In health care, the term ethics consists of ones moral standards, convictions, and qualities that guide us in making decisions about restorative care. The ethical standards come from ones feelings of good and bad and our convictions about rights we have and obligations we owe to others. In clinical ethics, which is, a “structured approach to ethical decisions in clinical medicine,” that is derived from what is called bioethics. In bioethics, there are four ethical principles that are relevant to medical care—the principle of beneficence, nonmaleficence, respect for autonomy, and justice (Johnson, Siegler, Winslade, 2015). The principle of beneficence refers to the ability to help the patient propel his or her own better self, while nonmaleficence is the ability to do no harm. When caring for patients it is extremely important to allow one to feel as independent as possible and capable to make his or her own decisions, which refers to the respect of autonomy aspect. Lastly, health care professionals must implement the ability to express fairness in all cases, and avoid bias. These four principles alter the way for us as health care professionals choose to make decisions and implement care.
Narrative Description of The Case:
A twenty-seven year old flight attendant who was noticeably healthy was rush to the ER due to symptoms of fever and lesions on skin thought to be chicken pox. Once evaluated it was in fact smallpox. Mr. Smith was put on isolation and unfortunately died within 12 hours of treatment at the emergency department. Since smallpox was suspected the emergency department notified the centers for disease control and prevention (CDC) as soon as possible. Once the physician confirmed the “diagnosis through the presence of antibodies to the virus, the CDC identifies the index case,” (Case 1, 2017) which is basically the initial case of the person who was first infected with the outbreak.
The CDC learned it was learned that Mr. Smith acquired smallpox from a friend who has also since died from it, putting everyone who came in contact at risk for developing smallpox. Since Mr. Smith was a flight attendant he came in contact with multiple people including people from Chicago, Miami, Los Angeles, New York, and Seattle–putting them all at risk. Resulting in the CDC putting out “voluntary smallpox vaccines” offered to all citizens of the cities Mr. Smith and the index case were in over the past two weeks, and “mandatory smallpox vaccines” administered to all people who are considered high risk, including— “workers in the NYC hospital, patients who were in the ER, Mr. Smith’s co-workers, people living in Mr. Smith’s apartment complex, and airline customers who had been on any of Mr. Smith’s flights in the two weeks” (CASE 1, 2017).
One might think this is a good thing? They found the index case and people who are at high risk that should get the vaccination, which is correct. However, in this case, a woman who is considered high risk from Los Angeles is opposed to getting the vaccine due to religious beliefs. Typically, California law allows one to refuse vaccines due to religious or personal beliefs; however, the CDC “demands she accept the vaccine or face mandatory quarantine.” Another obstacle faced in this case study is a family who are considered low risk susceptibility to the virus, but demands that their family receive all the mandatory vaccines, but the request is denied due to limited vaccine supplies.
The Ethical Dilemma In this Case
There are many ethical concerns when it comes to the topic of vaccinations. Vaccinations are used as a preventative measure to protect adults and children from infectious diseases. In this case, with the CDC, there is a conflict of interest regarding the CDC’s regulation policy; consisting of the CDC forcing and/or not letting people get vaccinations. For instance, CDC is enforcing that people who fit the criteria stated above in the introduction should be forced to get the vaccine against smallpox; while the other dilemma is not letting patients get the vaccine who want to due to lack of resources. The ethical principles in this case that are most at risk for compromise consists of the respect for autonomy and the principle of justice.
Typically, everyone likes the idea to be able to make decisions for themselves, but in this case people are forced to get a vaccination that they may or may not want. In public health the main goal is to respect patients rights and still maintain the benefit of health. However, based on Daniel Salmon and Saad Omer, “restrictions on individual rights are justified for two reasons—for the benefit of the individual or the benefit of the community” (2006). When people make the decision to refuse vaccinations they render not only themselves, but also others, especially those who are considered susceptible to infectious disease, immune-compromised. In majority situations, the main concern is to protect the community health oppose to someone’s autonomy. However, it comes to question, how does the process of one having the ability, in the first place, to choose whether they want a vaccination or not. In the United States, there are no federal laws regulating vaccinations, vaccination laws are all passed on the state law, which can differ from state to state.
Justice is another big concern regarding this case, because it brings up the question is it fair for the CDC to have the ability to decide who can and cannot receive vaccinations. When it comes to having lack of resources, it is important to prioritize who are more important opposed to who are not. In this case, the family who wanted the vaccination did not fit the requirements of being high risk, so they were considered on the lower side of the spectrum. In this case, since there was lack of resources, it made those who were in close contact with Mr. Smith during the peak of his illness the high risk, resulting in mandatory vaccinations.
The Argument:
When it comes to vaccinations there are many arguments that agree or disagree with the ethical reasoning behind vaccinations. The question is what makes vaccinations so controversial, I assume it is the vaccine part of the word, in which, it could not seem like a preventative measure, due to the fact that foreign antibodies are injected into someone to help build their immune system. It is understandable that vaccines can be perceived as a negative thing, but what is worse is not having that protection from your immune system to combat the majority of pathogens in the world. The main ethical concern is should it be mandatory for people to get vaccinations. Personal decision making regarding vaccinations can be consider complex ethically, as a result of, it combines the ethics of medical care regarding the doctor-patient relationship with the ethics of public health, which results in the ability to compromise others if preventatives are not taken appropriately.
Making immunization obligatory by law is frequently observed as a method for enhancing consistence and managing the issue of vaccination reluctance or refusal. While individual autonomy is an important principle, those who refuse vaccination not only pose a risk to themselves but also to others. Based off Elizabeth Miller, who cited a philosopher, JS Mill, who is known for his essay On Liberty in 1859, states “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others”(2015). This consequently gives ethical justification in favor for mandatory vaccines.
On the other hand, some states allow what is called “exemptions” regarding special case—medical, religious, and philosophical. Meaning that people have the ability to refuse vaccination if they fall into one of these three ranges. Medical exemptions apply to those who cannot, for some reason, receive vaccines; for example, immune compromised. In regards to religious exemptions, states allow people the ability to refuse vaccinations as a legitimate reason, which correlate’s with the above case regarding the young lady who did not want the vaccination against smallpox’s due to her religious belief. Lastly, there are philosophical exemption offered for those who may not be religious or spiritual but they may not agree with the idea of vaccinations. This is seen in a lot of families who may not agree with vaccines because there is this persona that vaccines can be linked to autism.
Although one might agree with the right to exemption, I would have to disagree. According to the Boston College Law Review, “Lawmakers must tighten the valve on compulsory vaccination requirements in order to prevent the deterioration of the nation’s health. Laws should reflect the need for diligence in vaccination practices and prevent unnecessary or unwarranted medical, religious, and philosophical exemptions” (Lobo, 2016). This is suggesting that laws need to be stern and less available for exemption against mandatory vaccination laws, this in turn will result in diminished measure of people deciding against vaccinations.
Resolution:
The dilemma regarding CDC regulation policy can be difficult to decide when it comes to disregarding people’s autonomy. Although the young lady wants to disregard not getting the vaccination due to religious beliefs, her request should be denied. When it comes to a situation where one has a high possibility to be affected from a virus, it should not be just their own considerations about how they feel towards vaccinations, but it is more important to consider other people who may be affected due to this lack of prevention.
However, when it comes to people who are less likely to be affected, they should not be consider priority in the case of lack of or limited supply of the vaccination. Since smallpox’s are considered highly contagious via “inhalation of airborne droplets from infected person or via contact with smallpox pustules,” it is considered a medical emergency. According to Matthew Wynia (2006), there are three broad ethical issues when it comes to handling public health emergencies; he calls them the “three R’s”— Rationing, Restrictions, and Responsibilities. When it comes to rationing he brings up the example of the influenza vaccination incidence in 2004, where half of the supplies were lost resulting in people who wanted the vaccine were not able to get the vaccine. However, the response of people not being able to get the vaccine was quite positive and accepting, opposed to in the above case about smallpox. I believe this occurred due to a more drastic outbreak in a virus that is considered incurable, and vaccination is the only source that can “prevent or lessen the severity of the disease if given 3 days of exposure” (Smallpox Virus CDC, 2017). When it comes to health care ethics, there should be a plan that comes into play as how to prioritize vaccination, in cases where there is lack of supply.
Broader Implication:
All in all, vaccinations can be a delicate topic when discussing with others. However, in cases like Mr. Smith, who died from an infectious disease, preventative measures are extremely important, even if one’s autonomy might be compromised, or it might not seem fair to others. In cases like these it should be recommended that, state laws concerning vaccination should be stricter when it comes to who can and cannot refuse vaccinations. When states implement stern laws, people are more likely to abide by them rather than trying to finesse their way out of it. It also should be recommended that