Hadassah Medical Center in Jerusalem has told the hospital's employees, who are entitled to be vaccinated but don't get the vaccination, not to come into work and to take an unpaid vacation. If an employee is unable to be vaccinated, they must submit a request to an exemptions committee and it is also possible that other essential employees will be exempted.
With this policy, Hadassah has become the first Israeli institution to put into practice the 'green passport' concept regarding the Covid-19 vaccinations. The Israeli government itself recently presented the 'green passport' initiative to the Knesset Constitutional Committee, to examine the legal and ethical issues about the decision it wants to take.
Jerusalem-born Prof. Vardit Ravitsky of the University of Montreal School of Public Health BioEthics Program told "Globes," "While in Canada where I live and work the issue of a passport for those who have recovered and now also a passport for those who have been vaccinated is among the most burning social issues being discussed, in Israel it seems that the decision was taken quickly without giving another consideration to the ethical issues."
Prof. Ravitsky is also president of the International Association of Bioethics and Chair of the Trudeau Committee on Covid-19.
She said, "The ethical issues around the green passport focus on the tensions that have been accompanying us since the start of the Covid-19 pandemic - between equality and freedom on the one hand and the considerations of public health and efficacy on the other hand. Both have significant weight."
Ravitsky stresses that the discussions are complex and nuanced. "The green passport makes the vaccination into a condition in certain settings but the question is a condition for what? Can we assume that the vaccination must be a condition for working in the health system? Perhaps in the supermarket? In settings in which the employee is at high risk of being infected and infecting, there is perhaps justification for requiring a vaccination but to lose your job because of your inability or concerns about the vaccination is a tough blow and an issue that has substantial legal and ethical ramifications. On the other hand, if the vaccination is a precondition for going into a supermarket, then the need for a green passport becomes a tough restriction touching the overall population and this is a measure that is hard to justify."
Another example is the vaccination as a condition for travelling abroad. At first glance it is easier to justify this because of the risk and we are generally talking about a luxury but in this situation also there are special circumstances like family unification, visiting the sick, or job considerations in which impose restrictions is most problematic. In most western countries there is a lively public discussion about the topic of the green passport and it is appropriate that in Israel too we should give our opinions about the ethical aspects.
"It seems that in Israel, just as they hurried with the vaccination drive, so they have been in a rush to decide about the green passport policy. In Canada there is an almost obsessive approach about the distributive justice and equality and scrupulously following the instructions and that also has advantages and disadvantages."
"For example, this week it was discovered in Canada that bottles (of vaccine) had been thrown in the garbage because there wasn't swift enough access to people that met the criteria of 'top priority' (the elderly and medical workers). In other words, if not according to the rules then not at all. In Israel, flexibility is shown and the vaccines left in the bottle are given to whoever is available, even if they are not on the list. In this context, the speed and flexibility in have contributed to the fact that we are number one in the world in the number of people vaccinated and are perceived as someone to be jealous of and emulated."
Perhaps it can be put differently. We have already decided that it is permissible to impose Covid-19 restrictions, so we simply still impose them on the overall population but exempt whoever has had a vaccination.
"Restrictions are a public health decision that applies to the overall population while the green passport is a policy applied to each individual. It's different."
But even the public health decisions discriminate against certain parts of the population, for example those who cannot work from home or own businesses.
"We are thinking all the time about those who can return to normal lives with a green passport and not about those who are restricted, who will be discriminated against. We live in a world in which there are many types of discrimination, but only some of them are justified. I don't want it to be understood from my words that I am saying that I absolutely support not being vaccinated. It is important to persuade everybody that medically can to be vaccinated, and that they should do so quickly, for themselves and for the entire public. But the decision on how to relate to the non-vaccinated population sector must meet ethical rules."
There are those who would say that if the virus continues and I cannot work because of those against the vaccination, then they should also bear a little of this burden.
"Medical ethical rules dictate that we do not punish people for their behavior through the health system, whether it is alcoholics with cirrhosis of the liver, or obese people who have developed diabetes or people who committed traffic violations and ended up in a car accident. Even a suicide bomber is treated alongside those that he injured. This is a foundation rule of the health system because if you open up the door to such considerations, it can very quickly descend into very unethical areas."
But the punishment here is not preventing the administration of medical but other restrictions?
"But restrictions on public health belong to the medical world. I repeat, I am not claiming that a green passport is necessarily a bad idea. I am only saying that we must pay attention to the subtleties and ethical considerations and not implement them in a sweeping way."
Published by Globes, Israel business news - en.globes.co.il - on January 10, 2021
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