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But our opinion is more important! we are the "customers"...
*backs slowly away*
I’m not trying to play devils advocate here (maybe it comes naturally 😂) but would you be happy to be treated by someone that is medically exempt from the vaccine? A lot of the arguments I have read in this thread are based around non vaccinated people being more of a risk to patients. Surely medically exempt or against the vaccine, outcome is the same? Unless we aren’t talking about safety and more about peoples own views?
Good question. I'd have to weigh up whether the exempt is likely to be more cautious about other means of protecting themselves, and whether vaccine avoider is indicative of 'don't care, won't affect me that badly'?
And then whether vaccine avoider is indicative of lower understanding of the science and consequently will the care given be the same.
@marksnook medically exempt, which is incredibly rare in reality, versus arses who don't want vaccination and claim exemption are poles apart.
Those who don't want it have no reason not to be able to have it beyond their own reasoning, the more who have vaccine means those few who can't actually have it are protected more by reduced chance of contact with the virus.
I would say if you are following the mandatory vaccination line then they should be sacked as well as if they have a medical exemption they are unfit medically to be a healthcare worker. Retired on medical grounds if you like.
There is no difference to the patient between someone who has a medical exemption, Someone who has a good reason for not wanting the vaccine and someone who is an anti vax loon. they all create the same risk to the patient
They may be poles apart but only in principal? If a medically exempt person doesn’t care and goes to clubs licking peoples faces and some one against the vaccine is super careful and doesn’t put themselves at risk then the medically exempt person is more of a risk but thats ok? Maybe medically expempt should be reassigned as well, risk is risk?
This is a very complicated and nuanced situation in my eyes
Yeah that was my thinking tj, i thought it crazy that one got a free pass even though the risk was the same
A point that occurred to me. many folk on here think being anti vax shows you are not competent to be a healthcare professional for being "anti science" ( a position I have some sympathy with)
So do we also need to route out those who believe in other nonsense. Homeopathy? Crystals? Religion ( yes I have met nurses who believe ill health is "gods will" ) I certainly do not trust fundamental religious healthcare workers because they may put their religious views first. ( I have seen this happen)
Do we have to root out every doctor / nurse that has non mainstream views?
Do we have to root out every doctor / nurse that has non mainstream views?
Only those whose views create additional unnecessary risk for the patient.
So those who prefer prayer to medicine or let their religious views interfere? Those who waste time faffing around with crystals and homeopathy?
Who decides if the additional risk is "unnecessary" surely any additional risk from non mainstream views should mean a sacking?
Does this mean an end to the religious exemption in healthcare ( people can refuse to do things that are against their religion even if those things are mainstream treatments)
It's not uncommon, pre pandemic, to redeploy staff due to medical reasons, or apply for ill health retirement.
I don't work nhs setting anymore but am aware of many at risk staff who have been moved or had restrictions on what and where can work temporarily for their protection. So it's not a new concept at all
northshoreniall
Thats for the staff members protection not the patients IME.
BTW - I do not believe the stuff I have outlined is right but its a corollary of wanting to sack anti vaxxers for their unscientic views that others with other unscientific views should also be sacked
I was referring to NHS staff. Those I know support all NHS staff being vaccinated if dealing with patients
NOBODY should be forced into having a vaccine.
And anyone that says 'just get another job', have a word. I actually agree with MOST of what tj has to say on the matter
@tjagain that is in response to the discussion about people unable to have vaccine due to medical exemption so still for their protection.
Fair enough
Yeah I guess that’s part of a wider conversation, arguably someone without a vaccine could still provide excellent levels of care putting perceived risk aside.
In my eyes the rules have to be absolute, if it’s no vax-no job that means all scenarios of people not just someone who believes something different. Where that would end is complicated, like tj said, if you think prayer or some kind of witch craft is the answer maybe you need rooting out too!
And anyone that says ‘just get another job’, have a word
Anyone who cannot do a job to the required standards of customer safety needs to find another one, doctors, nurses, gas engineers, electricians. Those standards change over time.
I would only agree to be seen by medical staff that have vaccinated in the last three months.
Last week the broadband engineer seemed surprised when I asked him for his vaccine status before letting him in. Can you imagine that? I said, "c'mon, I don't want to catch the virus".
Unfortunately he then asked me for my vaccine status before agreeing to come in. Took a while but luckily I managed to find proof.
It might be useful if people wore a badge type certificate, just to let other people know. You can't be too careful.
Anyone who cannot do a job to the required standards of customer safety needs to find another one, doctors, nurses, gas engineers, electricians. Those standards change over time.
Working to dynamic industry standards is not the same as being forced to have a vaccine, I'm sure you know that
NOBODY should be forced into having a vaccine.
And exactly how do you think Smallpox was eradicated?
I would only agree to be seen by medical staff that have vaccinated in the last three months.
This is me also.
Do we have to root out every doctor / nurse that has non mainstream views?
The comparison to believers in stuff like homeopathy is an unhelpful one I think. The point of mandating vaccines like HepB for clinicians is that it offers protection for both pat and clinician (as does the COVID vaccine) whereas belief in the healing power of crystals while unhelpful is unlikely to actively do harm.
I think this problem has only really arisen because who'd have thought that so many clinicians would be vaccine hesitant? It would be an interesting experiment to see how many of them would now refuse the childhood vaccines they received that have undoubtedly saved lives. Perhaps we'll see the return of iron lungs?
I have no problem with politicians deciding this, it may involve a change in law (to mandate vaccines) and that's literally their job, it shouldn't be the role of the NHS or clinicians. There has to be a deadline once that's been decided. If anything, I'm somewhat embarrassed by my fellow healthcare workers that this is even "a thing"
EDIT. I'm posting this, as a reminder; plus ca change, plus c'est la meme chose (apologies for lack of diacritics)
Hep B is only mandated in a small number of areas
The comparison to believers in stuff like homeopathy is an unhelpful one I think.
I have seen nurses waste time on prayer to the extent of delaying badly needed end of life care. I have seen nurses use religious exemptions to refuse to participate in treatments, I have seen nurses waste valuable time with all sorts of non scientific mumbo jumbo that compromises care
Its not just a change in the law - its a massive change to the whole ethical basis of modern medicine. Its a question of whether yo think this is worth that and also if you are prepared to accept the effects from that massive change
the whole medical ethic on consent and autonomy now needs to be rewritten
Nickc - not meaning to be derogatory but you are a practice manager IIRC - not having any actual medical qualifications nor are you bound by the various codes?
whereas belief in the healing power of crystals while unhelpful is unlikely to actively do harm.
You may not be aware, but as TJ says there are countless examples of people refusing proper care in lieu of ALT medicines and then suffering/dying because of it.
What is even worse is that you can get a "degree2 in homeopathy and holisitc medicine etc, which fools the unwary in to thinking these people have any idea about how to help the sick.
So I am hugely against it, especially int he medical profession.
There is a great blog here from a leviathan of debunking. https://edzardernst.com/
Its not just a change in the law – its a massive change to the whole ethical basis of modern medicine
Yes, that's why it should be decided in parliament. That's the proper place.
not meaning to be derogatory
TJ, I'll say this but once, although others have said it already. I think you have to allow that others may disagree with you for perfectly valid reasons. I think everyone here understands and allows that you have strong feelings, but the opinion that certain treatments shouldn't be mandated is just that - an opinion, and the opposite view - that certain treatments should be required under law for the overall good health of a nation, is a valid argument, and has merit, whether you agree or not. Medical ethics change over time. (consent being the very obvious one being discussed here) Go back less than hundred years and the medical establishment would've been arguing very strongly that patients shouldn't be consulted at all. Would that been your position if you were a recently retired nurse at the time? (the answer is that it very likely would've)
Argue the rights and wrongs by all means, but have some respect for the opposing view at least. Up until this point we haven't had to mandate vaccine, the uptake is so broad, the benefits so obvious that the outliers pose little to no risk to society. But the counter argument that induvial rights shouldn't be allowed to be the cause of widespread societal ill-health is a valid one. You may personally disagree with it, but it has merit
Oh I do Nickc - sorry if it comes over that way I agree it has some validity I just think its less than the need to follow established medical ethics
I totally understand the desire to get rid of anti vax idiots. I agree they are a huge problem. I just disagree that this is the right way to go about it because of the huge shift in medical ethics this means. Personally I would put anti vaxers in the same category as religious fundamentalists and homeopaths etc- damaging to healthcare. so if we get rid of the anti vaxers can we also get rid of the fundamentalist religious and the alternative medicine bampots? I have seen both cause sub optimal care.
the answer is that it very likely would’ve
that is outrageously offensive and 100% wrong Ethics and morals are something I have a huge interest in, have studied at a high level to the extent I struggled thru "critique of pure reason" which is a basis of much modern thinking about ethics and morals and is far more than 100 yr old as well as various works by John Stuart Mill and iother thinkers in the area. Apply the categorical imperative to mandatory vaccinations and see what comes out
i was reading about ethics andmorals before I left school. I actually had uni places to study philosophy
Jeepers - why did I come back to this thread
All of us have grown up in a world where previously endemic diseases have all but been eradicated, so that treatment didn't need to be mandated because the benefits were clear to everyone. No more polio, no more smallpox. Miracles! Society has changed, there's no one alive that can really remember a time when children died of preventable disease, and where there was once a queue out the door, there's now disinformation and distrust. It may happen that now to make sure those diseases don't return, we may have make it law, like wearing seatbelt, or no cycling on a motorway.
It's not so unimaginable
Oh I do Nickc – sorry if it comes over that way I agree it has some validity I just think its less than the need to follow established medical ethics
But you're claiming that medical ethics has only one facet - consent / autonomy. Even me, with my relatively superficial (ha!) knowledge of ethics knows that there are three other pillars to consider.
So it's not black and white, and barking on about one pillar when there are so many perspectives to consider is just wrong. You are wrong. Not about everything, but about this one thing. Bodily autonomy is not the only thing to consider, it is not sacrosanct. To give an example that should be blindingly obvious for you: when someone is detained under the mental health act ('sectioned'), their autonomy is usually removed.
that is outrageously offensive and 100% wrong
I didn't say it to be offensive, I said it to highlight the fact that ethics change over time. It was a perfectly normal belief and reasonable behaviour in the medical establishment that pts didn't need to be consulted. You know this. Had both of us been in either primary or secondary care even just 50 years ago it's likely our opinions regarding treatment would've been shaped by the colleagues around us.
To give an example that should be blindingly obvious for you: when someone is detained under the mental health act (‘sectioned’), their autonomy is usually removed.
yes - and a court supervises treatment. ( mental health tribunal if you prefer) Its seen as a very strong step to take and can only be taken if there is clear danger to themselves and / or others. there are a lot more safeguards over it which are completely absent in this case. Where is the right of appeal? Where is the right have recourse to courts> Where is the legal oversight? Even if someone has been sectioned they still have the right to refuse some treatments - they donot lose their entire autonomy - one of the cases that is a basis for our law around consent demonstrates this clearly Bolam v >Friern Hospital Management Committee is an absolute cornerstone of law
yes there are other aspects to ethics - "first do no harm being one" for example 🙂
I am not wrong - I have a different opinion to most of you that comes from what I know. I put more emphasis on autonomy and consent than many of you - thats a product of who I am
its very clear that this step means a large rewrite of medical ethics - i agree its a balanced judgement and others may judge it differently. Politicians are NOT the people to do this tho. No training in ethics, no medical background, driven by short term political aims.
How do you square the need for consent to be given freely without pressure with this policy? that part of the NMC code now needs to be rewritten
There is also "the doctrine of necessity" which allows procedures without consent. however to proceed under that it has to be in the individuals best interests not societies
Final point - if the entire medical establishment agreed with the policy then I would clearly be in the minority. But the medical establishment is highly divided with senior managers, the royal colleges being against it and averyu vigorous debate in the BMJ that I have been following
perhaps some greater safeguards could be introduced? that would go a long way to assuage my concerns
finally - if this policy is so critical why is it not happening in wales and Scotland?
We cannot give informed consent when we are very young or very ill, mentally impaired, demented or unconscious, or merely frail or confused. Often people cannot give informed consent to emergency treatment. we may even find it quite taxing to give informed consent to complex medical treatment when feeling crappy (with COVID perhaps).
Then there's the obvious limitation of informed consent procedures in medicine; that they are useless for selecting public health policies. Public health policies, have to be uniform for populations. We cannot adjust water purity levels or food safety requirements to individual choice, or seek informed consent for health and safety legislation or quarantine restrictions.
and another limitation of informed consent is that medical treatment of individuals uses personal information about third parties that is disclosed without their consent. For example, family history information, genetic information and information about exposure to infections are often disclosed to clinicians without the consent of all to whom the information pertains. We do not expect patients to obtain prior consent to disclosure of such information from their relatives and contacts, and this would often be impractical or impossible. This fact about the way medical information is sought and used cannot be reconciled with the claim that informed consent is necessary for all ethically acceptable medical practice
Autonomy and consent should not be and cannot be the limit to treatment. Vaccination polices are an interesting and possibly hybrid case: in so far as we think of them as a matter of public health policy they cannot be based on individual choice, or on informed consent. But however, thus far we have treated vaccination only partly as a public health matter. We allow parents to refuse to have their children vaccinated without medical reason. Some have done so at little or no cost or risk to their children by sheltering behind protection provided by others' vaccinated children. The proportion of children vaccinated with measles, mumps, and rubella (MMR) has fallen, and free riders now face a problem. They still do not want to expose their children to the risk of measles, but can no longer do so by refusing vaccination. Public health policies can be undermined if their implementation depends on individual informed or uniformed (currently the likes of TJ make no distinction) consent. Should medical ethics allow that to happen?
@TJagain: The last 5 or so pages has been you beating a drum about autonomy when everyone else has been trying to convince you that there are other factors to consider.
yes – and a court supervises treatment. ( mental health tribunal if you prefer) Its seen as a very strong step to take and can only be taken if there is clear danger to themselves and / or others. there are a lot more safeguards over it which are completely absent in this case.
In that paragraph, you clearly agree that autonomy can be removed if it benefits society? There has to be a discussion, proportionality, oversight, checks etc. But autonomy is not absolute. I am glad you agree.
The rest of what you have said is down to proportionality and oversight which I believe exist in this country. You can argue the toss about that, but it's a completely different question to the one that you keep repeating, and certainly doesn't require a "Rewrite of medical ethics."
To be absolutely clear, I am not in favour of mandatory vaccination for healthcare workers in the current (Omicron) climate, because I don't think it is proportional / justified. Two months ago, I may have had a different opinion. In either case, I am not a virologist / modeller / policy person and I don't have enough information to come to a firm decision anyway, and I firmly believe that most of the public are also not sufficiently well-informed to be able to hold opinions about the nuances of public health policy.
intheborders
And exactly how do you think Smallpox was eradicated?
Of course the smallpox vaccine actually prevented smallpox. Covid vaccines don't prevent infection or spread. They reduce it.
"Covid should be treated as an endemic virus similar to flu, and ministers should end mass-vaccination after the booster campaign, the former chairman of the UK’s vaccine taskforce has said."
I am vacced and boosted. If I was 30 years younger I may have needed to give it more thought.
Of course the smallpox vaccine actually prevented smallpox. Covid vaccines don’t prevent infection or spread. They reduce it.
It didn’t. It reduced the risk of catching it, then if you did the risk of it reaching an infectious level. Just liked the covid vaccine.
nickc's last post was spot on. Do we all consume florine with informed consent? Umm. NO. Its just a public health policy.
It reduced the risk of catching it, then if you did the risk of it reaching an infectious level.
Which is why such a huge percentage of the population needed to receive the vaccine for it to do its work. Population level effects of vaccination are not the same as effects when looking at the individual level. Something that doesn't sit so well with a lot of people right now in our modern society... "no benefit to me".
5plusn8 - except that nobody is forced to consume fluoridated water - you can buy water without fluoride, filter it to remove fluoride or currently move to an area without fluoride. The policy of fluoridation of the public water supply isn't without its critics either.
It didn’t. It reduced the risk of catching it, t
It did prevent it at a population level because the virus was eliminated. Are you claiming Covid can be eliminated by vaccination?
“no benefit to me”.
Like the no maskers, or peoele who are happy wearing a one way mask with an outlet valve. FFS.
It did prevent it at a population level because the virus was eliminated. Are you claiming Covid can be eliminated by vaccination?
It was eliminated due the massive up take and how the virus acts. No, I’m not. Just like the flu, measles and TB vaccine don’t the virus it but help control the spread and outcome if you catch it. You completely changed your point on prevention.
We cannot give informed consent when we are very young or very ill, mentally impaired, demented or unconscious, or merely frail or confused. Often people cannot give informed consent to emergency treatment
Yes - thats the doctrine of necessity which has clear limitations. You can only give treatment under doctrine of necessity that is minimal, that is unequivocally for the patients benefit ( not for public health reasons)
The rest of what you have said is down to proportionality and oversight which I believe exist in this country. You can argue the toss about that, but it’s a completely different question to the one that you keep repeating, and certainly doesn’t require a “Rewrite of medical ethics.”
We come back to consent - consent must be given freely without pressure. a key cornerstone of medical ethics and this policy runs roughshod over that. so now its coercian can be used on a politicians say so for public health benefits. thats a huge departure from medical ethics as it stands right now. thats why it needs a rewrite
Also as you state it needs to be proportional and with checks and balances - where are the checks and balances here?