To go by the best available advice, then, you are increasing your risk of serious illness by avoiding vaccination and increasing it even more if you are also planning to become pregnant. A doctor who encouraged a patient to skip vaccination out of concerns about fertility or who, in the name of such unfounded claims, assisted her in evading an employer’s mandate would be violating the first-do-no-harm principle.
There are valid medical reasons for some people to avoid vaccination — but these are extremely rare. Having a compromised immune system is not such a reason; having a serious allergy to vaccine components is. We trust doctors to certify when there are valid reasons to avoid vaccination. A doctor who certified that a patient has a valid medical reason to avoid vaccination because it posed risks to her fertility would be betraying that trust.
Understand Vaccine and Mask Mandates in the U.S.
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- Vaccine rules. On Aug. 23, the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for an increase in mandates in both the public and private sectors. Private companies have been increasingly mandating vaccines for employees. Such mandates are legally allowed and have been upheld in court challenges.
- Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
- College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
- Schools. Both California and New York City have introduced vaccine mandates for education staff. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.
- Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
- New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations, although enforcement does not begin until Sept. 13. Teachers and other education workers in the city’s vast school system will need to have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
- At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.
These aren’t the only ethical violations to consider. If a doctor knew better but acceded to the patient’s request, the note would be a lie. If the doctor didn’t know better? That would be culpable professional ignorance — itself a violation of professional ethics. Notice that this is different from many other bogus medical notes in that it exposes both the patient and other people to medical harm. Certifying that someone’s pet is an emotional-support animal mainly risks annoying other people, like fellow passengers on an airline that still allows E.S.A.s. Lying about someone’s back condition to help the person qualify for Social Security disability benefits cheats law-abiding citizens. These are bad consequences, but they’re not the kinds of bad consequences that doctors have a special duty to help us avoid.
Either way, I count at least three serious violations. So, yes, you should report a doctor who did this to the state medical board and any other relevant authorities. Of course, the fact that this staff member has announced her plans doesn’t mean her physician will comply. There have long been doctors who supplied patients with bogus medical exemptions from routine state-required vaccinations, and even amid the pandemic there will doubtless be doctors who disgrace their profession in this manner. But we can hope such malpractitioners will prove few in number. For the sake of your clinic and of this particular staff member, let’s hope her physician recognizes that, in medicine, the customer is often wrong.
I’m a project manager at a small consulting company. The head of my department and I have weekly meetings with less experienced staff members to go over goals and progress reports. At one recent meeting, the department head stated that she has double-billed on numerous projects (e.g., conducting field oversight and writing a report during the same time period). She conveyed to the junior staff that this was perfectly OK and encouraged them to do the same.
I should have said something at that time, but I was caught off guard by someone not only admitting that she engaged in an illegal activity but also encouraging others to do so. How do I handle this situation going forward? Our company works under contract for several different local governments, and I am required to sign off on the invoices before submittal. Now I am concerned that I could be implicated. Do I seek legal counsel or consult with the corporate attorney? What if this manager denies everything? She is well respected within our company because her division is extremely profitable. Name Withheld
In a legitimate commercial enterprise, the object isn’t simply to make money; it’s to make money while obeying the law, treating employees decently and so on. Yes, it would have been better had you objected at once. But now you ought to uphold your obligations as a manager (and citizen), while protecting yourself and the company from the consequences of her wrongdoing. Consult with the corporate attorney — and, perhaps first, with an attorney of your own. This year’s Global Business Ethics Survey Report found that almost 80 percent of U.S. employees who reported misconduct said they experienced retaliation. That’s troubling. We can thrill to stories of moral heroism, but in a properly run institution, you shouldn’t have to be a hero to do what’s right.
Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to [email protected]; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)
