In my report, my view is that vaccinations should be mandatory in all cases except in cases for where I would put the patients’ health at risk. I believe this because the main reason that people parents do not vaccinate their children is that of a study that has been proven to be false. Vaccinations have no effect on development and the schedule provided by doctors is also safe and effective. Vaccinations are for the good of public health and provide safety for those who can’t get vaccinations because of health issues.
The notion that vaccinations especially the Measles, Mumps, and Rubella (MMR) vaccine causes autism comes from a 1998 study by Andrew Wakefield. The study investigated a possible link between vaccinations and autism. Twelve children between 3 and 10 years old were considered for the study (Wakefield, AJ). The study found the behavioral issues were associated with the MMR vaccine in 8 out of 12 children (Wakefield, AJ). 9 of the children had behavioral disorders including autism, 1 had degenerate psychosis (a condition with late-onset developmental delays) and 2 will post-viral disease (Wakefield, AJ). The study ultimately found a link between the MMR vaccine and development of regression in children (Wakefield, AJ). Due to the study, the vaccination rates dropped drastically. After the study was published in the Lancet Medical Journals the study was quickly called into question. The sample size was only 12 children, the design was uncontrolled, and the study could not be repeated (Rao, T). After the study was called into question ten out of the twelve co-authors of the papers published in a retraction saying, “no causal link was established between the MMR vaccine and autism as the data were insufficient” (Rao, T). Ultimately, the Lancet retracted the paper in February 2010. Wakefield and his co-authors were found guilty of ethical violations, scientific misrepresentation, and fraud (Rao, T).
After Wakefield studied many scientists wanted to look at if there are links to vaccinations and autism. The Department of Community Child Health, Royal Free and University College Medical School, University College in London, UK took a look at the relation. In their study “Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association” they looked at children that had autism since 1979. They looked at children with disabilities from 8 North Thrones Health Districts (Taylor, B). The MMR vaccine was introduced in the United Kingdom in 1988(Taylor, B). This gave researches nine years to look at children with special needs before the MMR vaccine and children with special needs after the MMR vaccine was introduced. Researchers found 498 cases of autism (Taylor, B). They found that autism was steadily increasing before the MMR vaccine was introduced and after the MMR vaccine was introduced there were no sudden change in rate (Taylor, B). There was no difference between the autism rates in the vaccinated children and non-vaccinated children. This was the same with children at 18 months as well as at 2 years old (Taylor, B). They found no causal link between the MMR vaccine and autism.
Although the link between the MMR vaccine and autism has been debunked, many still believe that the vaccination schedule and amount of vaccines have neurophysiological outcomes. Michael Smith and Charles Woods conducted a study “On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes” that tries to determine whether children who received the recommended vaccinations any problems compared to children with delayed treatments and to children who did not receive vaccinations. The study looked at children while they go to vaccinations and re-looked at them years later study (Smith, Michael). Children who got their vaccination within 30 days of the recommended age were considered on time for vaccinations (Smith, Michael). They also had secondary analysis look at the highest and lowest expose to vaccinations to children from the highs and lows exposure for the first seven months of life (Smith, Michael). They found that vaccinations given to children on time had no neurophysiological effects on them 7-10 years later (Smith, Michael). No statistics in the study favored children with fewer vaccines or no vaccines. This study proves that vaccinations have an effect on neurophysiological abilities. This also proves that children should be vaccinated on time because there is no difference in health in on time vaccinations and delayed vaccinations. From all this information many doctors and lawmakers, make their decisions based on a utilitarian view. Utilitarianism is the view that the right actions are those that result in the most beneficial balance of good over bad. The whole idea behind utilitarianism is what action has the most benefit for the greatest number of people. When it comes to vaccinations, the idea is to help the greater good. The vaccinations protect the health of the population through herd immunity. Parents that do not vaccinate their children are looking what they believe is best for their children. Yet they ignore the effect on the greater good.
To solve the vaccination issue I think that vaccinations should be mandatory except for medical exemptions. The main issue with making vaccinations mandatory is that it would take away patient autonomy and paternalism. Patient autonomy is the patient’s ability to make decisions on the medical care without influence. Most people who receive vaccinations are children so the decisions are made by their parents. While the children are the ones getting the vaccinations, they do not have a say in what they want. The parents are the one ultimately making the decisions on whether to vaccinate or not. This could go against what their child would want when given full information of what the vaccination does. Making vaccinations mandatory would take away the ability for parents to decide what is best for their children. This goes against patient autonomy but has a better effect on society. Making vaccinations mandatory would also have an effect on paternalism. Paternalism is the overriding of a person’s decision making for their own good. The question is should the government take on weak paternalism in the case for the greater good? The United States Courts have gotten involved in cases where a child’s health and safety is at risk. Child Protective Services, Public Health Officials, and The United States Government worked to make sure the newborn babies would receive the hepatitis B post-exposure prophylaxis vaccine even without the mother’s consent. This shot is supposed to stop people from getting HIV after being infected within 72 hours(“HIV/AIDS). The government got involved when it came to making sure newborn would have a chance not to get HIV. This should be the same when it comes to diseases like Measles, Mumps, Rubella, Influenza and other potentially fatal diseases. Many parents who don’t vaccinate their children or don’t have vaccinations rely on herd immunity for the health. Herd immunity is when a large part of a population is vaccinated so the chances of an outbreak decrease. This protects people who don’t have the vaccinations for certain diseases from getting infected. The more people that are vaccinated the higher the herd immunity. As fewer people get vaccinated the herd immunity decreases. Herd immunity is an important part of what makes vaccinations work as well as they do. The government has a duty to protect its citizens and that may even mean protecting them from their own bad choices. The decision on whether to vaccinate is not just a personal choice but it affects all people. Vaccinations are a public health issue. When it comes to issues like this it is better to think of the effect as a whole rather than how it affects one person. While making vaccinations mandatory in all cases except in health issues goes against patient autonomy and is a form of weak paternalism it is what is best for the population as a whole.
Making vaccinations mandatory has its issues when looking at the ethical theories. The ethics of care believes that context has greater say in decisions. This places a significance on the relationship between caregivers and patients. The ethics of care insist that medical care providers pay more attention to the specific needs of patients and their family. The ethics of care is fitting for nurses because they usually have a closer bond with patients. Whether a decision is right in the view of ethics is based on the effect on the patient and their family they. They have to look at the specific needs of the patient and their family while being aware of their relationship. With this view vaccinations would not be mandatory. Vaccination use would be decided by the patient and their family. With the ethics of care view, vaccinations would be used similarly to how they are used now. However, it would most likely not be mandatory. Deontological ethics says that the rightness of actions is not only decided by the consequences. Much of this is decided by their internal motivation. Whether an action is right is based on their intent not what happens after. In this case, vaccinations are good for people. Vaccinations are meant to protect people from getting diseases. The reason for vaccination is to do good and help. This makes vaccinations inherently good. Vaccinations are meant to do good despite what people may see as consequences. In the view of deontological ethics, vaccinations would be mandatory because of their desire for inherent good. They consequences like parent rage, or taking away patient autonomy would not matter. The way that vaccinations are decided now is a combination of the deontological ethics and the ethics of care.