Ethical Dilemma of Childhood Vaccinations

Abstract

This paper explores the ethical principles involved in childhood immunizations, analyzing the balance of autonomy of parents and the obligation to public safety (NCBI). The attitudes of parents about vaccinations are based on a variety of factors including, social and cultural customs, education and confidence in medicine. There are continuous efforts to promote communication in society about the importance of immunizations, as well as evidenced-based practice to support these efforts of universal immunization. Despite these efforts’ resistance continues with a range of reasons why parent refuse to have their children immunized. This paper analyzes ethical conflicts of childhood immunizations and possible resolutions to increase compliance with childhood immunizations.

Keywords: vaccinations, ethical principles, immunization

Childhood Vaccinations

Vaccinations protect children using their natural immunity to develop immunity against infectious diseases. These diseases can be dangerous or deadly and become a public threat. Because vaccinations are a proven method of protection against certain diseases, it has become mandatory for children, this has become a vast issue of controversy. Some of the individuals upset with this decision are concerned that this infringes upon their rights. However, exemptions are allowed for medical reasons in addition to that all except three states allow religious exemptions.

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The Dilemma

The recent measles outbreak Washington, New York, New Jersey and other states involving a group of parents who received an exemption from immunizing their children because immunization violates their religious freedom. This outbreak occurred in the mainly unvaccinated populace in ultra-orthodox Jewish communities, where they believe that vaccine causes diseases. (Washington Post 2019).

Another group the Amish, also are against vaccinations due to their mistrust in science and values because deeply rooted in their religious beliefs. Mandatory immunizations are a very controversial issue, because of the belief of infringement of parental rights and the ethical concern of coercion. While autonomy and the right to self-determination is on view, the other side of the argument deals with the principles of beneficence, non-maleficence, and the theory of utilitarianism. Whether the parent or custodian is for or against vaccination, the issue of public safety remains at the forefront.

“The principle of beneficence implies the moral obligation of the healthcare provider to benefit and help others, while non-maleficence is the corresponding negative principle suggesting first do no harm” (Moodley, et al., 2013). The proven benefits of vaccinations outweigh potential harms and provide crucial benefits to the public health. While patients have the right to self-determination (Butts,2016) it remains the nurse’s job is to protect and support the rights, health, and welfare of others, particularly in public health. In the theory of utilitarianism, actions are taken to protect the greater number of people.

When using this theory mandatory vaccinations would be considered justified because based on the statistics vaccination is better than their absence to the public as a whole. “In John Stuart Mill’s utilitarianism theory he believed communities usually agree about what is good and about things that best promote the well-being of most people- individual liberties are limited to the larger society is protected from diseases and the consequence is that people are happier because they are free of diseases’ (Butts & Rich, 2016). “Mills defends “the harm principle” which says that the only justification for interfering with the liberty of an induvial against her will is to prevent harm to others” (Plunkett, 2015). The problem with parents refusing these vaccines is that does not only put their own child at risk for acquiring preventable diseases, but they put the community at risk, especially those individuals who cannot be immunized due to underlying conditions.

‘For vaccine-preventable diseases were the consequences of individuals not accepting a vaccine can be viewed as a considerable risk for others in the community, mandating immunization may be an appropriate and acceptable intervention’ (MacDonald, et al., 2018).Current vaccination laws include requirements for vaccination for children in a school setting, ranging from daycare to college along with healthcare workers. State laws govern whether providing vaccination is within a practitioner’s scope of practice. The Public Health Law program gives selected resources for public health practitioners on state vaccination laws.

Ethical Theory

Utilitarianism, an ethical theory, stating that the most ethical choice is the one that produces the most good for the greatest amount of people. Utilitarianism is the most common approach to moral reasoning. Since childhood vaccinations is a proven method to control and prevent disease, it is the belief of the Centers for Disease Control that the benefits far outweigh the risks. Since we cannot predict the future, we do not know whether the consequences of vaccinating children will be good or bad. Utilitarianism does not account for the autonomy of the parents to have the right whether or not to vaccinate their child. A resolution to this issue is to allow parents to decide whether or not to vaccinate their child and take it out of the government’s hands altogether.

ANA Code of Ethics

ANA supports immunizations to protect the public from communicable and fatal diseases such as measles, mumps, diphtheria, pertussis, and influenza (ANA, 2014). The ANA has supported mandatory vaccination policies for health care workers and recommendations for the broader health care community. The statement of the American Nurses Association is to protect the health of the public, all individuals should be immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP).

ANA supports exemptions from immunization only for the following reasons, medical contraindications, and religious beliefs. Therefore, all requests for exemption from vaccination should be accompanied by documentation from the appropriate authority to support the request. Individuals who are exempted from vaccination must adopt measures for protection and reduction of the chance of disease transmission. Five provisions within the Code speak to the obligation of registered nurses to act in a manner that is consistent with maintaining patient and personal health:

• The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population (ANA, 2015).
• The nurse promotes, advocates for, and protects the rights, health, and safety of the patient (ANA, 2015).
• The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and acts consistent with the obligation to promote health and to provide optimal care (ANA, 2015).
• The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth (ANA, 2015).
• The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care (ANA, 2015).

Proposed Resolution

From the nursing perspective healthcare or prevention of an outbreak should be provided to everybody, but in such instances, like immunization, the parents are those who make the call. Nurses will ensure that their actions would not contradict someone else believes or reasons for not having their children immunized. It has been found through research that advantages for immunization far outweigh the disadvantages, therefore, morally and ethically the nurse sees immunization for all as a preventable option and it should be accepted by all. (CDC, 2019). This can lead to ethical Paternalism where nurses have conflicts of respecting a patient’s autonomy and nurses’ beneficence. It will be ethically right to prevent an outbreak by immunization and that is the best way to contain a contagious disease.

Conclusion

All methods of preventing diseases will depend on the effective use of communication. With therapeutic communication, using the ethical principles of autonomy, nonmaleficence and beneficence families educated to make the best possible medical decisions for their children. For nurses and health care providers, using communication during the clinical encounter is an optimal time to provide education about the risks and benefits of vaccination. As future nurses, we must remember to use any opportunity to educate, whether in the school, daycare or the health care setting.

It is the nurse’s duty to their patient to promote their best interest, but nurses must keep in mind that their patient may not agree with everything that is explained. The best way to help them understand that the nurse has their best interests at heart is to allow the patient to communicate all their fears and opinions so that the nurse can address each concern with the most accurate and relevant information. Having this open communication between the nurse and patient is the best way to alleviate their concerns and will have the most potentiality of helping the parents understand that the need for vaccinations will almost always out way any negatives.

References

1. ANA. (2015, July 21). ANA Position Statement on Immunizations. Retrieved from Nursing World: https://www.nursingworld.org/~49177c/globalassets/docs/ana/executivesummarypositionstatement_immunizations.pdf
2. Bailey, S. (2019, February 21). Some anti-vaccination parents cite religious exemptions. Measles outbreaks could change that. The Washington Post. Retrieved from https://www.washingtonpost.com/religion/2019/02/21/some-anti-vaccination-parents-cite-religious-exemptions-measles-outbreaks-could-change-that/?noredirect=on&utm_term=.f2333ff3c0e1
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