PoPulationand Public HealtH etHics

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policy for exemptions and declinations helps preserve these rights. To create a true choice, however, the consequences of exemptions and declinations should be reasonable in terms of protecting employee health without being punitive. Re-assignment of work during a potential exposure is likely acceptable, but some staff may view being on leave without pay as punitive. Based on this analysis, the need for and benefits of employee immunization are re-affirmed. The major argument of infringement of autonomy is mitigated by allowing for exemptions and declinations. Scenario shift In the event of an influenza pandemic, if a vaccine is not yet available, a large number of employees would be required to take daily antivirals for weeks to prevent illness. Experience is minimal for using antivirals in this way and, therefore, there is no evidence of their safety and efficacy as prophylaxis for a large, healthy working population. The risk assessment would have to consider the risk of exposure to influenza, severity of the influenza, other preventive measures, time until a vaccine is available, known risks of the antivirals and the unknown risks of using them in a large population for an extended period of time. In this situation, the ethical consideration of employee autonomy has a stronger bearing compared to mandatory immunization with routine vaccines. Mandatory antiviral prophylaxis may not be justified given its unknown benefit and potential side effects. Voluntary prophylaxis may be preferred, but accommodating all employees who refuse may not be feasible and exposing them without prophylaxis could lead to occupationally acquired influenza. Questions for discussion 1 A health unit employee who is susceptible to chickenpox signed the declination statement refusing immunization. Without known exposures to chickenpox, the employee was allowed to continue in his or her position of health promoter. However, the employee became infected with chickenpox and was infectious while teaching a class of expectant mothers. Should this event change the immunization policy? PoPulation anD Public HealtH etHics 116
2 An employee feels that she was denied a job transfer to a role that would require immunization for hepatitis B because she is not immune. She makes a claim of discrimination. What elements of the policy are necessary to address this claim? 3 An employee refuses influenza vaccination because his close family member had a significant adverse reaction to the flu shot. His physician provides documentation approving this as a medical exemption, even though family history of an adverse reaction is not a contraindication. 1 How should his refusal be classified? acknowleDgeMents Dr. Barry Pakes reFerences 1 National Advisory Committee on Immunization. (2006). Canadian Immunization Guide, 7th Ed. Ottawa, ON: Public Health Agency of Canada. 2 Canadian Charter of Rights and Freedoms, Section 7. Retrieved from: http://lawslois.justice.gc.ca/eng/charter/page-1.html#anchorbo-ga:l_I-gb:s_7 Mandatory immunization of local public health employees 117
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PoPulationand Public HealtH etHics
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contents Acknowledgements - page 5
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acknowleDgeMents The Partners would
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» Create a tool to support instruc
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Each of the discussants took on thi
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Twenty years on, things have change
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intervention (say reduction in mort
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ethics understands dilemmas not onl
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priority setting. 17 Once more, usi
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6 See for example the WHO Commissio
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obesity surveillance in scHool cHil
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esearch 2 Inevitably children will
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esearch Case discussion in response
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It would be ideal to get active inf
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esearch participation, leading to a
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to sHare or not to sHare? Secondary
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esearch Scenario shift » What if t
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esearch Many different parties have
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esearch of his concern for people w
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esearcH etHics anD conFlicts oF int
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esearch and non-public information
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esearch reFerences 1 Public Health
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esearch Key ethical dimensions Perh
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esearch such support, seen across t
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esearch Proposed resolution Enablin
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a tool For etHical analysis oF Publ
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esearch are explicit. In Quebec, su
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esearch reFerences 1 Bayer, R. and
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Part two Policy
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policy being increasingly introduce
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policy behaviour. Therefore, the et
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policy 18 Chapman, S. and Freeman,
Page 66 and 67: policy through outdoor smoking, any
Page 68 and 69: policy that this is an injustice. W
Page 70 and 71: DeFerring blooD Donation FroM Men w
Page 72 and 73: policy 26 per cent of new infection
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Page 76 and 77: policy public trust might also incl
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Page 80 and 81: policy 4 Zou, S., Musavi, F., Notar
Page 82 and 83: policy Case description For nearly
Page 84 and 85: policy 3 Economic conditions could
Page 86 and 87: policy essential to examine the his
Page 88 and 89: policy lMICs. Evidence-based introd
Page 90 and 91: policy governments, regional develo
Page 92 and 93: First nations Drinking water Polici
Page 94 and 95: policy federal government was aware
Page 96 and 97: policy reFerences 1 Health Canada.
Page 98 and 99: policy Core issue Case study author
Page 100 and 101: policy Additional issues It may be
Page 102 and 103: policy Arguably, an exception might
Page 104 and 105: policy Case Following the pharmaceu
Page 106 and 107: policy 3 What potential harms may b
Page 108 and 109: policy in the “anti-cancer vaccin
Page 110 and 111: policy adults may choose for themse
Page 112 and 113: policy Men also suffer some HPV-cau
Page 114 and 115: ManDatory iMMunization oF local Pub
Page 118 and 119: policy Case discussion in response
Page 120 and 121: policy the degree of infringement o
Page 122 and 123: Part tHree Practice
Page 124 and 125: practice Case The Inquiry found tha
Page 126 and 127: practice Questions for discussion 1
Page 128 and 129: practice is a basic ethical obligat
Page 130 and 131: practice harm is remote, the cost/b
Page 132 and 133: practice that the professional plac
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Page 138 and 139: practice In what follows, I will de
Page 140 and 141: practice will end up having to comp
Page 142 and 143: practice Getting Clear on What’s
Page 144 and 145: using PersonalizeD letters oF invit
Page 146 and 147: practice Cervical cancer is relativ
Page 148 and 149: practice Case discussion in respons
Page 150 and 151: practice principle should only be t
Page 152 and 153: practice potentially cause the gene
Page 154 and 155: practice Nations’ constitutional
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Page 162 and 163: practice Decision making While the
Page 164 and 165: alberta oil sanDs A toxic mixture o
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practice resolution calling for the
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practice Case discussion in respons
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practice Second, the process of oil
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practice contributing to “contrac
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practice How might the decision and
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wHose role is it to Deal witH socie
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practice same artisanal miners to d
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practice Case discussion in respons
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practice The ethical principle of b
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practice Identify the options avail
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