From a voluntary vaccination policy to mandatory vaccination against COVID-19 in cancer patients: an empirical and interdisciplinary study in bioethics

Abstract

Background At the start of 2021, oncologists lacked the necessary scientific knowledge to adapt their clinical practices optimally when faced with cancer patients refusing or reluctant to be vaccinated against COVID-19, despite the marked vulnerability of these patients to severe, and even fatal forms of this new viral infectious disease. Oncologists at Foch Hospital were confronted with this phenomenon, which was observed worldwide, in both the general population and the population of cancer patients. Methods Between April and November 2021, the Ethics and Oncology Departments of Foch Hospital decided to investigate this subject, through an empirical and interdisciplinary study in bioethics. Our scientific objective was to try to identify and resolve the principal bio-ethical issues, with a view to improving clinical practices in oncology during future major pandemics of this kind, from a highly specific bio-ethical standpoint (= quality of life/survival). We used a mainly qualitative methodological approach based on questionnaires and interviews. Results In April 2021, 29 cancer patients refused or were reluctant to be vaccinated (5.6%; 29/522). Seventeen of these patients said that making vaccination mandatory would have helped them to accept vaccination. In October 2021, only 10 cancer patients continued to maintain their refusal (1.9%; 10/522). One of the main reasons for the decrease in refusals was probably the introduction of the “pass sanitaire” (health pass) in July 2021, which rendered vaccination indispensable for many activities. However, even this was not sufficient to convince these 10 cancer patients. Conclusion We identified a key bio-ethical issue, which we then tried to resolve: vaccination policy. We characterized a major tension between “the recommendation of anti-COVID-19 vaccination” (a new clinical practice) and “free will” (a moral value), and the duty to “protect each other” (a moral standard). Mandatory vaccination, at least in France, could resolve this tension, with positive effects on quality of life (i.e. happiness), or survival, in cancer patients initially refusing or reluctant to be vaccinated, but only if collective and individual scales are clearly distinguished.

Bioethics after the COVID-19 pandemic: More research, fewer committees?

“…However, it rapidly became clear that a sizeable proportion of cancer patients were refusing or reluctant to be vaccinated. 5 Unfortunately, our hospital did not escape this phenomenon (5.6%, 29/522), as we explained in the first research letter , jointly written with oncologists from the oncology and supportive care department of Foch Hospital, in June 2021. This letter was published in the European Journal of Cancer , in September 2021.…”

“…Based on both our own data for a given population of cancer patients and the objective positive effect of introducing the pass sanitaire (health pass) in July 2022 on the whole French population, rendering vaccination obligatory appears to be a satisfactory solution for more effectively limiting the number of cancer patients refusing or reluctant to be vaccinated, in the context of future similar or equivalent health crises. 5 …”

“…This request led to the scheduling of the so-called "emergency" multidisciplinary team meeting (MTM), the principle of which was subsequently described in various scientific journals. 4,[5][6][7][8][9][10][11][12][13][14][15][16][17][18] The general idea was to expand the fields of competence and knowledge of "classic" MTMs, 19 which are limited to only a few medical specialties (e.g. oncology, radiology, etc.…”

“…Our results were published in August 2022, as a research article, in BMC Medical Ethics. 5 In summary, we identified, and then tried to resolve, a major bioethical issue: vaccination policy, here in the form of a tension between the recommendations for vaccination against COVID-19 (i.e. a new medical and/or biological practice), free will (i.e.…”

“…We meant simply that bioethics should be used at the appropriate time and in the appropriate manner, a position that we reexpressed in another letter to the editor published in the Lancet. 3 This is, indeed, what we have tried to do at Foch Hospital, 4,5 through an ethical theory, and precise research methodologies, focusing more on the future than the present. 6…”