SHE Pod Season 2 Episode 11: Diego Silva and Maxwell Smith on Vaccine Mandates
10:44AM Oct 17, +0000
Speakers:
Kathryn MacKay
Diego Silva
Maxwell Smith
Keywords:
vaccinated
mandate
vaccine
people
coercion
question
pandemic
vaccine mandates
settings
populations
diego
coerced
healthcare workers
testing
public health
protect
required
choice
max
conditions
Hello, and welcome to the SHE Research Podcast. I'm your host, Kate MacKay. And today I'm joined by Diego Silva from Sydney Health Ethics. and friend of SHE Maxwell Smith from Western University. Thanks so much for joining us, Diego and Max, it's great to have you both here. And today we're talking about vaccine mandates. Today's hot button topic. So um, I'll be honest, I don't know that much about vaccine mandates or how they're working. So I'm really curious to hear from both of you who've spoken a little bit about these at least, either in the media or in your work or on Twitter. So I'm very curious to hear what you think so Diego, why don't you start us off? What, what do you think are kind of the central moral issues with vaccine mandates?
Yeah, so I think that it depends on what constitutes the vaccine mandate in the first place. So usually, the idea is, is that you can't do certain things unless you're vaccinated in this case, with the COVID-19 vaccine, either partially vaccinated or fully vaccinated. Usually, you need a ladder. So I think the obvious issues is what do you do in situations where somebody doesn't want to be vaccinated? So presumably, I think we can just set aside issues with people who, for medical reasons can't be vaccinated? I think, yeah, those are sort of just set aside. So I think the the main issue is what do we do with individuals who don't want to be vaccinated for whatever number of reasons? So I think there is more hardline stances, which is vaccines are bust, and we'll get into I think we'll get into why that is the case. And then that I think there are certain, you know, other measures that say, Well, you know, even vaccine mandates, perhaps you you're, you know, you're permitted to have vaccine mandates for things that are kind of trivial pursuits, I don't know how else you'd put like, you know, going to a hockey game or going into footy match, versus, you know, going to, you know, shop for groceries, as it were. And then also in terms of, you know, testing. So I think this is a really interesting role. Is there a role for testing? Or is there a role for other other mechanisms? What is the goal of a vaccine mandate? So is it to have people vaccinated to protect public health for the both dovetails? Are they separate? So I think there's a whole host of different issues that are sort of think about when we think about vaccine mandates.
Diego before asked max to give us his point of view, what is the difference between the two protect individuals and the public health? All right.
So I think there's, there's a sense in which there's a sense in which we can have vaccine mandates, because they're the best way to ensure the public's health. But it's not clear that it's the only way to ensure the public's health. So France is a really good example of a jurisdiction. And I don't know actually how it divides within the country, but at least at a federal level. And maps, you might actually know more about the details, where there's at least a test, there's an option to test, right? It's very cumbersome. You know, for example, they only accept PCR, so they only accepting molecular testing, not rapid antigen testing as the sort of the marker for that. But the idea is, is that even if that's not ideal, even if that's cumbersome, you at least have that second option, by which if you provide a test within I think it's up to 72 hours, you can go into the loop, or you can go you know, wherever it is that you want to go to park the class to see a PSG play or whatever the case. But I think there's a distinction where, you know, what, you know, if what we're doing is for the public's good for the, for the public's health. The vaccine mandate might play out differently than saying, you know, we need vaccines, because that is the golden ticket out of the pandemic. So, yeah, I guess that's what I was trying to get out.
Right. Yeah. Thank you. So Max, what do you think? What do you think are the main moral issues when it comes to vaccine mandates?
So I think on the one hand, you know, we're clearly experiencing close to two years now of a very tragic pandemic that has really damaged a lot of people's lives and a lot of lives have been lost. So that sort of calculus on the one hand, and on the other hand, we have this intervention that we've developed that is very safe, and very effective, and actually is quite good at avoiding or preventing those outcomes. And so already, we sort of have this tension. It shouldn't be attention at this point, but we need to be taking or utilising this intervention. To avoid those outcomes, and so the question emerges, which speaks to what Diego res does. What if some people aren't willing to take that intervention? In many cases, we may not care if it's a matter of their personal health, we ought to care. And there's reasons why we might care. But some people might not care. But what we're seeing in some jurisdictions, I'm thinking of Alaska at the moment, Alberta, a province in Canada, we're seeing hospitals being overwhelmed by patients who haven't been vaccinated. And so this has caused people to think, Well, perhaps because we have such an efficient, safe and effective vaccine, that we ought to compel people to take it to avoid those sorts of negative outcomes. So I think what we're really seeing here is, is this question of what sacrifices Can we ask individuals to make in service of broader public health and protecting capacity in our healthcare system, which of course has implications for anyone who needs that sort of acute healthcare? Of course, there's a number of different issues that mandates create, such as issues potentially around discrimination, issues around coercion and informed consent and, and other sorts of issues. But I would say that that's the central moral tension that we're seeing with mandates at the moment.
Right. And so it sounds like it's really a question of the kind of collective impact, especially talking about the health care system, the collective impact on the health care system versus the individuals decisions, to? Well, I guess the individual's risk tolerance really, kind of because they might be aware that they could get sick, but they might not. I think that
when we talk in those terms, I think people quickly start to imagine that, well, everyone's health choices in some way have this broader effect on the health system and takes up a bed and, and uses up resources. And so aren't we not to compel things like eating healthfully? and all sorts of other things? And in many ways we do we regulate many spaces of our of our lives to make sure that we're avoiding those those adverse outcomes. But in particular, with a pandemic, as severe as we're experiencing, and an intervention as effective as it is, this just provides the context where mandates and really, you know, trying to find an intervention that we need people to take carries a lot more weight,
I think. Now, I have a question. That's, I don't know, maybe a little bit difficult to answer. But my question is, at what point should we turn to mandates? I guess, because it's obviously been discussed here in Australia. And as you said, you know, in Canada and in France, and in all of these different countries, there's a decision about what to require and when and how. And part of me wonders if mandates should be rolled out kind of from the beginning, or if we should wait until we see a kind of sufficient amount of vaccine hesitancy and I don't know what a sufficient amount of vaccine hesitancy means exactly. But we know that we need to have really high levels of vaccination in the population like 80 to 90%. For true kind of community protection. So should we be waiting until we know that we can't get to that stage because of people's vaccine hesitancy? Or is it better to kind of, I guess, in order to avoid some of those series outcomes, like you were saying, Max, is it better to start early with those? Or what do you think should we be kind of rolling the dice?
I think in general, and ethics and generally in Policymaking there, there's an attraction to use the least restrictive means possible to achieve the the objective, your policy objective, whatever it may be. And so it does depend on the public health objective that we're after, is it protecting the capacity of our acute health care system? Is it trying to achieve herd immunity? Is it trying to protect those most vulnerable in hospitals and long term care homes and other settings? And whatever we sort of land on, then I think there's an attraction to say, well, let's use the least restrictive means of being able to achieve that aim. And so if it's possible to achieve the vaccination rates and coverage in particular settings without a mandate, that I think many would say that's preferable because that's a more favourable risk benefit ratio in that context. The challenge here is we don't exactly know when that will be. And if we wait too long, you might have experienced illness and hospitalizations and deaths that you could otherwise avoid. And so it's interesting where you know, people will say that mandates This is a pretty heavy handed measure doesn't appear to be the least restrictive means to achieve our health objective. But of course, in the context of lockdowns and school closures and stay at home orders, saying, Well, look, we can still go about our business, keep our hospitals open, keep going to work, keep our kids in school, so long as we're all vaccinated and not avoid To the more restrictive measure, which would be locking everything down and have everyone worked from home. So it is certainly ambiguous as to precisely when that line is. But I think that's part of the thinking that goes into determining when to when to consider such a measure.
Yeah, that's a good point about the least restrictive means. I hadn't thought about that. Diego, did you want to comment at all?
Yeah, I think it's really interesting, what we what constitutes sort of less restrictive, so we act as if that's on a single continuum, or a single value single measure. But of course, so I don't disagree with Max I, I like being vaccinated because it means I can, you know, put on a mask and go shopping or go to work, right. But it doesn't seem implausible to me that somebody might have a conception of bodily integrity or what constitutes of good for them such that they find it a much greater offence to be told what to be put into the body, rather than to wear a mask indefinitely, or, or maybe be locked down. So I think that there's this really interesting question of what it is that we're what is the good that we're trying to measure when we think about Least Restrictive means. So yeah, this assumes that we agree with the least restrictive means I'm kind of partial to it. But again, this idea that there's a one singular sort of measure or continuum, I think it's kind of something that we need to question. I think another thing just based on what Max was saying that I think it's kind of really interesting to think about. And you talked about, sort of, when do you put in vaccine vaccine mandates? I think the I think the debate around vaccine mandates, even the last six to eight months has really changed given what we know in terms of whether vaccines, whether these particular vaccines can actually stop transmission or not. So I think that I think a lot of the early discussion was not just the effect that non vaccinated people have on the healthcare system. And I think just the further Max's idea of the idea that then you have this trickle on effect where you have to cancel cancer surgeries, hip surgeries, like, you know, things that things I, you know, optional, but really aren't optional. So I think there's real so I think that that's the I think this is justification. Now, I think that justification, maybe six or eight months ago, I thought the vaccine had a better shot of prevention transmission. And maybe this is prior to delta, was also this idea of actually you need to be vaccinated so as to not infect me. And I think that it's it's been kind of subtle, the shift in terms of what is being sort of touted as the justification for the Nazi mandate. But I think it's important not to lose sight of the shifting justification. Again, that doesn't mean that the justification can't shift. It's just them sort of be sort of cognizant of that. And I think the reason for that is precisely this idea of when you would Institute, a vaccine mandate. So I think that again, it has to do with, you know, we recognise that, that we're that the vaccines aren't really that great that stopping the spread, it seems like it is somewhat effective vaccine probably know the numbers off the hand better than I do. But it's not at the level that we would need for, say, other vaccines for other infectious diseases such that you're actually stopping transmission with a vaccine. And so in that case, then from a public health point of view, so not the health systems point of view, but from a public health point of view. Maybe you actually do want testing, right, maybe if you're going to the art gallery, actually what you want is somebody to not only be vaccinated, right? So this would be kind of an extreme kind of CounterPoint. You don't want people just to be vaccinated, you want to make sure that they're not asymptomatic either. So actually, what you need is a robust testing system. And and maybe in that case, you know, we are actually dependent on rapid antigen testing, say something like that. So I think that again, I think that when we Institute the vaccine mandate, and part depends on and this goes back to Max's point, what is the goal of what what is it that you're trying to achieve? in the first place?
That's certainly the case, at least given present data that the law at least I can't speak for every single vaccine, but the the main vaccines that are being used in places like Australia and Canada, are are effective at reducing the risk of transmission and infection, you know, perhaps not to the rate that they're preventing things like hospitalisation and death, but they certainly do reduce that risk. And so, you know, it could be a matter of how much they reduce it that we start thinking think about thinking about that sort of question, but I think it's certainly the case that they they do provide that benefit. And to Diego's point, you know, we should, I think, not think about this in as an either or situation that it's either a vaccine mandate or testing In some situations, you see both right? You see, you have a vaccine mandate, which will ensure that we're reducing, at least to some extent, risk of infection and transmission. So that at least has some protective effect and will test twice or three times weekly, to make sure that even if you are a carrier of the virus that are coming into work, we can we can catch that and not just rely on the protective effects of the vaccine.
Yeah, which sounds onerous, but I guess that's where we're at, at the moment. And I think that kind of I had a question for you about workplace specific mandates. And I think that that kind of segues nicely into this question, because there have been a few cases now where it's been particular industries that have been targeted, or where they've faced mandates and healthcare is clearly one of them. And it's pretty easy to understand why that would be an industry that's first on the mandate list, because people who are regularly coming into contact with patients, we would think, you know, you've got to be at the first line. In fact, they're the kind of group one a who's supposed to be vaccinated first before anybody else is vaccinated. So what do you think about the kind of workplace mandates in particular, where in order to go to your job, do your work? you're required to have this? And I guess my second question is, again, because I'm not I don't know, but sort of how necessary, is it? Are there really huge numbers of people who are vaccine hesitant among, say, the group of healthcare workers? I think here in Australia, interestingly, paramedics are one of the groups that are least vaccinated. And I'm not exactly sure what that is, if it's vaccine hesitancy, or if it's been one of the many issues with the vaccine rollout here that people are still coming to grips with, perhaps, but they seem like a group who really ought to be vaccinated, if not to protect others, although I think that that's a reason to protect themselves, because they come into contact with so many people and protect their loved ones than at home and their communities back at home. So should we be sectioning out these parts of society and saying, Well, if you work in industry x, we need you to be vaccinated, and we're going to mandate that. But if you work in, you know, any of these other industries, we were not going to mandate it, or we're still going to ask you nicely. What do you think?
So I think there certainly are settings and populations where a mandate is much more strongly justified, by virtue of the populations perhaps if they are working closely with they might be more vulnerable, or because of the greater risks of infection or transmission within the setting that they're there, we're thinking about. So healthcare, we're working with vulnerable populations, close contacts, long term care homes, very vulnerable populations, then you can think about universities where we've seen lots of mandates, at least in North America. These are settings where 1000s of people are congregating indoors. And you know, there's a greater potential for the risk of infection and transmission. And so they've been implemented in those settings as well, in settings where, you know, people aren't working with members of the public who are at greater risk, and their their job, perhaps you're working outdoors, you're a park ranger, I would suspect the risks are lower there. And so the justification would be less than those settings as well.
To go back to kind of tie in the last few questions that you had about sort of one vaccine mandates and now sort of in terms of who is subject to the vaccine, and in terms of their job. So in Australia, for example, we had Scott Morrison back in what was June, saying that there's going to be a vaccine mandate for aged care workers to have a single dose by somewhere in mid September, late September, I'm forgetting off the top of my head. So in that instance, we're talking about a situation where there was no there was very poor vaccine rollout, where we know given the accounts of people who were working in aged care that there were very serious access issues to vaccines despite being a priority group. So in that instance, that's an example where I think the vaccine mandate was just out no wrong, right. There was no attempt at working with In fact, there was clear sort of abandonment by the government towards aged care workers. And then all of a sudden, you know, things hit the fan and all of a sudden they went to the hard stick of vaccine mandates. So there's an example where I think it jumped way too quickly. And I think Again, it ties back to the sector itself. So I think that when we're talking about the the sectors that are at play, I think it also depends on what measures have been instituted to educate to sort of promote the vaccine in the first place. I think, again, I think it really matters, what the activity is. So healthcare workers, I would say, are probably top of the line top for the front of the key of being vaccinated through a vaccine mandate. Because they're even whatever marginal gains you get from protection of the vaccine to others. You know, those little margins count, you know, Park Ranger baby doesn't count at all construction workers a different interest. It's an interesting one, right? So if you're doing construction outdoors, you know, does the marginal gain of vaccinations, protection of others does that matter? But they're, you're in a situation where maybe as an industry, you don't want to have a lot of days lost illness, right, because it can put back your project. So again, I think the I think the reasons that an industry might mandate a vaccine might not even be health reasons, right? They might not have to do anything with public health. And, you know, we force people to do all sorts of things in their jobs, you know, whether they want to or not, you know, again, construction, I'm pretty sure you can't work, you know, even walk onto a construction site without a hardhat and heartless steel toed boots, you know, so is it because they really care about their employees? Yeah, partially, but also because, you know, they're liable or, again, it sort of puts their work back, you know, timeline wise. So I think that there's a whole host of reasons that somebody might justify, apart from the goodness of their heart. And I think it's worth highlighting
that there certainly are conditions that ought to be met for a mandate to be ethically justified, if vaccines aren't readily available and accessible to all those to which the mandate applies. And clearly, that's problematic, because it's unfair to those people because they can't get access in order to comply with the mandate. So I think that makes total sense. You know, I'm thinking of some settings in the province that I'm in, you know, you do have in long term care settings, high 90s percentage of coverage of staff working in those settings. But there's other long term care homes where it's 50%. Right? And here, you can really think that I think one of the ethical questions we need to consider is what's the ethics of not putting a mandate in place in those settings? Is that something that is fair to the populations that are there, and particularly given the sort of burdens that they've experienced over the course of the pandemic? Are, our residents of long term care homes in Canada, have been amongst those that have been hospitalised and died the most in this pandemic? And if we're seeing that only 50% of the staff and health care workers working with them have been vaccinated, and does call into question whether we're doing enough to protect those populations. And so while there are ethical considerations around the use of mandates, I think there are still good ethical reasons to think that, you know, if we don't do it, we're facing some trouble as well.
This is really interesting, this example that you just gave, right? Because the thing that jumps to my mind is, how is it that you have one aged care facility that has 90 plus vaccination, another one that has 50 plus? So again, I agree that I think the mandate is there to protect enough time with the fact of that we lose sight of that, right? So we just think about sort of the whatever freedom versus whatever, but actually, it's there to protect population, like an aged care population at home. But like, why is that? What you know, like, you know, what are the I think one of the things that gets lost are the context and the histories in which we're actually instituting public health measures. A and then the vaccine mandates. Right. So, you know, Max, I know you, you've thought about this a lot, but this idea of, Okay, well, you know, what's the population that's working at a particular home? Right? Do they have reasons to distrust? You know, are there long term ramifications to mandates on public health trust that we're underplaying? So I again, I think that it's not that the vaccine mandates aren't justified, but I think that there's a lot of there's a lot of minding your P's and Q's before you get to the point of having a mandates.
Yeah, I think that's a really good point. And the point about public health, potentially undermining trust in public health by doing this is a really important consideration. I think and it kind of leads into the next question that I wanted to ask, which really is a thorny one, but it was, I was gonna ask you, is it fair to make people choose between going to work and getting vaccinated? And I think Diego, what you've kind of just brought up there is that part of the answer might depend on who it is we're talking about, and what their history is, and what their experiences within the country in general, and how they experience the overall impact of public health orders. Because in Australia, there have been really differential impacts of the even the lockdown. And it's become kind of common to talk about, to cities, or to Sydney's, or to Australia's. And I even heard it on the radio this morning, before recording this a tale of two cities where, you know, people in the East have had very different experience from people in the west of Sydney. So I do still want to ask you, is it fair to be seen to be making people choose between going to work and being vaccinated or kind of, however, we might want to phrase that value? It might be bodily integrity, it might be a kind of religiously informed belief, it might be just fear, not understanding. So risk perception, perhaps. And how do we deal with the fact that we live in very diverse societies where people actually have had really different experiences of public health through this pandemic?
First off, it's it's important and to really emphasise that mandates can't be the only measure we put in place, right. So there's lots of different things that we ought to do to protect people's health and safety. And as Diego mentioned, even before mandates are considered we need to be doing the the more difficult work of engaging with people's reasons for not being vaccinated, and ensuring that different populations and their issues of trust or whatever it may be, are adequately addressed. So I think that that goes without saying needs to be put into place. In any case, when we're thinking about a mandate, when when we think about whether it's fair to ask people to make this choice about working in a particular setting, or not, if they're choosing not to be vaccinated. You know, fairness is a complex issue, because on its own, you might think about that in one way. But we also need to think about what is fair to, for instance, the, the 90 year old living in a long term care home and having staff and healthcare workers that are providing them direct care when they're very vulnerable, right? Is it fair to them to not have their there's their staff member or healthcare worker vaccinated? So I think, you know, fairness, we can think about this in a lot of different ways. But my view is that if vaccination is a bona fide occupational requirement, like it is arguably in health care, long term care, then it is fair to say that that is an employment condition. If you're unwilling to meet that condition, then you must find work elsewhere. Right? This is just something that's required to Diego's point, hardhats and steel toed shoes, also required in construction, it's a bonafide safety requirement. I also think when we think about fairness, you know, we think about how a mandate might disproportionately affect some populations. We also need to think about how mandates are actually protecting the most vulnerable populations. So those that can't be vaccinated or even if are vaccinated tend to be at greater risk, they might have a breakthrough infection, and if so, they might get severely ill and sick mandates will go far to actually protect those populations as well. So I think a lot of the equity and fairness questions are often brought up in consideration of those that might be negatively affected by mandate, but we do need to think about who it protects as
well. Yeah, I think that's I think that's well put. I think that Yeah, to I think the word that we're not using that we can use is course right? Are we coercing healthcare workers into, you know, choosing between your job and your it to me, we coerce people all the time. Like I think that we're afraid of using this word coercion. But we coerce people all the time. We force people's hands all the time. And a lot of there's a there's one way of thinking in political philosophy, certainly in the last two 300 years, as figuring out exactly what are the limits of state coercion? Right? We don't maybe that's not a common way of thinking about political philosophy. But a lot of you know, a lot of the stuff we spend our time on is precisely that, you know, what's the legitimate and justified use of say, coercion? So I think that I think that yeah, I think that there, there are instances where we can sort of have these these mandates. I think to Max's point, I think a lot of these mandates potentially hinder and potentially benefit the same vulnerable populations. So I think that is Actually yet another level of complexity is that I think that within, within populate, you know, within populations in Western Sydney, you know, you would have a very, very different understanding of vaccine mandates depending on who you ask as individuals. So I think that there's a sense in which we tend to homogenise people and we all know that we ought not to, and this is just one of the risks of dealing with public health is that you're often dealing with generalisations, but I think this is an instance where sort of being cognizant of the heterogeneity even within a group is really important for the reasons that kind of Max was getting to as well.
But I'd like to jump in on the question question, if I may, because this is something that's that's curious to me. Because Diego's right in jobs, we require that people do all sorts of things that they probably wouldn't otherwise do with the threat of some sort of sanction, and often dismissal, right? So you have to show up to work on time. If you're a surgeon, you have to wash your hands before operating. You know, if you choose not to do these things, you're fired, right? And so in a very straightforward way, we can consider that to be coercive, because it's it's asking you to do something that you wouldn't otherwise do with a threat of with threat or force or something like that. So I think, in one sense, everything we do in a job is coercive in some in some respect. I tend to not think that way. I think that actually, none of it is corrosion. I think those are just employment conditions. We have choices not to work in those settings. And so I don't think that it actually amounts to coercion. I think coercion in the morally relevant sense should really be be focused on this idea of a choice being irresistible, right? It's one that you have no other option available to you just because of how heavily weighted one of those choices is. And I don't think that's the case. And with jobs, to be honest, I think, you know, like I said, for working in health care, if vaccination is a bona fide occupational requirement, and you don't want to be vaccinated, you want to not work in healthcare, right? There's other sorts of jobs for you. So I think that at that stage, really, there remains a choice for you, depending on where you want to work or whether you want to meet those employment conditions or not. It's it's strictly in those cases where the choice is irresistible for you to be vaccinated, on where I would think that this amounts to coercion, but like Diego said, that doesn't necessarily mean it's wrong, there still can be legitimate uses of coercion by the state.
Yeah, I mean, I actually think that this fits your definition. Like I think it's actually a good definition of the origin Mac, so stay that it is a matter of it being irresistible. I think if somebody spent their life training for a particular profession, and then has worked in the professions for 1015 years, and then they're told that they have to do this thing that maybe they hadn't agreed to prior to, through their training, they hadn't agreed to they couldn't have foreseen could have been actually properly informed, informed, consented to the idea of, you know, so on and so forth. I think in that case, it's very Akin, you know, the, the your money or your life is very similar in this instance, right? It is your livelihood, it's your livelihood, it's your sense of identity, right, we identify as being nurses, doctors, or whatever the case might be. So I think it absolutely is an instance of being irresistible in a sort of intuitive sense of what that word means a sort of common common sense version of that word, but doesn't mean it's wrong. So I guess this is the this is to me the thing, right, is that is that just because we don't think about being coerced all the time, doesn't mean that we're not. And I think that it's a live debate, right? Whether you take the position that coercion ought to only be reserved for instances of things that are morally incorrectly irresistible. So you can think of it just merely that sort of normative sense, or you can think about it in a sort of descriptive sense. And then sort of the moral evaluation there aspects. And I tend to think in the latter, just because I think it makes I think it's occurred in from, again, from thinking in terms of state actions, it makes sense to think of to actually reserve descriptive sense of coercion, which then we can evaluate, even if we don't think about it in those terms Kind of day to day. I don't know that you mentioned any typical difference to what we're saying. But
it does. Absolutely, I wonder if the the employment conditions that we're asking people to meet, whether the reasonableness of those conditions matters, right, because if you've been working in a particular job for 30 years, and all of a sudden we implement this employment condition that is completely unrelated to your job. very unreasonable to meet and hard for you to meet, then it does seem in a sense more coercive to say you have to meet a real fire you if the conditions of your job or the conditions within which your job operates like a pandemic emerges, requiring those employment conditions to change for you to do your job in a way that's healthy and safe. So you health and safety requirements are required, given the context that we find ourselves in. And that requires your employment conditions to change to be to meet those standards of health and safety. I'm not sure it's coercive to ask people to meet those conditions, because they're very reasonable employment conditions in many senses. If it's unreasonable, going back to, I'm not going to stick my life on this but requiring vaccination for the park ranger, then perhaps you could say, well, that's an unreasonable employment condition and requiring that people need it has more of course of force, I'm not sure
to go back to the paradigmatic example of you know, somebody with a gun in your head in your life for your money, it's quite reasonable to have to be like, I'm required to give my money in this instance, right, there's a way of describing the actions to say that's a reasonable choice that you're taking. Right? So again, I think that we can say that for the healthcare worker, it's quite reasonable that the situation has changed, but it feels no less, or is no less of a very much a dual choice. It's a one, I guess the thing is, is that it doesn't allow, it doesn't allow for gradation. Either you meet this criteria, or you don't, either you have this job because of this criteria, where you're out. To me, that seems like version by any other name. Again, I repeat, doesn't mean it's unreasonable. So again, it can be perfectly reasonable to have this new requirement. And to have this discussion about the park ranger versus healthcare work,
I'm going to argue that your money or your life is an unreasonable choice, if we compare it to meet these employment conditions that are bona fide occupational safety requirements, or Lt.
So those the actual contracts have been placed to make that choice in the first place. And then there's the reasonableness of the choice once you're in that position. So it's such that we're in the middle of a pandemic, and that you're actually forcing people to make this choice, right. So you can you can, you can argue, but the reasonableness of the choice once you're in a position of whatever way you want to call it coercion or not, the reasonableness of the choice in that instance is a different one altogether. I think, although I agree that the situation in which you get into it in the first place, one's unreasonable, I would say that one's right. And the other one is just circumstance. One's wrong. And the other one's just circumstance.
Yeah, requiring that someone is vaccinated, in my view is a reasonable request, putting a gun to their head on that side of the equation is not reasonable. And that is never reasonable, right? So in the employment context, that's a reasonable ask, even if it's a situation you'd rather not find yourself in. It's the reasonable ask at least for some for some jobs.
Right, right. Right. But the but again, I think that the coercion doesn't have to deal with the reasonableness aspect of the witch of the situation in which you find yourself, hey, we're going round.
I think that's really interesting, because I think what I what I'm hearing is that, Diego, you think that the overall context can be a coercive one. And then we can decide within that whether or not someone is making a reasonable or an unreasonable demand of you
think, I think, I think this is one of the issues that we that is that we go on about in terms of organ sales. So which I, you know, you know, our people can work into selling their origins, it's like, Yeah, but the choice might still be reasonable for them to do it, even though empirically we know that it doesn't actually lead to benefits in their life overall, blah, blah, blah, and the money, you know, so whatever we can do, again, it sucks that they're, that they're put in that position. It's morally reprehensible that they're put in that position. Right, because of contextual historical reasons. They're sort of placed in that position in the first place. So yeah,
yeah. And then what I think Max was saying is that not every one of those scenarios could be described as coercive and would resist using the umbrella coercive term for all kinds of requirements that we ask people to fulfil? And that employment based conditions would not fall under the umbrella of coercion in the usual sense.
I mean, the worry that people have about coercion is often because it vitiates the voluntariness of informed consent to get the vaccine right and that's the worry people have is if informed consent, one of the conditions is that it be voluntary. And you're saying, well, they're being coerced to be vaccinated, that's no longer voluntary, and therefore informed consent does not apply. And I think, you know, in this case, you know, the the, the moral sense in which informed consent is voluntary exists at the vaccine clinic, when you have every opportunity to ask meaningful questions of your healthcare provider, got all the information, you need to make the decision and still walk out of the vaccine clinic if you feel like you'd rather not be vaccinated, that is the morals the important moral sense in which vaccination is voluntary, that it's required to be in the military, or to be an astronaut, or whatever it may be, is a slightly separate question, right? And you do not need to be an astronaut, you do not need to be a member of the military. And so I don't think that the requirement that that attaches to being deployed in those settings vitiates, the voluntariness of your informed consent.
Yeah, but I think decontextualize this is kind of, you can't separate the choice that you're making in the vaccine clinic, apart from the all the other life story and identity of that individual as they enter the vaccine clinic. So I agree at that, like one moment in time, but I think this is the problem with having sort of these sort of moment slices and time doesn't work, right, is that the the soldier sees themselves as well, not all soldiers, I assume, but many soldiers see themselves as soldiers source of identity, surprise, so and so forth. Right. So that, that when they're walking into the vaccine clinic, it absolutely will weigh on how, what what choice they're going to make?
I totally agree. And, you know, the, again, the important sense in which it's voluntary is that, you know, in the vaccine clinic, the health care provider you're interacting with, there's no undue pressure to get the vaccine in that setting. If you said, Well, you know, I actually I'm being forced to do this, because I want to be an astronaut, the health care provider may say, Well, you could just not be an astronaut, right? If you really care that much about this, this being vaccinated, right? And then so that's where, you know, it really just turns on this other choice that you have to make about your your vocation, right, which is separate than your decision about being vaccinated. If you choose that for your vocation, then, you know, it's not you're not being forced to be vaccinated, because you could simply just choose not to have that as your vocation, which has these these particular requirements.
So what you're saying is that by becoming an academic, I accepted emails, and that I am not just being coerced by my inbox, but it is a matter of something that I accepted by choosing to become an academic.
I think you're coerced, Kate (laughs).
Yeah that's completely it (laughs).
(laughs). Well, I think we'll leave it there. That was such an interesting discussion. Thank you so much, Diego, and Max for joining me.
Pleasure. Thankyou, Kate. Thank you Diego.
Thank you.
And thanks to all of you for listening to this episode of the SHE Research Podcast. You can find a transcript of our discussion linked in the episodes notes. SHE Pod is hosted by me Kathryn MacKay and produced by Madeline Goldberger. You can find our other episodes on Spotify, Radio Public, Anchor or wherever you get your podcasts of quality. Thanks so much for listening. Bye.