Do vaccine mandates breach the NMC Code?
Saturday 22nd January 2022 saw large demonstrations of NHS staff and supporters, including midwives, through London and many towns and cities throughout Britain. Demonstrators were demanding the scrapping of vaccine mandates. Hundreds of people placed or threw their uniforms on the ground as part of the protest.
I will speak of the NMC Code because as a midwife, that is the Code with which I am most familiar and which day in, day out, I strive to apply as a registered health professional in my interactions with clients – in my case, pregnant women and their babies. “The values and principles set out in the Code can be applied in a range of different practice settings, but they are not negotiable or discretionary.” This means that any registered practitioner not applying the principles may be removed from the Register. It also, in my opinion, means that the new law cannot be applied without contravening the Code – a situation that is quite bizarre and unprecedented. Relevant sections of the NMC Code include:
- 1.5 the requirement to “respect and uphold people’s human rights”
- 2.5 “respect, support and document a person’s right to accept or refuse care and treatment”
- 4.1 “balance the need to act in the best interests of people at all times with the requirement to respect a person’s right to accept or refuse treatment”.
The threat of losing one’s job if one does not accept vaccination is coercion
It is not only ethically wrong, it is against the NMC Code for any registered practitioner to coerce a person. Let me be quite clear that any form of coercion, by definition, prevents a person from giving true consent. As a midwife I cannot give as much as a paracetamol if the client declines it. If a midwife gave a paracetamol or pethidine or any other drug against a woman’s wishes, or carried out any treatment, even for good clinical reasons, the woman would have a case for complaint to the NMC and the midwife could be sanctioned and even struck off. She could also face criminal charges, including assault.
The threat of losing one’s job if one does not accept vaccination is coercion. The conversation between a manager and a “hesitant” worker, as suggested by the NHS England report (see references) is coercive if the worker will lose their job unless he or she complies. I contest that any registrant coercing a person, or vaccinating or supervising the vaccination of a coerced person, would be in breach of the Code and vulnerable to being reported to the NMC.
It has been difficult to write this article as a health professional surrounded by people I greatly respect who are convinced that only pharmaceutical solutions can bring us out of the threat of Covid. I have a different view, but I do not want to rehearse that view here. This is not about the merits of vaccination, or about the controversies surrounding the various Covid vaccines. I acknowledge the efforts of those who have poured their energies and hearts into the vaccination effort in good faith. My focus is purely on whether or not it is legal to impose vaccine mandates. The argument on the other side would perhaps hold slightly more water if any of the vaccines against SARS-COV2 had been subject to the usual extensive, long term, research. All the current Covid vaccines available in England use novel technology. While I believe these products have been successful in reducing hospitalisations and deaths, long-term outcomes have not been assessed, and there seems to be little in the way of systematic assessment of adverse outcomes – indeed, any suggestion of adverse outcomes is met with censorship. Adverse and long-term outcomes really matter in research – well, they always have until now. This may be particularly relevant for young people for whom the risk/benefit calculations regarding vaccination with our current knowledge may be finely balanced. Another point to consider is that immunity is partial, appears to last for a relatively short time, and is always subject to new variants. What does “full vaccination” under these conditions even mean? But even in the case of the best vaccination in the world, conferring long-lasting immunity and with years of safety records, a person (even an NHS or health and social care worker) has the right to decline treatment and not be coerced under current UK law as it stands.
Freedom of choice for medical treatment underpins our health system
The responses of the Royal Colleges and regulatory bodies have been disappointing to say the least. While the RCM, RCN and other Royal Colleges have spoken out against vaccine mandates, they have not taken any action – this compliance lets Government off the hook. Freedom of choice regarding medical treatment underpins our entire health system and undermining our freedom could have a further destabilising effect on a system that is already in crisis – to say nothing of the loss of essential staff. Midwives, nurses, doctors and others who are used to working to the most stringent ethical standards will feel undermined and ever more demoralised; mere tools to be used and ordered about, rather than autonomous human beings. Forcing, or witnessing the forcing, of medical treatment causes moral injury. Arguably, the most heinous moral damage is not to those who are vaccinated against their will in order to keep a job, but to those who follow orders, colluding in a system that overrides normal consent procedures.
- James, Steve (2022) ‘Why Should I be Sacked for Refusing the Covid Vaccine?’ The Spectator, 15th January 2022
- Mitchell, Gemma, ‘Mandatory Vaccination for NHS Staff in England Voted through by MPs’, Nursing Times, December 2021
- NHS England, Vaccination as a Condition of Deployment (VCOD) for Healthcare Workers, 14th January 2021
- Nursing and Midwifery Council, The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates., 2020
All photos courtesy of Erika Thompson
Midwives angry over compulsory jabs with Erika Thompson – Sky News
By Nicky Grace, RM, MA in Research Methods (Health)
Midwifery educator, independent midwifery consultant, writer and researcher (writing in personal capacity)
Prohibit employers from requiring staff to be vaccinated against Covid-19
Make it illegal for any employer to mandate vaccination for its employees. This should apply to all public sector (including the NHS, armed forces, care workers), third sector and all private sector.
Parliament debated this topic on 24 January 2022
*note: No Health Minister or Shadow Secretary was present; the only one present was the Under-Secretary of State for Business, Energy and Industrial Strategy ,Paul Scully
By law, the Public Health (Control of Disease) Act 1984 (Section 45E) gives the Government the power to prevent and control an infection. However, the legislation specifically prevents a person from being required to undertake medical treatments such as vaccinations. Accordingly, further primary legislation would need to be introduced in order to legally mandate a COVID-19 vaccination. The Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2022 did exactly that. The House of Lord’s Secondary Legislation Committee has stated that the Government’s case is too weak to justify a mandate.
‘For consent to immunisation to the valid, it must be given freely, voluntarily and without coercion by an appropriately informed person who has the mental capacity to consent to the administration of the vaccines in question. ‘ (The Public Health England Green Book: Immunisation Against Infectious Disease)
UNESCO declaration on bioethics and human rights states: all medical interventions are subject to prior, free and informed consent that may be withdrawn at any time and for any reason without disadvantage or prejudice.
The Nuremberg Code and the UN Int covenant on civil and political rights state: no one shall be subjected without his free consent to medical or scientific experimentation.