By Jacob Molyneux, blog editor

Nurse blogger Not Nurse Ratched has written a post on her decision not to get the H1N1 vaccine shot until she is more convinced of its safety.

I’m just urging caution against the knee-jerk fear reaction that is, no doubt, going to make hordes of people swarm out to clamor for this vaccine. I’ll be watching for more data on it and might modify my decision, but for now I’m going to just say no.

Judging from responses to a recent post we ran on the topic (“cancel my subscription” appeared more than once), the loudest clamor may be from those who are driven by fear of the vaccine rather than fear of the H1N1 virus. In the post in question, Doug Olsen, a nurse ethicist, examined the ethical side of the question of whether or not nurses should get vaccinated. 

(Whether or not you agree with Olsen’s guarded conclusion in favor of vaccination, his post demonstrated how a professional ethicist uses a set of concepts as tools—not to come up with a definitive answer that can be called “right” or “wrong” but instead to examine the moral dimensions of a decision. We hope that some of the concepts he used will be seen as tools to help nurses make their own informed decisions.) 

By way of update, here’s an addendum we received from Olsen that addresses some of the concerns about vaccine safety expressed in the various comments:

Any obligation of nurses to protect the patient by getting flu vaccine depends on trust in the science and in the system for doing and reporting the science. Reasons for not trusting the system run the gamut from easily dismissed conspiracy theories to healthy, well-founded skepticism. My own skepticism is at an all-time high after my cat’s experience (as described in my previous post). Despite this, it’s my personal feeling, based on a trust of the system, that the risks to self are outweighed by the apparent risk to others from an uncontrolled pandemic—making vaccination the right thing to do.

I deliberately did not answer the question of whether vaccination should be forced, as this is a very different issue (for a bit more on that, see my 2006 article, “Should RNs Be Forced to Get the Flu Vaccine?”). It may be worth noting that other forms of vaccination are required as a condition of employment, and some states require seasonal flu vaccination for nurses.

I agree with “lin, rn,” who commented that the danger in presenting ethical decisions as risk-to-benefit calculations is that it gives an appearance of simplicity to decisions that are anything but simple or mathematical. Assessment of risks and benefits is subjective and related to our nonquantifiable values. Futher, there is never enough “data” or certainty to reduce the decision to math. I believe that in ethics, “risk-to-benefit decisions” are more metaphor than math.

With H1N1 likely to spread more widely this fall, and the possibility of more pandemics in the future, this is a topic we should be thinking and talking about. Finding the right balance between personal freedom and professional obligation is not easy, but it deserves our attention.

We hope you’ll join the conversation on this important topic as the dangers actually posed by the H1N1 virus become clearer and a new vaccine is closely monitored for possible adverse effects.

(Update, September 21: As New York State mandates H1N1 flu vaccinations for health care workers, experts and health care workers continue to have a widely varying set of responses on the topic . . . Update, October 27: AJN‘s poll about whether nurses should be mandated to receive the vaccine had some pretty one-sided results. Our most recent post on the topic, which looked at one of the several reasons nurses have given for not wanting the vaccination to be mandatory, also notes that last week a New York State judge temporarily halted the mandatory vaccinations.)

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