Others have questioned the need to increase influenza vaccination rates among HCWs, claiming that HCWs should simply avoid patient contact when ill. Unfortunately, although HCWs say that they will stay home when sick, in reality, many HCWs routinely come to work with symptoms of influenza-like illness.32,46,47 In addition, people may shed influenza virus during the 24 hours before the onset of clinical illness48 or in the absence of clinical symptoms,49 which enables HCWs to transmit the virus to their patients, even when the HCWs feel well. A variety of ethical issues are involved in a mandatory program such as this. In sum, one attempts to balance the benefits that accrue to patient safety against the loss of the individual’s right to choose.50-52 During the planning process for our program, the ethics committee was involved, and we enlisted the help of outside ethicists as well. Overall, it was felt that the importance of protecting our patients was paramount. However, a mandatory program needs to be flexible enough so that valid reasons for avoiding vaccine use can be accommodated. We include both medical and religious reasons as part of this process.…