“Our goal is to bring experts in surgical ethics forward who can shed light on different viewpoints and form a model for a debate on how we can approach this issue,” said Sharmila Dissanaike, MD, FACS, FCCM, co-moderator of the Special Session Should COVID-19 Vaccination Be Mandatory? Dr. Dissanaike is professor and Peter C. Canizaro Chair, department of surgery, and assistant medical director, Timothy J. Harnar Burn Center, Texas Tech University Health Sciences Center, Lubbock.

“We want to present the ideas on each side, equally and fairly, so that hopefully by the end of this session, all of us will have a better understanding of the thoughts and beliefs that are making us feel one way or the other about these mandates,” said moderator Linda G. Phillips, MD, FACS, Truman G. Blocker, Jr., MD, Distinguished Professor and chief, department of surgery, division of plastic surgery; and professor, School of Medicine, University of Texas Medical Branch, Galveston.

Peter Angelos, MD, PhD, FACS, Linda Kohler Anderson Professor of Surgery; chief, endocrine surgery; and associate director, MacLean Center for Clinical Medical Ethics, University of Chicago, IL, spoke about the advantages of mandating vaccinations. “As of September 19, 2021, over 228 million people have been infected with COVID-19, and there have been over 4.6 million people who have died from this infection. Certainly, without question, this is a tragic toll no matter how you look at it,” he said.

Dr. Angelos focused his pro-mandatory vaccination presentation on ethical arguments. Some of the ethical principles he considered were beneficence, non-maleficence, and respect for autonomy. “What’s important about these ethical principles is that there is not an absolute ordering of the importance of the principles. Despite what some people may believe, it is not always the case that respect for autonomy has precedence over beneficence or non-maleficence,” he said.

“The past 18 months have taught us that in public health, our own choices—things like wearing masks and social distancing—can have a tremendous impact, and, in fact, can greatly harm others,” he explained, adding that at times “the choices of some must be limited in order to avoid harming many.”

“If all states were to have gotten vaccinated at the rate that the fastest states in the U.S. got vaccinated, we would have anticipated 19,500 deaths from COVID-19. Instead, we actually had over 35,700 deaths.” Given this data, Dr. Angelos argued that the greatest tragedy of the COVID-19 pandemic was the unnecessary deaths for people who could have been saved had they been vaccinated.

“We cannot allow claims of individual freedom of choice to undermine the social contract upon which all modern societies are based,” Dr. Angelos said.

On the con side of mandatory vaccines, Catherine J. Hunter, MD, FACS, associate professor of surgery, Oklahoma Children’s Hospital of the University of Oklahoma, Oklahoma City, discussed the barriers, perceived and real, that surround COVID-19 vaccination. “Unfortunately, these events have become highly politicized, which is really not helpful, given that COVID-19 doesn’t care about your ballot box choices.”

“We do have to acknowledge that there are indeed some people who have genuine medical issues that would prevent them from getting the vaccine,” Dr. Hunter noted, such as allergies to certain components of the vaccine.

Like Dr. Angelos, Dr. Hunter focused on the ethical principles of a mandatory vaccine. “Within the United States, we are a classic individualistic culture, where we value self-sufficiency, uniqueness, autonomy, and independence,” she said. Collectivist cultures, on the other hand, place less value on autonomy, preferring to work together as a group and doing what’s best for society. Because the U.S. values autonomy more than other cultures, Dr. Hunter believes that a vaccine mandate, within this framework, is not ethically sound.

“Although vaccines are incredibly safe and effective, as with any medication or any intervention, there have been complications and side effects recorded,” Dr. Hunter said. These issues include anaphylaxis and blood clots in young, healthy people, specifically from the Johnson & Johnson vaccine. This puts the mandatory vaccine at odds with the principle of non-maleficence.

When it comes to the health care worker mandate, Dr. Hunter said that “we could end up losing even more of our workforce” if the mandate is enforced. “Threats and negative consequences are not justified. If possible, it’s much better to have consent and cooperation as opposed to coercion and force.”

For more details on this session, view the Clinical Congress Daily Highlights video interview with Drs. Dissanaike and Phillips.

This Special Session and other Clinical Congress 2021 sessions are available to registered attendees for on-demand viewing for a full year following Congress on the virtual meeting platform.