The latest in the growing spate of clashes between sound healthcare practice and the self-interested intrasigence of caregivers comes about in Washington state, where a group of hospital nurses sued and won in federal court to prevent implementation of a hospital policy mandating flu vaccinations for all personnel (both to protect them and to prevent transmission to patients). The vaccinations serve a clear public-health good and are probably sound policy (the absolute risk from the vaccine is small; the relative risk to presumably healthy hospital workers from the vaccine is vastly lower than the risk of the flue itself to possibly-compromised hospital patients; and the hospital - and caregivers - have a positive obligation to minimize iatrogenic risk to patients). The nurses’ refusal is somewhat complicated - it is at least partly a union issue (the hospital imposed the policy after the recent collective bargaining round was closed and a deal had been finalized), and partly a response to the hospital’s apparently unilateral approach to the policy, but there are also questions of professional independence and personal liberty raised in the case. The end result, though, is a court ruling that, in some cases at least, hospitals may not impose vaccinations as a condition of employment. The corollary is that, in some cases at least, healthcare professionals may assert self-interest to evade what would otherwise be a reasonably clear obligation of professional ethics. Add that to the growing religious-exemption movement, and it is getting hard to see where healthcare professionalism exists anymore except as an excuse for caregivers to behave unprofessionally.

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