CANMORE, ALTA. -- In the midst of a fourth wave, Canadian hospitals are pulling out all the stops to prevent further outbreaks of COVID-19.

After much of the country’s hospitals moved to implement mandatory vaccine policies for employees, a growing number are turning their attention to visitors and occasional care staff, requiring they too show proof of vaccination before being allowed to enter hospital facilities.

It’s a move that has stirred yet another pandemic-era debate for Canadians and ethicists alike, particularly considering the delicate and sometimes life-altering business that happens behind hospital doors.

“I think of all the places that we need to show proof of vaccinations, this is one of them,” Elizabeth Bardon, COVID incident commander at Kingston Health Sciences Centre in Ontario, told CTV National News.

“People who come to hospital are not coming by choice, they are very ill and right now, our patients are sicker than they've ever been... we have a special duty of care to make sure that they don't get infected with something else while they're here.”

Starting Oct. 22, Kingston Health Sciences Centre will require that all registered family visitors who are coming to visit inpatients be fully vaccinated and show proof of vaccination before entering the hospital.

The hospital joins several other Greater Toronto Area health centres, including the University Health Network (UHN), and hospitals in Quebec in implementing these new rules.

In B.C., visitor vaccination requirements first adopted in long-term care homes will expand to acute care and community care visitors on Oct. 26. Meanwhile in Alberta, where hospitals were hit hard by the fourth wave of the virus, calls to adopt a similar policy are growing louder.

From an epidemiological standpoint, ethicists say the policy is in line with hospitals’ main priority: keeping patients safe.

But looking at the topic from a compassionate standpoint is where it gets tricky.

“I have to admit from an ethical and human perspective, this is potentially the hardest context in which we are requiring vaccine proof because when are we more vulnerable when a loved one is in the hospital? When else do we have the incentive or desperate need to be there for a loved one,” Vardit Ravitsky, professor of bioethics at the University of Montreal, told CTV National News.

“We need to keep in mind how sensitive how this requirement is because it touches on families at their most difficult moments, in their most vulnerable situations.”

Ravitsky notes that hospitals should make exemptions for those who are medically unable to receive a vaccine, but adds that there should be compassionate exemptions in place under certain circumstances.

“For example, you’re accompanying someone into the ER and they need help… you’re accompanying your child,” she said. “If you’re accompanying a woman in labour, if you’re accompanying someone who is actively dying, at the very end of their life, or if you’re an essential visitor, which means you’re providing physical care for the visitor.”

At the same time, Ravitsky agrees that hospitals should limit the entry of those unvaccinated by choice to those very limited situations and require additional safety measures from those visitors if exemptions are approved, such as providing rapid testing, protective equipment, and limiting the amount of time spent with patients.

“Even if it only lasts a few weeks or months, we have to be aware of the human need and tragic nature of some situations and create enough space for nuance in the way that we implement this idea,” Ravitsky explained.

Hospitals like Kingston Health Sciences say they have provided some wiggle room to unvaccinated visitors by announcing these policies in advance and say, overall, the reaction has been supportive thus far.

“Our goal throughout the pandemic has been to really balance safety and compassion and we've worked really hard to do that,” Bardon said.

“We don't want to go backwards. We want to continue to be in a position that we can open carefully and slowly as we go, rather than having to do a shutdown because of an outbreak where we're actually excluding more people from the hospital.”