The controversy over mandatory flu vaccination has raged for months, especially in light of the 2009 H1N1 pandemic influenza. New York State at first mandated vaccination for all health care workers and then rescinded the mandate. Unions and organizations have been opposed to mandates while at the same time encouraging nurses to be vaccinated. To put some perspective on the debate, we asked two nursing leaders with opposing views (Daniel J. O'Neal III, GCNS-BC, CNL, and Ann R. Converso, RN) to weigh in and asked nurse ethicist Douglas P. Olsen, PhD, RN, to critique their arguments.

POINT: In Favor of Mandatory Vaccination

'The vaccine is the most effective means of preventing the disease.'

I decided I'd receive the 2009 H1N1 pandemic influenza vaccine as soon as it became available. It's my responsibility as a nurse to integrate knowledge, research, and ethics into practice. Emerging literature and statements from responsible authorities such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization led to my conclusion that the vaccine is the most effective means of preventing the disease. I support mandatory vaccination against H1N1 as one step in the control of a pandemic.

The decision to receive the vaccine is an ethical dilemma for some nurses. There have been comparable dilemmas in recent decades, with some nurses refusing to treat patients with conditions that put the nurse at risk, such as HIV, severe acute respiratory syndrome (SARS), or multidrug-resistant tuberculosis, or to administer chemotherapeutic agents that can pose a risk to the nurse's future children. Nurses have refused to treat patients, such as prostitutes who use injection drugs, whose lifestyles they don't condone. Although these refusals are often made on moral or religious grounds, or expressed in the language of conscientious objection, they can be fear masquerading as personal autonomy.

Because health care workers can be carriers, many jurisdictions and employing organizations require periodic screening and immunization against measles, mumps, hepatitis infections, rubella, and other diseases. It's my ethical duty to reduce my risk of contracting preventable diseases. If I fail to be vaccinated against H1N1 influenza, I'm more likely to get it, which will render me incapable of caring for patients for a period of time. The ethical duty to care means I must be available in a local or national emergency like an epidemic or pandemic. Therefore, I employ the most effective means possible (the vaccine) to give a measure of protection from contracting the disease.

Receiving the vaccine means that I'm less likely to become a patient, less likely to become a burden on our health care system at precisely the time the public has the greatest need for the care I provide. I'm also less likely to transmit the disease to others, especially vulnerable patients. My decision to get the H1N1 vaccine was guided by recommendations from competent authorities, as well as my own assessment of the latest information; it fulfills the public's trust in the profession and serves as a powerful example to patients and other health care workers.