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Universal Vaccination Ethical Dilemma
Introduction
Since the development of modern medicine and vaccinations, there has been a 90%
decrease in the number of infections each year (“Why Immunize,” 2015). Yet, many parents and
families are suspicious about the ingredients of these vaccinations, the side effects they cause,
and their overall effectiveness. Most of these arguments society has, come from being
misinformed. The purpose of this paper is to discuss both sides of the ethical dilemma - should
vaccines be mandatory nationwide – informing people on the pros and cons of mandatory
vaccination, ultimately, to make a rational decision through problem identification, the decision-
making process, and a scholarly analysis of Christian values.
Problem Identification
What is a dilemma?
A dilemma is a difficult circumstance that requires a choice between two equally
unfavorable options. When a person is faced with a dilemma, there seems to be no option that
provides the satisfaction one might be looking for. In some cases, the options may not
necessarily be right or wrong, however, the challenge is making a decision that will provide the
best possible outcome for the most amounts of people. Aside from dilemmas that encompass a
typical day, there are ethical dilemmas: when each choice has “conflicting moral claims”
(Burkhardt and Nathaniel, 2014, p.153). In such cases, there tends to be no conclusive research
stating one choice is better than the other. There is usually evidence to both sides. As a nurse,
ethical dilemmas occur on a day-to-day basis with patients, families, providing treatment, and
even between other healthcare professionals. Most frequently, nurses will struggle between
doing what is morally right or preventing legal issues.
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Description of the Dilemma
Immunizations have proven to be one of the most cost-effective ways to prevent disease
in Public Health (National Conference of State Legislature, 2015). Not only do they protect the
individual from dangerous diseases, but they also protect the surrounding public who may be
immunocompromised and unable to receive vaccinations. Nurses are bound to persuading
patients and their families to get vaccinated, because it promotes a healthy community.
However, persuasion is not always effective. Many parents stand firm in vaccines being
unnecessary and hazardous to their child’s health. Ultimately, the dilemma is denying
someone’s right to make their own decisions regarding vaccinations and their health. On the
other hand, those pro vaccinations will argue that is selfish, because vaccines work on a
community based level. As of January 1, 2016, the law SB277 has been passed stating
personal/religious belief exemptions will no longer be accepted for currently required vaccines.
Meaning, without the currently required vaccines for attending public or private school, children
will not be allowed in classroom instruction and will only be able to partake in independent study
(“New Law,” n. d.). In summary, the two conflicting moral claims revolving around universal
vaccination is either healthcare professionals are disregarding the individuals right to make their
own decisions about their health, or purposefully, a large population is put at risk for contracting
a disease, which could cause serious complications, that otherwise could have been prevented.
Other conflicting beliefs and their effects will be discussed in the following section.
Conflicting Point of Views
Vaccinations have brought up controversial opinions for decades. There are typically
three stances that an individual might take: there are too many vaccinations required,
vaccinations are not necessary, or vaccinations should be mandatory for everyone (Campbell,
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2015). Behind each one of these views is a long list of conflicting reasons why that stance is
right or wrong.
Pro vaccinations.
Universal vaccination is based on the risk of injury or death without being vaccinated
outweighing the risk of injury from vaccines. Before the Diphtheria Vaccine was invented, there
were over 175,885 cases of Diphtheria in the United States. After modern medicine discovered
the vaccine for this disease, there were no cases reported in 2009. Vaccinations protect the
public, and if the majority of the population is protected from these easily preventable diseases,
an outbreak is less likely to occur. A study in Ohio, in a group of Amish people, there were over
341 cases of Measles as a result of refusing to be vaccinated. Due to the outbreak, most of the
Amish have now reconsidered their previous refusal (“The Debate,” 2014). When studying the
Polio outbreak in 1988, there were a recorded number of 350,000 cases in 125 countries.
However, due to the success of the polio vaccine, by 2004 polio existed in only 6 countries, now
being almost completely eradicated (Campbell, 2015). Vaccinations have become powerful
tools to decrease childhood infectious diseases; therefore, parents do not consider vaccines
absolutely necessary, due to rarely seeing these diseases occur. There is a lack of understanding
in parents. The reason these diseases are not frequently seen in the community anymore is due to
herd immunity. If children and their parents continue to refuse to be vaccinated, they put the
public at risk, and violate the ethical principle of imposing harm on someone else. Which brings
up an ethical debate, if allowing someone their right to choose brings harm on a great number of
people, should that individual be allowed the right to opt out of being vaccinated (Gostin, 2015)?
Some people believe vaccinations to be harmful; there is not quite any medical procedure or
medication that will ever be 100% safe. However, since 1989, only $2.3 billion has been paid by
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pharmaceuticals for vaccine injuries. Considering the number of people in the United States and
the 26 years that have passed, that number is not very high (Campbell, 2015). Regardless of the
theories being debunked multiple times, people continue to argue vaccines are linked to autism.
Not only is this theory unsupported by research, but also, the statistics prove otherwise. In the
1990’s, there were 555 children diagnosed with autism a year, but by 2013, only 50 developed
autism every year. Therefore, how could vaccinations lead to autism when there is such a great
decline in cases today, even after requiring so many vaccines (Campbell, 2015)?
Against vaccinations.
By requiring vaccinations, parents feel that their right to freedom and the right to
protection under the law are being denied. Individuals going to school deserve the right to
decide if they want to be vaccinated (“The Debate,” 2014). There are many reasons why
children are not being vaccinated today. Many of these theories revolve around the side effects
of the vaccinations. Parents believe they can harm children worse than the disease they are
preventing (“Anti-Vaccination,” 2014). The development of autism tends to occur consistently
with a child’s vaccination schedule. A study of 12 children concluded that 8 of them that
received the MMR vaccine were then diagnosed with autism (Gleberzon, Lameris, Schmidt, and
Ogrady, 2013). Aside from the concern of developing autism, in a study on why parents refused
or delayed vaccines, one of the greatest reasons was there were too many shots to be given.
Parents also listen to other parent’s opinions, or search the Internet for answers in unreliable
places, because they do not trust Doctor’s seek their child’s best interest. Webpages can share
negative things about getting vaccinated, or provide false evidence that they are ineffective and
lead to disease. All of these theories result in the refusal of vaccines (Smith et al., 2011). In
recent years, an alternative medicine used is chiropractic treatments. Studies have shown they
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can have more powerful effects in preventing communicable disease. Many chiropractors
believe all answers to disease can be found in the spine, it is called a subluxation. By adjusting
the vertebrae, the body can continue in its normal functioning to prevent disease. Due to the
increase in patients who visit a chiropractor and a chiropractors disbelief in immunization, there
is likely to be a decline in these patients getting vaccinated (Gleberzon, Lameris, Schmidt, and
Ogrady, 2013). Lastly, a study done in the Netherlands concludes the main reason parents refuse
vaccinations for their children is their chosen lifestyle. Instead of injecting unnatural sources of
antibodies to prevent disease, they rely on eating healthy and the body’s immune system to fight
off disease naturally. Getting a vaccine will only provide immunity for so long, but allowing the
body to produce the antibodies will provide life-long immunity. Parents are not always well
informed about the vaccination, the side effects, and the purpose; therefore, they also may
choose not to receive it (Harmsen et al., 2013).
In conclusion, there are only two strategies and options that apply to the dilemma of
universal vaccination. Either the government decides to make vaccinations mandatory for all
peoples, resulting in the loss of an individual’s right to choose; or it is decided that vaccinations
are no longer required for all populations, eventually causing outbreaks of previously eradicated
diseases. Neither option is ideal; nevertheless, the outcomes require one to choose the lesser of
two evils.
Decision-Making Process
What is the decision-making process?
In order to make a decision, there must first be a problem. First, the problem must be
clearly stated, so a rational conclusion can be made. Once the problem is well defined, the goal
will be also. Then, there must be at least two solutions to decide between. One must consider
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the uncertainties that are included with each solution, because that can determine the outcome.
Therefore, each uncertainty should be assessed and anticipated to evaluate the affect it will have.
Ultimately, decision-making requires that one transition from the current circumstances to the
desired situation. Of course, moral reasoning plays an important role in the decision making
process. To use moral reasoning means to thoughtfully consider the right and wrong and the
good and bad in each situation. This includes analyzing one’s own ethical beliefs, to be able to
make an informed decision. Emotions, such as empathy, can play a part in ones moral reasoning
and cause the person to lean in one direction over the other. (Burkhardt and Nathaniel, 2014).
Foundational Virtue Ethics
Virtue Ethics plays an important role in decision-making, because it is what makes up a
person’s character. Morally, character describes the part of a person that is in their control; and a
person’s character determines the ethics that they value. Virtues are essentially a habit that
makes one a better, more flourishing person. Regarding decision-making, a person’s virtue
ethics will determine how they choose and what they choose as a solution to their ethical
dilemma.
In application to universal vaccination, there are a few virtues and vices that come to
mind. First, from a Physician or Nurse’s point of view, Nonmaleficence is a common virtue
used in decision-making. Nonmaleficence is to avoid causing harm, whether that is to an
individual person or a group of people (Burkhardt and Nathaniel, 2014). Not only does this
include deliberate harm, but also risk of harm, or harm that occurs by doing good things.
Healthcare Professionals use the virtue of Nonmaleficence by promoting vaccinations to keep
vulnerable patients from being harmed. Secondly, justice is a virtue that may also be involved in
deciding to be vaccinated or not. “Justice implies fair, equitable, and appropriate treatment in
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light of what is due or owed to persons…” (Burkhardt and Nathaniel, 2014, p.298). In regards to
universal vaccination, an argument that is typically made using this virtue is a person’s moral or
legal right to refuse vaccinations. Whether or not a person really has that right, due to the risk it
imposes on others, is controversial. The third virtue seen in decision making towards this ethical
dilemma is wisdom. Doctors typically have wisdom, the knowledge on how to live a flourishing
life. Therefore, a healthcare professional probably knows best about whether or not vaccinations
are necessary to live a flourishing life. However, on the other hand, a parent will argue that they
know best how to provide a flourishing life for their child, and that could mean refusing
vaccines. Even though there are many good qualities a person might possess to make this
decision, there is also a vice that may be present: recklessness. In determining whether or not to
refuse immunizations, parents may think they know what is best for their child, but they do not
weigh both sides of the argument. Not understanding the consequence of refusing vaccinations
could be considered recklessness.
Integrating the Decision-Making Process
Ultimately, the problem that revolves around vaccinations is should it be mandatory to
receive immunizations, disregarding one’s right to make decisions about their own health. As
previously stated, there are many risks and benefits regarding vaccines. For example, if
everyone received his or her immunizations, the communicable disease rate would continually
go down. This allows the immunocompromised people to live in a safe environment where they
can be protected from contracting disease. Risks of refusing vaccines are way higher than
getting vaccinated in itself. Although, people against getting vaccinated think that vaccines
cause serious health issues such as autism, and they are an unnatural source of antibodies. The
desired outcome is that all parents and public would understand the need for vaccinations and the
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risk involved with refusing. There are really only a couple strategies that can improve this
situation. One, continually educate the public on the importance of being immunized. Respect
the individuals who choose to refuse, but as a healthcare professional inform them of the
consequences. Hopefully by implementing those two strategies, people will slowly understand
how vaccines are a necessity. Therefore, after weighing the pros and cons, people should be
vaccinated unless they cannot be for medical reasons. As a nurse, it is important to take part in
these strategies in hopes to protect the public.
ANA Code of Ethics
Provision 2 of the ANA code of ethics states that all nurses have a commitment to protect
their patients, whether that is a person, family, or a community. This means protecting the public
and their immunocompromised patients by promoting vaccinations in all individuals. Provision
1 state that the nurse is also responsible to respect each individual’s rights and human dignity.
This can be complicated, because nurses are supposed to protect the community by promoting
vaccines, but at the same time they have to respect a patient’s rights to refuse medical treatment.
Hence, the ethical dilemma of vaccinations presented from the perspective of being a nurse
(“Code of Ethics,” 2015). However, in order to protect the good of the most amounts of people,
nurses should promote mandatory vaccination, and direct patients to other healthcare
professionals if they will not comply.
Humanbecoming Theory
The humanbecoming theory focuses on providing a meaningful and valued life according
to the individual. This is contradictory to allowing mandatory vaccination, because that would
mean the person gets to determine if being vaccinated will provide that life. However, on top of
this, the person may be free and able to choose, but they are held responsible for the results of
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their own life. Another part of the humanbecoming theory that can be integrated into parents
deciding to vaccinate their children, is true presence. Only through listening and building a
trusting relationship with the patient, will a nurse ever be successful in educating the patient on
vaccines. If there is no trust, the patient will not listen to what the healthcare professional has to
say (Parse, 1999).
Legal/Policy Values
The Bible does not discuss whether people should be required to receive vaccinations, or
whether nurses and doctors should promote them to be mandatory. However, there are many
laws pertaining to the requirements of vaccinations for attending school. Children are required
to receive these vaccines, because the risks are known of them refusing vaccines. All other
children will then be exposed because of their decision. Second, because of the recent outbreak
of Measles, laws have changed. In the state of California, no longer can parents submit religious
or philosophical exemptions from vaccines. This law was implemented, because a disease that
was once almost gone in the United States, came back and spread quickly. Both of these laws
prove that measures need to be taken to promote vaccination, because of the harm it can cause to
the public (“State School,” 2015).
Scholarly Analysis
Universal Vaccination is a controversial subject, so much so that it proves difficult to
align it with the humanbecoming theory. Parse’s theory focuses a lot on the patient, treating
them as a unique individual, and doing what is best for their values and meaning of life. When
considering the decision to make vaccinations mandatory nationwide, there is not much support
from her theory, due to the outcome that decision presents. Patients are forced to oblige and do
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not have the ability to decide for themselves, taking away their patient dignity and what they
want; which was Parse’s whole incentive behind this theory.
Biblically, one verse stands out that could be used in favor of mandatory vaccinations.
Mark 12:31 says, “Love your neighbor as yourself…” (English Standard Version). What this
implies is the Golden Rule of doing unto others, as you would do unto yourself. By refusing
vaccinations, one is exposing their neighbor to disease. If the situation was reversed, and the
person refusing vaccines was the one immunocompromised, they would be wishing everyone
would receive their immunizations also. No one wants to be put on their deathbed, because of a
disease that could have easily been prevented. A part of loving someone means to consider their
best interest, and the Bible’s greatest command is to love one another. Therefore, people should
have respect and act selflessly on behalf of those who cannot act for themselves.
Conclusion
Everyone is given the freedom and right to make their own decisions about healthcare.
But how much good has that brought upon society? Sometimes the effects of choosing our
treatment hardly are noticed and do not effect anyone but the individual themselves. However,
choosing to refuse vaccinations is a decision that has a ripple effect upon all society. People will
get sick, and some people may die. All because a few individuals thought their kids were too
good to receive their immunizations. Consider how every society ultimately has to work
together to create a healthy world. A parent may think they are just one of a few that is refusing
the vaccines and such a small person will not matter in such a big world; but it does. It only took
one person to bring Measles into the United States in 2015 and hundreds of people’s lives were
affected by it. That one individual, refusing one vaccine, could be the next one exposed to an
illness and sicken thousands of people; and how terrible that would be to know you are the cause.
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