In the 1991 movie The Doctor, William Hurt plays the protagonist, Dr. Jack McKee, a renowned yet callous surgeon who discovers that he has a malignant tumor in his throat. He is suddenly transformed from “captain of the ship” into a patient in a world where the idea of patient-centered health care is unknown, and its amorphous principles are rejected and even ridiculed. Dr. McKee’s experience as a patient teaches him that practicing medicine involves more than surgical skills.
Today’s health care delivery has evolved from the physician-centered model showcased in The Doctor into a more patient-centered model. Although the definition and boundaries of the patient-centered health care movement are still being developed and refined, patient-centered care is arguably distinguishable, both historically and conceptually, from public health. Nonetheless, just as public-health concerns and individual medical choices have come together in some health care decision-making contexts for centuries, contemporary questions such as whether hospitals should mandate annual influenza vaccinations for their health care workers involve legal and ethical principles underlying the patient-centered movement, most notably that of informed consent.
This Essay discusses some of the legal arguments addressing health care employers’ mandatory influenza vaccination policies in the United States. In particular, we examine the relationship between influenza vaccination mandates imposed on health care workers by private-sector employers and informed consent to vaccination, in the absence of federal or state vaccination requirements. This Essay proposes that the practice of requiring employees to sign a consent form as a condition of continued employment when they receive the influenza vaccination conflicts with the ethical and legal doctrine of informed consent, and concludes that when an employer’s policy effectively removes an employee’s freedom to choose whether to become vaccinated, it is unethical to require that the health care worker sign a consent form. The Essay advocates that if—despite controversy over such policies—employers choose to mandate immunization, they should be required to provide an alternative form, so that health care workers who would not seek vaccination except to avoid termination of employment may acknowledge that acquiescence to vaccination is informed but not voluntary.
