Blog | Monday, March 8, 2021

Should we pay people to get vaccinated for COVID-19?


I read recently that Kroger, who runs a grocery store chain, has joined with other retailers in paying employees who receive a COVID-19 vaccination. The $100 payment should serve as an incentive for employees to roll up their sleeves.

There is an ongoing debate whether employers can or should mandate COVID-19 vaccinations for their employees. The state of play now is that employers are encouraging, but not requiring vaccines, as mandating vaccines creates legal exposure for employers. For example, if you require that an employee is vaccinated against the worker's wishes, and a complication occurs, is the employer responsible? Can an employee be disciplined or terminated for failure to vaccinate if there are no vaccines available within a reasonable distance? And mandating vaccinations may be complicated when workers are unionized.

The right to refuse treatment is a bedrock medical ethical principle that I support. For example, if I advise an individual with acute appendicitis to proceed with surgery, this patient has a right to decline, assuming that the patient is competent, and I have properly informed the patient of the risks and benefits of the reasonable options.

This right, along with all of our rights, is not absolute. If refusing medical treatment has a public health dimension, then the issue becomes more complex. And the terrain can be murky. If a parent refuses to have his school age child vaccinated against communicable diseases, this right collides against the rights of other children and personnel in the school. Indeed, it is for this very reason that school districts can require students to be vaccinated. If a parent objects, then they are free to home school their youngster.

This is why the failure to wear masks when advised to do so is not just a personal decision. It puts other as risk. I don't object if someone chooses to become inebriated at home. But it's quite different if this individual decides to operate a motor vehicle on city streets.

While no vaccine or medical treatment is 100% safe, and there may be unknown vaccine risks that will emerge later, I recently received the two-shot Moderna series enthusiastically. The only incentive I needed was my belief that I would be much less likely to become infected and to infect others.

If a hundred bucks is a necessary incentive, and a business has the will and resources to expend on this effort, then good for them. We're familiar with similar strategies, such as paying kids to do homework.

Should we also pay people to be honest or to be polite or to stop at red lights or to be on time for appointments or to observe speed limits? What should the per diem reimbursement be for wearing a mask?

In other words, should we pay folks to do stuff that they should be doing for free?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.