All frontline NHS to be double jabbed to keep a job

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.”

https://www.theguardian.com/world/2022/jan/08/end-mass-jabs-and-live-with-covid-says-ex-head-of-vaccine-taskforce

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?

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

Utterly wrong – that should never happen like you describe. Personal medical information cannot be shared without consent unless its for very limited reasons and not freely as you describe

that really basic stuff.

NMC code

share necessary information with other health and care professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality

Its a very serious step to do so and not one taken lightly.

you are really worrying me with your lack of respect for medical ethics.  I am glad I am not a patient at your practise if this is your attitude

Autonomy and consent should not be and cannot be the limit to treatment

100 % wrong.  thats a basic principle you are missing

NMC code

respect, support and document a person’s right to accept refuse care and treatment

Lots and lots of case law on that – I refer you again to Bolam.

So you’ve never asked a patient if there’s a history of say; heart disease in the family? or asked a patient who they’ve slept with recently? or if they’ve shared a needle with someone?

Also as you state it needs to be proportional and with checks and balances – where are the checks and balances here?

Well, the government are clearly guided by public opinion, their think tanks & researchers etc, and laws have to be passed through parliament. Ultimately the government are held accountable by voters. Simultaneously, any redundancies would, of course, be challenged in the courts.

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.

It only does if you handily ignore everything else I said. You can believe vaccine mandates are wrong, disproportionate etc. But you can’t state that autonomy is the only relevant factor. Let’s also not forget that we are a degree of separation away from forced vaccination – we are talking about forced redeployment or redundancy, NOT vaccination itself. Clearly there is a very substantial link (a doctor or nurse that cannot work for the NHS will have a difficult time finding employment in this country) but it’s a false equivalence.

Personal medical information cannot be shared without consent unless its for very limited reasons and not freely as you describe

I agree with this. We get explicit written consent for sharing (E.g. genetic) information with other family members.

@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.

I know and accept that – however the law and the ethical codes we work under make it very clear how key autonomy is.  to overturn Autonomy needs a very pressing need and all other times this is done its under legal oversight 0- from compulsory treatment of those with TB ( plague mary) to treatment of those with mental illness checks and balances exist

Read the various acts POVA, mental capacity act  etc

How many of you have read the full code?  How many of you have read the various legal cases around this?  Bolam is a key one as is Bolitho

Bolam sets a cler marker – just because a decision may appear irrational it does not mean it is not a competent decision.  Even people with advanced dementia are capable of competent decisions.  the key test is ” are they aware of the consequences of their actions”  thats the main takaway from Bolam

When this question of competence in children is tested it is known as Gillick competence.  a child can accept or refuse treatment and the decison is valid so long as they understand the consequences of their actions.

But you can’t state that autonomy is the only relevant factor

Fair enough – I quite agree and its as you state about proportionality and interactions with other factors.

My reason for banging on about autonomy is that some folk debating this do not realise what a key component it is

So you’ve never asked a patient if there’s a history of say; heart disease in the family? or asked a patient who they’ve slept with recently? or if they’ve shared a needle with someone?

That’s not the same thing. You can ask a patient if they know any information relevant to their own health. They should only know about their uncle’s genetic condition if the uncle had chosen to disclose it to them.

I suppose for a GP who might happen to know some genetic information about a relative, it would be difficult for them not to act on it. But if they do, they absolutely shouldn’t disclose that information to the patient without the relative’s explicit consent.

Ta superficial –

Nickc – you were making a point about children and consent – here is the guide for you from your oversight body ( I think>?)

https://www.cqc.org.uk/sites/default/files/Brief_guide_Capacity_and_consent_in_under_18s%20v3.pdf

Wat you are doing there is asking the patient to share information

That’s my point, a patient may share information with you without the consent of the third party.

 to overturn Autonomy needs a very pressing need

such as a public health crisis perhaps?

 you were making a point about children and consent

My point was about the very young. I’m aware of the Gillick competency test, they’re unlikely to be needed for most childhood vaccinations that are given from 8 weeks old, to 3years are they?

Perhaps yes – but not on the say so of a politician.  Proportionality comes into it as does minimal necessary and it would need legal oversight by my reading and preferably agreement among the senior medical staff ( not nurses)  GMC ethics committee should be the ones deciding not a politician

You can only give treatment under doctrine of necessity that is minimal, that is unequivocally for the patients benefit

Are you suggesting that the vaccine isn’t for the patient’s benefit?

Elsewhere on the Internet people are arguing that the vaccine doesn’t prevent you contracting covid or spreading SARS2, it just means that you’re exponentially less likely to be seriously ill or die from it. I’ve seen this first hand (as readers may remember I mentioned earlier and Ernie tried to strawman), I had mild flu symptoms and fatigue, the person who almost certainly gave it to me was bedbound for over a week.

That’s my point, a patient may share information with you without the consent of the third party.

only as it pertains to them and the practitioner cannot share information

however the law and the ethical codes we work under make it very clear how key autonomy is.

Personal medical autonomy as it’s practiced now in the UK is mostly staged and bureaucratic, it’s about as far from Kant’s definition of the supremacy of the individual as its likely to get. He certainly wouldn’t recognise what most clinicians practice as giving true autonomy to patients.

And round and round we go again!

I do apologise for coming over so pedantic.  From my practice and education I understand how key autonomy is, how precious it is and how much risk is involved in minimising it

I really do apologise for appearing so dogmatic.  It was in response to those to whom autonomy is an inconvenient thing that gets in their way of doing what they think is right. Yes its true the principles of autonomy are a damn pain in creation of public health policy but that the law as it stands

I do wonder when the first legal challenge over this has come.  Even the RCN which is an incredibly conservative pseudo union has said they will represent nurses challenging the mandated vaccine policy

RCGP statment on mandatory jags

Following the Government’s decision to mandate Covid-19 vaccination for NHS workers, Professor Martin Marshall, Chair of the Royal College of GPs, said the following:

“The Covid vaccination programme has been a huge success with almost 45 million over-16s fully vaccinated in the UK, showing that overall take up has been very high. The vaccine is our most important tool in protecting people from the virus. All vaccines that we’re currently using in the UK have undergone rigorous testing to ensure they are safe and effective – as such, we’d urge anyone who is offered a jab to have one.

“The decision of the Secretary of State is to ignore the views of the College, and many other representative bodies across healthcare including the Academy of Medical Royal Colleges, to mandate Covid-19 vaccination for NHS workers, is disappointing and sets a concerning precedent.

“We would strongly urge all health and care professionals to be vaccinated, unless there is a medical reason why they shouldn’t. The fact is the vast majority are already vaccinated; they know they are at high-risk of contracting Covid-19 and getting vaccinated will help protect themselves, their colleagues, and their patients. But the RCGP believes that informed and educated choices about health interventions are more beneficial long-term than enforced interventions, which risks leading to resentment and mistrust.

“The move to mandatory vaccination is particularly concerning at a time when we need as many people as possible working in general practice and across the health and care sectors delivering essential patient care and services. We can ill afford to risk losing staff with personal objections to the vaccine, however unfounded those objections may be, and we are unlikely to be in a better position with workforce pressures come next April.”

GMC ethics committee should be the ones deciding not a politician

That the wrong way around, surely? the clinical professionals should give their considered opinions, and politicians should act on that information. It’s the same as clean drinking water. How that’s achieved isn’t the remit of politicians , why it’s required isn’t the remit of water purification engineers. (or whatever they’re called)

And round and round we go again!

You could, you know stop.

 Yes its true the principles of autonomy are a damn pain in creation of public health policy

Personal autonomy has nothing to say in public health.  For the obvious fact that “public” health the total opposite of personal autonomy You (as an individual) don’t have any say in how clean your water is for instance, do you?

Personal medical autonomy as it’s practiced now in the UK is mostly staged and bureaucratic, it’s about as far from Kant’s definition of the supremacy of the individual as its likely to get. He certainly wouldn’t recognise what most clinicians practice as giving true autonomy to patients.

that is an incredibly worrying statement.  Autonomy should be a keystone of practice and should be considered at every point.  If it “staged and bureaucratic then you are not practicing in line with the codes

Have you actually had training in this stuff Nickc?

You could, you know stop.

I can?  But but but…………………………….

Have you actually had training in this stuff Nickc?

consider the fact that if I’d not had any training in this, would you currently be so constantly and begrudgingly having to concede that in many cases patients don’t have autonomy?

Do I take it thats a “no”?

you certainly seem very confused about basic concepts and willing to ignore legally binding guidence

Ok ok – im outahere.

you certainly seem very confused about basic concepts

Says the man who over the last couple of pages has had to concede that in many cases pts don’t have autonomy, nor should they necessarily be consented for treatment.

and willing to ignore legally binding guidence

My patients are perfectly safe from me badgering you in an anonymous internet forum, don’t panic.

Autonomy should be a keystone of practice and should be considered at every point.

Why?

Just over half the populace who a) were allowed to and b) could be ringed to turn up voted for brexit. Do you really think we can be trusted with choosing autonomy over the greater good?

“Mandatory vaccination” is a worrying prospect, of course it is. But (again) no-one in this country is seriously proposing this outside of tabloid headlines. On the other hand, requiring a vaccination in order to be able to work with potentially vulnerable people, with the option of relocation if for whatever woolly bullshit reason you want to decline… how is that a bad thing?

Again (again again, you do like to ignore uncomfortable questions) would you expect to be able wander around a building site without a hard hat because something about choice? This is a rock away from the anti-mask argument, the only difference being it’s your own safety you’re gambling with rather than everyone else’s.

Again (again again again), is it not in fact unethical NOT to require healthcare staff to take adequate steps to protect their patients?

I’m sorry TJ, I know I’m giving you a hard time here and I think I understand where you’re coming from and why. But the elephant in the room is that there is no legitimate reason to refuse the vaccines unless you have pre-existing medical issues which may cause complications. The only arguments are ignorance (I don’t understand it) or obstinance (I’m not having it because you’re telling me I should) and both are bogus.

It’s a little needle. It takes seconds. I’ve had worse horsefly bites. People need to grow the hell up, doubly so if they want a career in healthcare (aside from anything else they should be setting an example). This entire conversation is bloody pathetic and veering towards disgraceful, there’s parts of this planet absolutely screaming out for treatment which isn’t available to them.

Get vaccinated, stop being a pussy. Anyone have a bus I can write that down the side of?

Canada are talking about an additional health tax on the unvaccinated population.

That is concerning to me, as this kind of thing can easily be the thin end of a thick wedge, In an ideal world we wouldn’t have the anti-vax brigade and no changes to law etc. would be required.

This is why we can’t have nice things, as they say.

 and no changes to law etc. would be required.

The problem is that vaccines fall into both camps: They are at the same time a part of any sensible group of public health measures but also fall squarely into personal medical treatments. So what to do? Mandate for the increased safety of all?  Or rely on informed consent and adherence to the social contract? What if some folks don’t believe they’re safe? what if the social contract starts to crack at the edges? Trying to work it out in the middle of world wide pandemic isn’t ideal, probably, but I suspect that if the pandemic was just a wee bit more deadly, we wouldn’t be having this problem…

Mleh, some one needs to make a decision. At some point you’ll piss off everyone.

Canada are talking about an additional health tax on the unvaccinated population.

That is concerning to me, as this kind of thing can easily be the thin end of a thick wedge,

Tricky, isn’t it. Is this not the ‘self vs society’ argument perhaps?

Like, on the one hand is it fair for me to pay the same NI as someone who smokes two packs a day? Is it fair for someone else to pay the same NI as someone who lobs themselves down a hill on a bike?

On the other… well, I’ve never needed the fire brigade, or an ambulance, or the coastguard, yet, so why should I be paying for them?

I don’t believe there’s an easy answer here. Aside from anything else, the fact that some people cannot be vaccinated because they’re immuno-compromised or otherwise a bit broken immediately **** up any notion of punitive actions towards the unvaccinated.