Informed decision making and consent

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INFORMED CONSENT

This article includes information based on the Australian Government’s Guidance for the administration of vaccines (Australian Immunisation Handbook)[1].

Queensland’s Guide to Informed Decision-making in Health Care[2] (Guide) defines informed decision-making and informed consent as follows:

Informed Decision-Making

Informed decision-making is the two-way communication process between a patient and one or more health practitioners that is central to patient-centred health care. It reflects the ethical principle that a patient has the right to decide what is appropriate for them, taking into account their personal circumstances, beliefs and priorities. This includes the right to accept or to decline the offer of certain health care and to change that decision. In order for a patient to exercise this right to decide, they require the information that is relevant to them.

Informed Consent

For the purposes of this Guide, consent means a person’s agreement to the provision of public sector health services. Informed consent means that a patient has received the information relevant to them to make an informed decision and they have given permission for the health care service to be provided. In an ethical sense, the agreement by a patient to receive public sector health services reflects the end point of a process of engagement in which one or more health practitioners have supported the patient to come to an informed decision to agree to the health care offered.

In a workplace scenario, the employer is enforcing a rule that all workers must receive a medical procedure to protect all workers and broader community. The worker essentially takes on the role as the patient as referred to in the Guide. For your informed consent to vaccination to be valid, the following principles must be fulfilled:

  • the patient has the capacity (ability) to make a decision about the specific issue at the specific time, and is not affected by therapeutic or other drugs, or alcohol
  • the consent is voluntarily given, and free from manipulation by, or undue influence from, family, medical staff or other social coercive influences
  • the discussion between the patient and the health practitioner is transparent, well balanced, and involves two-way communication which is sensitive to the situation
  • the patient is able to clearly understand the information because it is provided in a language or by other means that the patient can understand
  • as far as possible, the patient is advised in simple terms of:
  • the diagnosis
    • recommended health care, including the expected benefits, common side effects and alternative health care options
    • the material risks including complications associated with:
    • the recommended health care
    • alternative health care options
    • a decision not to receive the health care offered
    • any significant long-term physical, emotional, mental, social, sexual or other expected outcomes
    • the anticipated recovery implications
  • the patient has sufficient time to consider and clarify information in order to make an informed decision, taking into account the context of the clinical situation
  • the information provided and the consent given relate to the specific health care provided.

What is Coercion?

The Merriam-Webster dictionary defines coercion as follows:

  • to make (someone) do something by using force or threats; or
  • to get (something) by using force or threats.[3]

Taking the above information into account, all workers have a right to choose whether they receive a vaccination or not. The issue here is that the employer is influencing the outcome of your decision by threatening you with termination of your employment. Your employer is coercing you to decide which directly influences the outcome.


[1] https://immunisationhandbook.health.gov.au/vaccination-procedures/preparing-for-vaccination#accordion-para-11276-189034

[2] https://www.health.qld.gov.au/__data/assets/pdf_file/0019/143074/ic-guide.pdf

[3] https://www.merriam-webster.com/dictionary/coercing

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