Wednesday, October 13, 2021

BOSTON: City Suspends 812 Employees for Exercising Their Right to Refuse Medical Treatment

Source: Boston

Published: October 12, 2021

By: Julia Taliesin

"We continue to work closely with our diverse workforce, and our union partners, to ensure employees have access to vaccination, testing and verification systems to comply with the mandate."

Boston suspended 812 city employees without pay on Tuesday for failing to comply with the vaccine mandate.

This move leaves the city short about 4% of its workforce of 18,000 employees, that is until each one provides a negative COVID-19 test result. A city spokesperson told NBC10 Boston that the city is leading by example as Boston’s largest employer.

Acting Mayor Kim Janey’s office sent out notices last week to around 1,400 employees who were not compliant, the Boston Herald reported, but about 600 of them got into compliance by Tuesday. The city estimated the suspensions were most likely to be felt by schools.

“We are now implementing contingency plans for bus transportation and other school operations impacted by employee leaves of absence, due to unverified vaccination or testing,” Janey’s office said in a statement Tuesday. “We continue to work closely with our diverse workforce, and our union partners, to ensure employees have access to vaccination, testing and verification systems to comply with the mandate.”

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A recent publication by the National Center for Biotechnological Information states the following about patient rights with regard to modern medical treatment.

A patient who can defend his or her judgments has the right to make decisions that do not coincide with what the physician believes is beneficial to that patient. This philosophical concept has become a legal right essentially throughout the Western world. As legal precedents have advanced the requirements for patient autonomy to a greater degree than the requirements for health care provider beneficence, patient autonomy has arguably become the dominant principle affecting patient rights. For example, a patient may refuse treatment that the physician deems to be an act of beneficence. In such cases, the unwritten social contract between patient and physician requires that medical professionals still attempt to inform the patient of the potential consequences of proceeding against medical advice. A patient's autonomy is violated when family members or members of a healthcare team pressure a patient or when they act on the patient’s behalf without the patient’s permission (in a non-emergency situation).
Informed Consent

The right to informed consent is composed of two parts: first, the right to be informed of potential harm to one’s property (one’s body) caused by a hired agent, and second, the right to autonomy. It was not until the 19th century that physicians began to advocate that a patient should be given an adequate amount of information to understand his or her state of health.[5] After landmark decisions by judges in the 20th century, especially in the 1970s with Canterbury v. Spence, Cobb v. Grant, and Wilkinson v. Vesey, in 1981 the American Medical Association recognized for the first time informed consent as "a basic social policy" necessary to preserve patient autonomy even at the expense of a healthcare provider’s desire for beneficence.

The roots of informed consent stem from the social contract theorists of the 1600s and 1700s mentioned previously. Under this social construct, patients own their bodies (their “property”). Medical therapies may have a genuine possibility of damaging that property. Thus, patients have the right to decide independently what risks and costs to incur regarding their bodies. The null assumption by physicians for most of the history of Western medicine has been that the patient is interested in whatever plan the medical professional thinks is best. In contrast, the null assumption under the moral philosophy of autonomy is that the physician has no way of knowing what patients want and must enable patients to decide for themselves whenever the patient has the mental capacity to do so. American courts have established that a risk of harm as low as 1% must be explained to the patient before submitting the patient to any therapy if that harm entails death or a life-altering complication, such as paralysis (Canterbury v. Spence).

In the United States, the right to informed consent is protected to some degree by legislation at both the state and federal levels. 42 CFR § 482.13 states that the "patient or his or her representative (as allowed under State law) has the right to make informed decisions regarding his or her care. The patient's rights include being informed of his or her health status, being involved in care planning and treatment..." Nearly all states have statutes that provide more detail than the US Congress with respect to the specifics of informed consent rights in their particular jurisdictions. Nevertheless, in large part, because of the vagueness of informed consent rights specified by executive branches of government, the judicial branch of government is usually the branch that enforces informed consent rights as part of tort claims brought by patients against healthcare providers.

The following are the required elements for documentation of the informed consent discussion: (1) the nature of the procedure, (2) the risks and benefits and the procedure, (3) reasonable alternatives, (4) risks and benefits of alternatives, and (5) assessment of the patient's understanding of elements 1 through 4.
Refusal of Treatment (by both patient and physician)

A patient may refuse treatment that the healthcare provider deems to be an act of beneficence out of the principle of autonomy. In the United States, the right to refuse treatment is protected by 42 CFR § 482.13. Conversely, a physician may refuse to offer a treatment out of nonmaleficence because the physician believes the treatment would cause greater harm than good. Physician refusal of treatment is a more complicated issue that depends on the situation. That is primarily addressed in the United States at the state level by statutes or judicial decisions. Either way, the medical professional must provide informed consent regarding the issue when it is possible to do so (i.e., in a non-emergent condition). 
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