The COVID-19 Vaccine: Balancing Autonomy & Nonmaleficence
Do no harm.
That’s the oath everyone thinks of when they think of medical professionals; it’s the oath we want to promise and deliver when we join medical school.
But at the same time, we work to value patient’s autonomy, striving to make sure that we aren’t paternalistic. We don’t want to practice medicine as parents, we want to practice as coaches, who can guide and educate. Ultimately, it’s up to the players to decide what they want to do.
So, what do you do when those two thoughts come at odds?
This question isn’t new in medicine. We’ve long asked the same of the non-adherent patient who won’t take the medication to keep their complicated diabetes in control; in the lifelong chain smoker with COPD on home oxygen who still can’t be convinced to quit smoking; in the patients who need to think about their next paycheck to support their family more than the MRI we need to rule out a brain tumor. And now, in those who refuse to vaccinate against COVID-19.
The Delta variant is running rampant, and ICU beds are filling up again. But people are tired of being afraid; they don’t want to stay home anymore. Those in the medical field see that COVID-19 is anywhere from being gone, and increasing frustrations grow at those who remain unvaccinated. In many clinics and hospitals, there is a push to not only ask if, but why, people choose to remain unvaccinated. That is new to me, and to many of those I work with on a day-to-day basis.
But this pandemic is also new to all of us. Each patient’s decision is capable of affecting countless other patients. Those who receive a COVID-19 vaccine not only impact themselves, but entire communities. Their decisions alter our shared ability to protect the immunocompromised, children, and those for whom the vaccine just wasn’t enough.
We know that high rates of vaccination are vital for herd immunity in typical vaccines. With COVID-19, it’s so much more than that: It’s long-term protection. Every time an unvaccinated person is infected with COVID, we increase the risk of mutations, we risk their lives, and we risk the lives of those around them -- namely those who can’t be vaccinated.
Despite us knowing this, the conflict remains. As healthcare workers, we must continue to ask questions, probing into better understandings our patients’ viewpoints.
I see the fear of the future in my patient’s eyes. I see the frustration of feeling like they’ve been forced into a corner. Day in and day out, I hear patients explain these fears. They have a right to be scared. This is a new thing, and they hear different truths from different people they trust. We as a country are divided. The people most confused and harmed are those that are stuck with two trusts that have two different opinions.
I hear patients explain how afraid they are of losing their autonomy, as if they feel like this is a swing back to the paternalistic days of medicine. I hear fellow medical professionals profess fear of stories they hear at work. I understand the mistrust from big pharmaceutical companies and Google searches. It’s frustrating and exhausting, but it makes sense.
In a world where fear is king in everything, fear of the vaccine is understandable.
Meanwhile, I see exhausted medical professionals every day, fighting the urge to protect their patients with the ethics of autonomy. I see them attempt to educate their patients and often fail in light of friends and family who contribute to this fear related to the vaccine. There is frustration and it is justified. The trauma we've seen and experienced makes us desperate to change the wave seen today and the one we anticipate tomorrow.
I go on social media and see loved ones begging each other to be vaccinated to protect not only themselves, but other loved ones. I myself have done it. I see relationships breaking as the vaccinated family members choose to isolate from unvaccinated family to protect them.
And I hear the excitement in my preceptors’ and co-workers’ voices when I get to come out of a room saying I convinced another person to get vaccinated.
We don’t know what the world is going to look like if, and/or when, this pandemic is behind us — but we know that vaccines are a way to get there.
To my fellow medical professionals:
As we continue to fight between the desire to provide autonomy and do no harm, keep strong in knowing that we stand in solidarity.
With every patient and every loved one you help educate, a force of medical professionals smile with you. Ask with compassion and encourage with kindness knowing that, below all this distrust and spite, there may simply be fear.
We will get through this.
Arashpreet (Arshi) K. Gill
Fourth-Year Osteopathic Medical Student (OMS IV)
Pacific Northwest University of Health Sciences