Question from Shaunavon, Saskatchewan, SK. "I read that some paramedics in Kingston [Ontario] were suspended from the job because they refused their flu shots. Should they be made to get flu shots?"

Up until 2000, paramedics were immunized against polio, hepatitis B, measles, mumps and chicken pox. In May 2000 the provincial government of Ontario added the flu shot to the list. Paramedics began protesting, stating that the government canÕt forcibly vaccinate its employees if itÕs against their will. In response, public health officials have struck back hard against the ambulance workers. According to Kingston regionÕs chief medical officer of health Dr. Ian Gemmill "to say Ôyou canÕt tell me what to doÕ is not a very good reason when it comes to our professional, ethical responsibility to our patients."

In order to understand the ethical issue here, it is critical to set aside the bold overstatements offered in the public record and consider the main concerns that make up the larger question of Ôshould we make paramedics get the flu shot?Õ Questions about the effectiveness of the flu shot, the seriousness of influenzaÕs effect on patientsÕ health, and the competing interests of the paramedicÕs professional obligations versus their autonomy should provide the guidance to help us answer the question.

What threat does influenza poses to patients? This is a serious condition that is a major cause of hospital visits and death. Influenza A carries significant risks for patients, particularly considering the weakened immunity many ill patients have, and especially in cases of the elderly and those with existing health issues, such as chronic obstructive pulmonary disease, asthma, and chronic heart disease, among many other common conditions.

Knowing influenza is a serious health concern, our next consideration is the effectiveness of the vaccine. Research shows that immunization can reduce influenza occurrences by 75-80 per cent in healthy adults, and up to 40 per cent in ill elderly patients.

So, if the flu is dangerous to patient health, and it is largely preventable with vaccination, what moral considerations would prevent us from making this mandatory for paramedics?

As health care workers and citizens of Canada, paramedics have the right to self-determination, also known as Ôautonomy.Õ Autonomy must be respected, but isnÕt absolute. It must be respected until the moment when oneÕs actions interfere with the autonomy of another. In the example of influenza, the autonomous decision of a paramedic to refuse the vaccine is overridden because they subsequently pose a risk of infection to many others. As such, it seems that paramedics should want to have vaccinations as part of their duty of care to their patients.

Having considered the issue as it relates to paramedics, we can go further and say that all health-care professionals have a moral obligation to get a flu shot. And this claim leads into one of the main points that paramedics have made in protesting obligatory vaccinations Ð fairness. In published studies, it becomes clear that the higher up the health-care hierarchy one is, the rates of immunization decline in proportion. In one study conducted in long-term care facilities in Alberta, 96 per cent of housekeeping staff had been immunized, along with 99 per cent of all Registered Nurses, but only 56 per cent of the physicians had their flu shots. This constitutes an unconscionable inequity, where health care workers with less power in the health care system feel compelled to do whatÕs right, while those in higher strata, who pose equal or greater infection risk to patients, feel less compelled and are allowed to continue on without comment by the provincial government.

If the evidence is clear that influenza is harmful and infectious, and that the vaccine is as effective as research claims, then all health care workers should want to have it, and those who donÕt should be ordered to do so. There should be no Ôsliding scaleÕ of professional obligation, wherein paramedic, nursing, and housekeeping staff are expected to take their obligations seriously, and physicians are not.