Firing health-care workers who refuse to vaccinate raises ethical concerns: experts
'I get very uncomfortable with people being fired over this,' says bioethicist Kerry Bowman
As workplace vaccine deadlines rapidly approach, thousands of unvaccinated Canadian health-care workers are having to decide whether to risk their jobs or to get the jab.
Some health-care workers in Ontario and British Columbia have been suspended without pay from their jobs due to not being vaccinated. Others are bracing for a similar fate when their province or territory's vaccine deadline arrives.
For bioethicist Kerry Bowman, these dismissals are concerning.
"I get very uncomfortable with people being fired over this," he told Cross Country Checkup. "If there are other solutions that are reasonable, I think it would be good to pursue those first."
Bowman is pro-vaccine, and he believes health-care workers have a moral obligation to be vaccinated, especially given their roles and the people they interact with.
"When it comes to the rights of health-care workers … [and] balancing that with the safety and well-being of patients, I would say that the safety and well-being of patients needs to come first," he said.
What he doesn't agree with is the obligation being put on employees — both by their employers and by various levels of government — to take the vaccine or risk losing their jobs.
"We've got a prime minister and we've got political leaders and we've got columnists that are just about ready to go after [unvaccinated] people," he said. "We're incredibly angry and intolerant towards people that aren't vaccinated. There's not much of a spirit of understanding at all."
He said officials should seek to understand their unvaccinated employees' viewpoints and explore other avenues before rushing into a decision that could have consequences on the individual's personal and professional lives.
"You can't deal with a problem you don't fully understand, and I'm not sure we've really gotten to the bottom of this with everybody, because not everyone's the same on this topic," he said.
Dismissals 'the right thing to do'
Some health-care workers say it's their choice whether to get vaccinated and no one can force them to make that decision.
But according to labour lawyer Howard Levitt, arguments such as those don't matter when it comes to the law.
"People talk about 'We have the right to [protect] the body. No one can inject something into our body without our approval,'" he said. "That's of course true, but that doesn't mean you can keep your job."
Levitt said in a workplace scenario, public safety trumps that personal right. He argues that the employer has a duty to maintain a safe workplace, and they must address things that threaten that environment.
He gave a potential scenario, in which an employer — despite what's being advocated by the government and public health officials — fails to implement a vaccine mandate. This results in an employee suing them due to COVID-19 complications or even a death caused by COVID-19.
"By the time this case reaches trial in a couple of years, the court may say, given the public safety pronouncements, given the legislative pronouncements, given the chief medical officer of health pronouncements, it was negligent not to require mandatory vaccinations for everybody," he said.
"That could be a multimillion-dollar lawsuit for one person alone who dies or becomes permanently incapacitated from COVID."
That's why he argues that subject to "very, very limited medical and religious exemptions," employers have the right to fire workers who refuse to be vaccinated.
"In fact, it's the right thing to do; to require vaccination in the workplace and terminate employees who refuse to be vaccinated, unless they have a creed or medical exemption," he said.
Making informed decisions
According to some experts, part of the problem with enforcing a vaccine mandate for health-care workers is the risk of losing personnel. This could increase the workload for those who remain and affect the level of care patients receive.
"We have shortages of health-care workers, and if you have a significant portion … who are going to lose their jobs because they're choosing not to be vaccinated, there are serious implications in terms of hospitals and other facilities being short-staffed," said Cara Zwibel of the Canadian Civil Liberties Association.
It's a point some provincial governments have considered. Quebec recently delayed its Oct. 15 vaccine deadline by 30 days to avoid potentially losing as many as 22,000 health-care workers.
In Ontario, Premier Doug Ford asked hospital CEOs, local medical officers of health and other health-care organizations for input on implementing vaccine mandates amid similar concerns.
"Any decision will need to balance the risks posed by COVID-19 to hospitals with the risk of further exacerbating health human resourcing challenges and the risks these may pose to the sector's ongoing delivery of high-quality care," he wrote.
There's also a concern that forcing health-care workers — and workers in general — to take vaccines in order to keep their jobs goes against health-care messaging about informed decision-making.
"Our goal as health-care works is to make sure that our patients … are making informed decisions; that they have all of the right information and the best information to make the best decision they can," Bowman said. "This has shifted to: do we like your decision or not?"
Bowman said by painting all non-vaccinated Canadians as being extremist and potentially dangerous, some public figures are failing to preserve autonomy.
"Case in point, I know a person is accepting vaccination because they have three young children and they need an income…. They don't want it and their job is on the line," he said.
This [pandemic] story is not over yet, and we're going to have to look back on this and this will be part of our history as to how we dealt with it.- Kerry Bowman
By not respecting an individual's bodily autonomy, Bowman fears public leaders are creating conditions that will tarnish Canadian health-care post-pandemic.
"I've even heard bioethicists saying things like, 'People just have to learn to make better decisions,'" he said. "We're drifting much more towards a judgement of whether we like the decisions they're making or not."
That's why Bowman and Zwibel agree that rather than forcing health-care workers to take vaccines or face severe consequences, employers and government officials should try to understand why health-care employees are refusing to be vaccinated.
"Especially in health-care, it's worth looking at why it is that some health-care workers are choosing not to be vaccinated, and either seeing if some of those reasons can be addressed or offering some alternatives," Zwibel said.
"This [pandemic] story is not over yet, and we're going to have to look back on this and this will be part of our history as to how we dealt with it," Bowman said. "And I wonder how we'll score ourselves in the years ahead."
Written by Mouhamad Rachini. Produced by Abby Plener and Arsheen Shamalia.