1
|
Affiliation(s)
- Mohammad S Razai
- Population Health Research Institute, St George's University of London, London, UK
| | - Tasnime Osama
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| |
Collapse
|
2
|
|
3
|
Editor's Note: March 2021. Kennedy Inst Ethics J 2021; 31:vii-viii. [PMID: 33716224 DOI: 10.1353/ken.2021.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
4
|
|
5
|
Valera L, Ramos Vergara P, Porte Barreaux I, Bedregal García P. [Parental refusal to mandatory vaccination in Chile. Ethical and legal challenges]. Rev Chil Pediatr 2019; 90:675-682. [PMID: 32186592 DOI: 10.32641/rchped.v90i6.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/30/2019] [Indexed: 06/10/2023]
Abstract
This article is an ethical and legal reflection about the current trend of parents to refuse vaccination of their children under a legal regime that establishes mandatory use of certain vaccines. We analyze the main arguments used by parents to refuse obligatory vaccination, i.e., the fear of the negative effects that vaccination may have on the child; the violation of the "right to autonomy"; religious or pseudo-philosophical beliefs; and the resistance to the State intervention in personal or family mat ters. Therefore, this statement implies a necessary ethical analysis of childhood vaccination. Finally, it will be discussed the responsibility of parents and the State -the health authority- in the care of mi nors. Vaccination is a benefit for both the inoculated and the community, the best preventive policy. At the same time, it is considered a complex case that demands a profound debate, whose purpose should be the transition from an apparent conflict between parents and the State, to convergence for the care of minors. In other words, it is emphasized the fact that parents, beyond the fulfillment of a heterogeneous normative duty, must act motivated by voluntary adherence to the best interest of the child and the community.
Collapse
Affiliation(s)
- Luca Valera
- Instituto de Filosofía, Facultad de Filosofía, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Ramos Vergara
- Centro de Bioética, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Paula Bedregal García
- Centro de Bioética, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
6
|
Forster M. Ethical position of medical practitioners who refuse to treat unvaccinated children. J Med Ethics 2019; 45:552-555. [PMID: 31249107 DOI: 10.1136/medethics-2019-105379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/02/2019] [Accepted: 06/13/2019] [Indexed: 06/09/2023]
Abstract
Recent reports in Australia have suggested that some medical practitioners are refusing to treat children who have not been vaccinated, a practice that has been observed in the USA and parts of Europe for some years. This behaviour, if it is indeed occurring in Australia, has not been supported by the Australian Medical Association, although there is broad support for medical practitioners in general having the right to conscientious objection. This paper examines the ethical underpinnings of conscientious objection and whether the right to conscientious objection can be applied to the refusal to treat unvaccinated children. The implications of such a decision will also be discussed, to assess whether refusal to treat unvaccinated children is ethically justifiable. The best interests of both existing and new patients are crucially important in a doctor's practice, and the tension between these two groups of patients are contemplated in the arguments below. It is argued that on balance, the refusal to treat unvaccinated children constitutes unjustified discrimination.
Collapse
|
7
|
Abstract
OBJECTIVES To explain vaccination refusal in a sample of Australian parents. DESIGN Qualitative design, purposive sampling in a defined population. SETTING A geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal. PARTICIPANTS Semi structured interviews with 32 non-vaccinating parents: 9 fathers, 22 mothers and 1 pregnant woman. Purposive sampling of parents who had decided to discontinue or decline all vaccinations for their children. Recruitment via local advertising then snowballing. RESULTS Thematic analysis focused on explaining decision-making pathways of parents who refuse vaccination. Common patterns in parents' accounts included: perceived deterioration in health in Western societies; a personal experience introducing doubt about vaccine safety; concerns regarding consent; varied encounters with health professionals (dismissive, hindering and helpful); a quest for 'the real truth'; reactance to system inflexibilities and ongoing risk assessment. CONCLUSIONS We suggest responses tailored to the perspectives of non-vaccinating parents to assist professionals in understanding and maintaining empathic clinical relationships with this important patient group.
Collapse
Affiliation(s)
- Catherine Helps
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia
| | - Lesley Barclay
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Stacy Carter
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
8
|
Arora KS, Morris J, Jacobs AJ. Refusal of Vaccination: A Test to Balance Societal and Individual Interests. J Clin Ethics 2018; 29:206-216. [PMID: 30226822 PMCID: PMC6457107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
While all states in the United States require certain vaccinations for school attendance, all but three allow for religious exemptions to receiving such vaccinations, and 18 allow for exemptions on the basis of other deeply held personal beliefs. The rights of parents to raise children as they see fit may conflict with the duty of the government and society to protect the welfare of children. In the U.S., these conflicts have not been settled in a uniform and consistent manner. We apply a test that provides a concrete and formal rubric to evaluate such conflicts. For some vaccinations, based on the individual medical characteristics of the disease and the risks of being unvaccinated, the test would suggest that permitting conscientious exemptions is ethical. However, for vaccinations protecting against other diseases that are more severe or easily transmitted, the test would suggest that the federal government may ethically impose laws that deny such exemptions.
Collapse
Affiliation(s)
- Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, and Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Jane Morris
- Department of Obstetrics/Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Allan J Jacobs
- Department of Obstetrics and Gynecology, Coney Island Hospital, Brooklyn, New York, and Department of Obstetrics and Gynecology and Department of Bioethics, Stony Brook University, Stony Brook, New York, USA
| |
Collapse
|
9
|
Abstract
Since the last century, vaccination has been one of the most important tools we possess for the prevention and elimination of disease. Yet the tremendous gains from vaccination are now threatened by a growing hesitance to vaccinate based on a variety of concerns or objections. Geographic clustering of some families who choose not to vaccinate has led to a number of well-publicized outbreaks of vaccine-preventable diseases. Of note is that some of these outbreaks are centered within some Christian religious groups that increasingly avoid vaccination due to moral concerns, fears about safety, or doubts about the necessity of vaccines. We argue from the perspective of Catholic social teaching on why there is a moral duty to vaccinate.
Collapse
Affiliation(s)
- Paul J Carson
- a North Dakota State University and University of North Dakota School of Medicine
| | | |
Collapse
|
10
|
Abstract
A recent measles outbreak in the United States was linked to a single source, yet it spanned eighteen jurisdictions and infected 121 people. 1 Forty-seven states currently allow legal exemption from vaccination on religious grounds, eighteen of which also allow it on philosophical grounds. 2 Recent research usually accepts a fundamental right to vaccine exemption and primarily seeks ways to protect herd immunity while also respecting that right, for example, by keeping the exemption available yet harder to procure or by imposing torts for infection-related injury. 3 We argue that when herd immunity is at risk, any moral claim to exemption from vaccination on conscientious, philosophical, or religious grounds is overridden. Our argument rests on an analogy to a series of situations in which a person puts others at risk through philosophically or religiously motivated choices. In these situations, intuitively, there is no claim-right to compromise the safety of others. Similarly, we propose, there is no claim-right to refuse vaccination, regardless of one's conscience, when refusal is sufficiently likely to seriously affect herd immunity and the safety of others. We also address several counterarguments. The lack of a claim-right to exemption when herd immunity is at risk does not mean, however, that it is always prudent for the state to force vaccination, or even that forcing vaccinations must be legal. Alternatives to forced vaccination may prove wiser and more conducive to high vaccination rates.
Collapse
Affiliation(s)
- Isha Ann Emhoff
- MD FACS, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115,
| | - Ellen Fugate
- BA, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115,
| | - Nir Eyal
- D. Phil., Harvard TH Chan School of Public Health, Department of Global Health and Population, 651 Huntington Avenue, Boston, MA 02115,
| |
Collapse
|
11
|
Abstract
Thousands of U.S. parents choose to refuse or delay the administration of selected vaccines to their children each year, and some choose not to vaccinate their children at all. While most physicians continue to provide care to these families over time, using each visit as an opportunity to educate and encourage vaccination, an increasing number of physicians are choosing to dismiss these families from their practice unless they agree to vaccinate their children. This paper will examine this emerging trend along with the reasons given by those who advocate such an approach. I will argue that the strategy of refusing to allow families into a clinic unless they agree to vaccinate their children is misguided, and the arguments for doing so fail to stand up to close scrutiny. Such a strategy does not benefit the child or the health of the community, and may have a negative impact on both. Furthermore, some of the arguments in support of dismissal policies ignore the importance of professional obligation and appear to favor self-interest over the interest of the patient.
Collapse
Affiliation(s)
- Douglas S Diekema
- Professor of Pediatrics in the Department of Pediatrics at the University of Washington School of Medicine with adjunct appointments in the Department of Bioethics & Humanities and the Department of Health Services in the School of Public Health. He also serves as the Director of Education for the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Research Institute. He received his M.D. at the University of North Carolina School of Medicine in Chapel Hill, North Carolina, and his M.P.H. at the University of Washington School of Public Health in Seattle, Washington
| |
Collapse
|
12
|
Abstract
Dealing with the continuously increasing rates of families wanting to either significantly delay or completely postpone their infant's vaccines has created an alarmingly untenable dilemma for the general pediatricians dealing with these families on a daily basis. Pediatricians must decide whether to continue to provide substandard care by foregoing many or most of the infant's highly recommended protective vaccines, or whether to dismiss from the practice the family who refuses vaccines. Much has been written about why they should retain these families, but this paper will discuss some reasonable rationales as to why nearly 40% of pediatricians choose dismissal of these families.
Collapse
Affiliation(s)
- Stan L Block
- Practicing full time general pediatrics in rural Bardstown, KY for over 33 years; and has published over 160 peer-reviewed medical articles on vaccines, antibiotics, general pediatrics, adolescent medicine, and infectious diseases. He is a full professor of clinical pediatrics on the medical faculties of the University of Louisville, the University of Kentucky (Lexington, KY) and the Pikeville Osteopathic College. He has won numerous national awards for his research, speaks at CME meetings across the U.S., and has been elected to the editorial boards for such prestigious monthly journals such as The Pediatric Infectious Disease Journal, Pediatric Annals (writing a monthly column for over 3 years), Pediatric Drugs, and Infectious Diseases in Children. He was voted the "Best Pediatrician in Nelson County" for the last 6 years
| |
Collapse
|