vaccine schedule as they see fit. These decisions are simply then documented in the medical record, without undue coercion and regardless of the personal opinions held by either the provider or by other parents. Currently, however, many of those same parents no longer have the right to select whether they themselves will receive the vaccine, due to threats of employment termination. This push for the widespread vaccination of society does not allow for autonomous decision-making. To reference the words of Varelius, this new push for vaccination can be considered the result of “controlling interference” (2006). The loss of autonomy in medical decision making in any capacity sets a dangerous precedence for the future of healthcare. As providers, we share a unique responsibility to uphold the standards of medical autonomy, as described in the Nursing Code of Ethics.
Call to Action
Regardless of one’s individual opinions regarding COVID-19 vaccination policy, the vaccine itself falls under the aegis of healthcare and, as such, is subject to an individual’s acceptance or denial as are all other medical recommendations, treatments, and protocols. We should not, as either healthcare providers or as individuals, force, coerce, or threaten others to follow our wishes on these subjects, despite any benefit, whether perceived or actual. To do so is in violation of both patient autonomy and our role as patient advocates.