Today we have to face the feeling that they have “won”. Health network personnel who refuse to be vaccinated will have another month before being placed on unpaid leave, a reprieve that will continue to unduly expose vulnerable patients to COVID-19.
However, with all the ink that has flowed on the subject in Quebec, we should have a good understanding of what may or may not constitute reasonable accommodation in the workplace. Being anti-tax is not included in the long list of grounds protected by the Quebec Charter of Rights and Freedoms (such as sex, language, age, marital status, disability, race, social condition) on the basis of which employers cannot discriminate. And even if the refusal to be vaccinated was a protected “identity”, employers may still find a request for accommodation unreasonable when it involves undue hardship, such as a material breach of the safety and rights of others. Since unvaccinated people endanger others, refusing to accommodate them in workplaces where human contact is important is absolutely legal and ethical.
However, the health system has been so weakened in the last year – or rather, the last decades – that several essential health services, in some regions, would be compromised without the still unvaccinated staff. We therefore had the choice, this week, between putting patients at risk of being exposed to COVID-19, or imposing dangerous treatment delays on them in certain sectors. Impossible dilemma. On Wednesday, the Minister of Health, Christian Dubé, chose the lesser evil, in the circumstances, hoping that the vaccination has progressed enough and that the reinforcements are important enough for the situation to present itself differently by November 15. Hard to blame him.
It is imperative to ask questions, however. How did the health care system get there? In particular by concentrating the wage bill in the hands of doctors, particularly specialist doctors, to the detriment of other professions. We will never be able to calculate the number of Quebeckers who would have chosen these careers if it were not for the too often derisory remuneration. We have a better idea of the number of people who preferred to showcase their skills in the private sector, contributing to the shortage of manpower in hospitals. The managerial reaction to this shortage, particularly in the health emergency, was to increase compulsory overtime and to cancel vacations. This only demotivates current staff and potential recruits even more. Cash bonuses (taxable) can entice a number of them in the short term, but do not solve the fundamental problem.
With the labor shortage and the health crisis, healthcare professionals have found themselves increasingly exposed not only to the risk of burnout, but also moral injuries. While the two concepts have long been confused, they are nevertheless distinct phenomena. On the one hand, exhaustion is linked to too much work, too much stress. On the other hand, moral injury refers to the trauma that occurs when systemic constraints no longer allow us to “do well”. People who have chosen the health professions are driven by the desire to help others by providing them with the best possible quality care. When the working conditions are so appalling that we can no longer provide adequate care, the vocation, the efforts and the sacrifices of the professionals lose all their meaning. The absurdity of the system and the inability to offer care that meets any ethical standard wears out the soul, in a way.
With moral hurt often comes compassion fatigue, and anger – towards managers and politicians who unwillingly orchestrated the staff shortage, towards unvaccinated colleagues who put patients at risk, and even towards unvaccinated patients. , who now constitute the vast majority of people with COVID-19 who are hospitalized. It is that while we take care of them, who have not seen fit to protect themselves with a simple gesture, we cannot devote all of our energy to people who have been waiting for too long for their treatments for problems. serious health problems unrelated to the pandemic. We may have minimized the load shedding in Quebec, but we are still far from the pre-pandemic waiting times for a set of services.
Under the circumstances, it is easy to fall into the trap of general judgment of the unvaccinated, which really does not help the quality of care. Unvaccinated people defend their decision with all kinds of distinct reasoning, but exasperation forms effective responses to none of them. All the more so with the passing months, the ego plays a growing role in the stubbornness to refuse the vaccine. The more time you spend justifying your mistrust of vaccines, the more likely you are to continue defending the indefensible – even in the face of worried loved ones, even under an oxygen mask. It is therefore essential to allow the unvaccinated to change their minds without “losing face”.
In the short term, the frustration that one tries to censor so as not to undermine the immunization efforts too much and the desperation that one tries to hide in order not to demotivate one’s colleagues seems to be here to stay, unless the The health system’s situation is not surprisingly improving. In this sense, Mr. Dubé’s turnaround on Wednesday shows how difficult it is to escape this epidemic of moral wounds which strongly affects the well-being of health professionals. I can’t wait for the day when we can offer the said “guardian angels” who brought us through this pandemic something other than the “least worst” ethical choice for public health, and that we resume a direction that gives meaning to their hard work. .