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Should influenza immunisation be mandatory for healthcare workers? No

BMJ 2008; 337 doi: (Published 28 October 2008) Cite this as: BMJ 2008;337:a2140
  1. David Isaacs, professor of paediatric infectious diseases 12,
  2. Julie Leask, research fellow23
  1. 1Department of Infectious Diseases, Children’s Hospital at Westmead, Westmead, NSW, 2145, Australia
  2. 2University of Sydney, NSW, Australia
  3. 3National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead
  1. Correspondence to: D Isaacs davidi{at}

    Charles Helms and Philip Polgreen (doi:10.1136/bmj.a2142) believe mandatory immunisation is necessary to achieve good uptake, but David Isaacs and Julie Leask argue that it infringes autonomy and could backfire

    Healthcare workers should be immunised against influenza, for their own protection and to protect their patients against influenza. The issue is whether it is ethical and good practice to make immunisation mandatory.

    John Stuart Mill, the British philosopher, famously wrote: “The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others.”1 This statement of what we now call the principle of autonomy, or a person’s right to choose, invalidates any argument that we should force healthcare workers to be immunised for their own sake.2

    The state sometimes exerts benign paternalism to coerce personal choice. Examples are the mandatory use of seat belts or of motorcycle helmets, where the infringement of autonomy is justified by the effect on public health, and where the intervention poses little or no harm to the individual and has been proved to save lives. But …

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