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Ethical analyses of institutional measures to increase health care worker influenza vaccination rates.
Vaccine. 2013 Dec 16; 31(52):6172-6.V

Abstract

Health care worker (HCW) influenza vaccination rates are modest. This paper provides a detailed ethical analysis of the major options to increase HCW vaccination rates, comparing how major ethical theories would address the options. The main categories of interventions to raise rates include education, incentives, easy access, competition with rewards, assessment and feedback, declination, mandates with alternative infection control measures, and mandates with administrative action as consequences. The aforementioned interventions, except mandates, arouse little ethical controversy. However, these efforts are time and work intensive and rarely achieve vaccination rates higher than about 70%. The primary concerns voiced about mandates are loss of autonomy, injustice, lack of due process, and subsuming the individual for institutional ends. Proponents of mandates argue that they are ethical based on beneficence, non-maleficence, and duty. A number of professional associations support mandates. Arguments by analogy can be made by mandates for HCW vaccination against other diseases. The ethical systems used in the analyses include evolutionary ethics, utilitarianism, principalism (autonomy, beneficence, non-maleficence, and justice), Kantism, and altruism. Across these systems, the most commonly preferred options are easy access, assessment and feedback, declinations, and mandates with infection control measures as consequences for non-compliance. Given the ethical imperatives of non-maleficence and beneficence, the limited success of lower intensive interventions, and the need for putting patient safety ahead of HCW convenience, mandates with additional infection control measures as consequences for non-compliance are preferred. For those who opt out of vaccination due to conscience concerns, such mandates provide a means to remain employed but not put patient safety at risk.

Authors+Show Affiliations

Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, 3518 Fifth Avenue, Pittsburgh, PA 15261, United States. Electronic address: zimmer@pitt.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24188752

Citation

Zimmerman, Richard K.. "Ethical Analyses of Institutional Measures to Increase Health Care Worker Influenza Vaccination Rates." Vaccine, vol. 31, no. 52, 2013, pp. 6172-6.
Zimmerman RK. Ethical analyses of institutional measures to increase health care worker influenza vaccination rates. Vaccine. 2013;31(52):6172-6.
Zimmerman, R. K. (2013). Ethical analyses of institutional measures to increase health care worker influenza vaccination rates. Vaccine, 31(52), 6172-6. https://doi.org/10.1016/j.vaccine.2013.10.066
Zimmerman RK. Ethical Analyses of Institutional Measures to Increase Health Care Worker Influenza Vaccination Rates. Vaccine. 2013 Dec 16;31(52):6172-6. PubMed PMID: 24188752.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ethical analyses of institutional measures to increase health care worker influenza vaccination rates. A1 - Zimmerman,Richard K, Y1 - 2013/11/01/ PY - 2013/08/05/received PY - 2013/10/18/revised PY - 2013/10/22/accepted PY - 2013/11/6/entrez PY - 2013/11/6/pubmed PY - 2014/7/16/medline KW - Ethical analysis KW - Health care worker KW - Influenza vaccine KW - Mandate SP - 6172 EP - 6 JF - Vaccine JO - Vaccine VL - 31 IS - 52 N2 - Health care worker (HCW) influenza vaccination rates are modest. This paper provides a detailed ethical analysis of the major options to increase HCW vaccination rates, comparing how major ethical theories would address the options. The main categories of interventions to raise rates include education, incentives, easy access, competition with rewards, assessment and feedback, declination, mandates with alternative infection control measures, and mandates with administrative action as consequences. The aforementioned interventions, except mandates, arouse little ethical controversy. However, these efforts are time and work intensive and rarely achieve vaccination rates higher than about 70%. The primary concerns voiced about mandates are loss of autonomy, injustice, lack of due process, and subsuming the individual for institutional ends. Proponents of mandates argue that they are ethical based on beneficence, non-maleficence, and duty. A number of professional associations support mandates. Arguments by analogy can be made by mandates for HCW vaccination against other diseases. The ethical systems used in the analyses include evolutionary ethics, utilitarianism, principalism (autonomy, beneficence, non-maleficence, and justice), Kantism, and altruism. Across these systems, the most commonly preferred options are easy access, assessment and feedback, declinations, and mandates with infection control measures as consequences for non-compliance. Given the ethical imperatives of non-maleficence and beneficence, the limited success of lower intensive interventions, and the need for putting patient safety ahead of HCW convenience, mandates with additional infection control measures as consequences for non-compliance are preferred. For those who opt out of vaccination due to conscience concerns, such mandates provide a means to remain employed but not put patient safety at risk. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/24188752/Ethical_analyses_of_institutional_measures_to_increase_health_care_worker_influenza_vaccination_rates_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(13)01462-X DB - PRIME DP - Unbound Medicine ER -