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CASE 11: THE HEALTH-CARE WORKER WHO REFUSES IMMUNIZATION A new influenza virus is circulating around the world and has been detected in the community where Dr. M works. Dr. M works in geriatrics. Since he has daily contact with individuals considered to be at high risk for influenza virus infection, Dr. M is at the top of the vaccine priority list. Due to Dr. M’s personal beliefs regarding influenza immunizations, he refuses to be vaccinated. What is to be done with Dr. M?
What values are at stake?
Discussion; Clearly steps must be taken to deal with conscientious objectors, in particular those working in the health-care sector. How should they be dealt with? Should policy come from the macro, meso, or micro level? Should Dr. M be denied the right to tend to patients who may be ill (a risk to Dr. M’s health)? Should Dr. M be denied the right to treat healthy patients (he may have had incidental contact with an infected individual)? Are there institutional guidelines in place to mediate these dilemmas when they arise? •
What is the nature of the policy issue? • Are there policies in place to deal with conscientious objectors, health-care workers, professionals and essential service providers who refuse immunizations? For example, are guidelines in place to deal with health-care workers or professionals who conscientiously object to immunizations or drugs? • Such policies may be unique to institutions (e.g., hospitals and the health authority or province). If such policies do not exist, are steps being taken to draft them?
What is the ultimate goal of these policies or decisions? Who is responsible for making such decisions? Who should be invited to sit at the table to make this decision or draft this policy? Will it be a hospital-specific policy, a district health authority policy, or a provincial policy? Is the goal to ensure that all employees can continue to contribute to the health-care system during an emergency situation?
Is the goal to protect patients already within the healthcare system, or those entering the health-care system? Is the goal to protect the employee? Can a goal be defined that encompasses all of these questions? Once the goal has been defined, how should the process proceed towards the defined end? Again, the procedure should be fair, informed, open (transparent), and accountable. Moreover, in this instance, the procedure should also be responsive, and adaptable as new information emerges regarding the use of drugs and vaccines. For example, a vaccine may not yet be available, and there may not be enough antivirals to use in prophylaxis (the priority for antivirals is to treat infected individuals).

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