Misgivings Regarding Vaccination Among the People - Article Example

Penalizing Parents who fail to vaccinate their Children [Name of the Student] [Name of the University] ABSTRACT This work claims that it is not ethically acceptable to penalize or incarcerate parents if they are unwilling to vaccinate their children. Reasons for this claim have been examined and conclusions arrived at. The following discussion proves this contention. The main body of this work will be along the following lines. An analysis will be provided regarding the right of the public to health care. Issues, such as herd immunity, harm caused to third parties, moral legitimacy in public health interventions, individual autonomy and public health. Subsequently, the following assertions have been made in support of the contention that it is morally unacceptable to penalise parents for not vaccinating their children. The issues taken up in detail are the following. Mercury and other toxic substances, in vaccinations, cause harm to the inoculated; the public has lost confidence in vaccination; the absence of evidence based decision making, with respect to interventions has produced several harmful results; intervention exemptions should be taken in to consideration, before forcibly vaccinating individuals; and many people desire exemption from vaccination on medical and non-medical grounds The conclusion to this work establishes that immunisation without proper assessment of the outcomes and necessity, proves to be harmful to the public. This work proves the contention that it is morally unacceptable to penalise or imprison parents for not vaccinating their children. This work suggests that evidence based decision making is the best solution for immunizing children through vaccination. TABLE OF CONTENTS ABSTRACT 2 Penalizing Parents who fail to vaccinate their Children 5 Introduction 5 Ethics and Preventive Interventions 6 Right to Health Care 7 Herd Immunity 8 Harm caused to Third Parties 9 Individual Autonomy and Public Health 10 Public Health Intervention’s Moral Legitimacy 12 Individual Wellbeing as opposed to the Public Good 13 Presence of Mercury and other Harmful Substances in Vaccines 14 Loss of Public Confidence in Vaccines 15 Evidence Based Decision Making 15 Exemptions from Interventions 17 Conclusion 18 List of References 20 Penalizing Parents who fail to vaccinate their Children Introduction It would be ethically unacceptable to penalize or imprison parents for not vaccinating their children. The following discussion proves this contention. The advantages and disadvantages of vaccination have been hotly debated from centuries. In the initial stages of vaccination against the variola virus, some of the inoculated persons had developed the disease with fatal outcomes. In the contemporary period, parents tend to nurture misgivings regarding the benefits provided by vaccination (Morin, 2008). For example, Washington DC had made it mandatory for parents to have their children inoculated with the MMR Vaccine. Failure to comply with this direction would render the recalcitrant parent liable to pay a fine or to be incarcerated. On account of this stringent provision, a majority of the children had been vaccinated with this vaccine. This vaccine was employed to prevent the onset of rubella, mumps and measles (BBC NEWS, 2002). However, evidence based decision making can provide effective guidance to vaccine policy makers, only in the presence of an ethical foundation that takes into account all the pertinent values. It should also consider vaccination recommendations from the perspective of societal norms and individual apprehensions (Vaccine Weekly, 2012, p. 31). Ethics and Preventive Interventions The development and employment of vaccines tend to be directed at the various populations or subsidiary groups in a population. This generates difficulties associated with equity. Moreover, the alternative preventive interventions that are applied to the same population could have differentiated influences upon the subsidiary groups of that population. Some of these groups are, males, females, and racial or ethnic groups. Even in such instances, equity issues can arise (Dawson, Verweij, & Verweij, 2007, p. 126). It has been deemed important to concentrate upon the influence of individuals in encouraging public health. The question that naturally arises in this context is to what extent are individuals morally obliged to contribute towards the public good or the community. The importance of this query is strikingly evident with respect to policies relating to smoking and infectious diseases. Certain groups, such as health care personnel can be regarded as possessing a special obligation towards the health of the public (Dawson, Verweij, & Verweij, 2007, p. 127). However, if it were to be conceded in isolation that people had to avert causing harm to others, this could impose extremely arduous requirements upon the people. Thus, individuals could be placed under an obligation to undergo vaccination, in order to prevent harm to others (Dawson, Verweij, & Verweij, 2007, p. 127). Right to Health Care The development of public health, as a discipline, has been influenced to a major extent by the right to health care. This right enjoys a legal definition at the international and national levels. This right endeavors to ensure that every citizen possesses the right to actively participate in society. The ramifications of the right to health care are several, and these range from having in place a social framework that promotes and preserves healthy living to ensuring individual access to health care (Hirschberg, Littmann, & Strech, 2013, p. 8). An adaptation of Kant’s conception of ethics leads to the following observations. The principal problem of public health ethics pertains to populations and individuals. It has been observed that ethical concerns regarding public health frequently come to the fore due to the implementation of policies and initiatives. These initiatives and policies are aimed at improving or maintaining the health of some specific target population (Holland, 2007, p. 23). However, this objective is realized at the expense of a few of its individuals. From the perspective of Kantianism, these individuals are utilized as a means to an end and not as ends by themselves. Such interventions tend to incorporate the moral danger of having the least regard towards the fate of individuals, on account of the intention to attain some specific goal. Upon recognizing and taking suitable corrective steps, the danger inherent in adopting such a naïve utilitarian approach can be significantly rectified (Holland, 2007, p. 23). The population has been encountering health threats and the concerned authorities have been seized with formulating appropriate policies to address these threats. One of these relates to the development of new vaccines to contain or destroy the new varieties of infectious diseases. A major concern that such policies have to necessarily address is the employment of mandatory inoculation. This could have serious and far ranging implications with respect to the protection of individual human rights, which have been enumerated in the Universal Declaration of Human Rights and the other human rights treaties (Peckham & Hann, 2010, p. 172). Herd Immunity The likelihood of a vaccine achieving herd immunity or eradication of a disease is significant. When a vaccination program can render an entire community free of some disease, then there is every reason for its widespread implementation. In such cases, personal autonomy will in all probability be ignored, as the benefit of the majority will be at stake. This has been illustrated in Nigeria. In this country, poliomyelitis tends to be endemic. The government officials of Nigeria threatened the populace with the imposition of fines or jail terms, if they refused to undergo vaccination (Field & Caplan , 2012, p. 1012). In addition, some diseases are such that they are more prevalent among the sections of the population that enjoy a lower socioeconomic status. Justice demands that health benefits should percolate to these lower rungs of society. Likewise, some diseases afflict the very young, very old or the frail to a disproportionately greater extent (Field & Caplan , 2012, p. 1012). Medicine and scientific research have been seized with determining the manner in which organisms fight infection. Such interest has been present from centuries and constitutes a perennial object of trial and error in the war against disease. The success of vaccination depends upon exposing vulnerable individuals to pathogen constituents that do not produce excessive pathology. (Babayan & Schneider, 2012, p. 1). Moreover, successful vaccination should induce specific immune memory in the vaccinated person. The functioning of immunity at the group level, can be deciphered by resorting to mass vaccination. Increasing population density enhances the risk of transmission of disease between individuals. However, after immunity is achieved by a critical proportion of the populace, herd immunity comes to the fore. In the context of social species, the members who are not immune to a particular disease, can be safeguarded from it by an amalgamation of behavioral control of infection and the assemblage of immune individuals (Babayan & Schneider, 2012, p. 1). In combination with other research findings, this research demonstrates the evolution of variegated mechanisms that undertake common functions. Some of these functions are; transference of immunity between associated individuals, discrimination between pathogens and the advantages of immunization at the group level (Babayan & Schneider, 2012, p. 1). Harm caused to Third Parties Children, who have not been vaccinated can infect to other children. Art Caplan, a bioethicist, has vehemently declared that parents who fail to have their children vaccinated, should be rendered liable, if some other child is infected by their unvaccinated child. Furthermore, he states that public health personnel have acquired the technological expertise to precisely locate the source of an infection. This would make it possible to identify the child that infects the other children (Young & Hobson, 2013). The objectives achieved by making an unvaccinated person or that person’s legal guardians liable for infecting others are enumerated in the sequel. The first benefit provided is that the affected family is provided with a measure of justice. The other benefit is that the threat of being subjected to a lawsuit would induce people to undergo vaccination. The issue involved is that of striking a balance between responsibility to the community and individual choice (Young & Hobson, 2013). Individual Autonomy and Public Health Public health initiatives have been seen to affect the individual autonomy of the people. Governmental measures adopted for the express purpose of controlling infection, invariably have an impact upon the autonomy of individuals and population groups. These measures have been vindicated by the benefit that they bestow upon public health. Therefore, infection control ethics highlight justice pertaining to the common good and community values. On the other hand, clinical ethics emphasizes the importance of patient autonomy (Briem, 2011, p. 13). The autonomy of individuals includes, obtaining control upon their private affairs, exercise of choice, and continuing under the institutional and social covenants that promote independent lives. It is the usual practice to assume that features, such as, immunization, automobile safety and dietary dangers of disease are to be determined by individual freedom rather than the competing objectives of public health (Powers, Faden , & Saghai, 2012, p. 6). Public health ethics differ dramatically from clinical medical ethics, as they involve moral association between the individual and the state, thereby relegating it to the realm of political philosophy. In this perspective, it is generally perceived that state coercion constitutes a moral threat to personal independence (Powers, Faden , & Saghai, 2012, p. 6). One of the major issues of public health ethics relates to discerning the appropriate correlation between the liberty of individuals and the healthcare system of their country. From the perspective of public health it could be beneficial to implement inflexible vaccination programs, provide fluoride in drinking water or to prevent school children from imbibing liquids with high sugar contents. Such policies have frequently been opposed vehemently (Harald, 2013, p. 63). One of the cardinal reasons for such opposition is the conviction that such public health measures breach the right of the people to freely select what they regard as being best suited to their individual pursuit of a good life. Such opposition tends to be quite strong, when the proposed intervention could result in a health hazard that individuals regard as being incommensurate to the risks involved in not participating in that intervention (Harald, 2013, p. 63). Public Health Intervention’s Moral Legitimacy Compliance with the conditions detailed hereunder are essential for rendering public health interventions morally legitimate. The satisfaction, and the extent thereof, of the following conditions determines any public health intervention’s moral legitimacy. First, established effectiveness, which requires the presence of adequate empirical evidence on the effectiveness of the public health intervention. This condition necessitates an unambiguous definition of the objectives of the intervention. It also demands an evaluation regarding the extent of the achievement of these goals. Moreover, it is essential to demonstrate that the morbidity and mortality of the target population have been diminished, consequent to the attaining of the public health intervention’s goals (Marckmann, van Delden, Sanktjohanser, & Wicker, 2013, p. 211). Secondly, there has to be a favorable benefit to harm ratio. In other words, the health risks and burden imposed upon the individual participant in a public health intervention has to be much less than the health benefits to be derived by the target population. Thirdly, the efficiency or cost to benefit ratio has to be acceptable. The limited nature of public resources, and the correlation between the expenditure to be incurred and the attainable health benefits should be satisfactory (Marckmann, van Delden, Sanktjohanser, & Wicker, 2013, p. 211). Fourthly, the public health intervention has to admit of the least amount of restrictiveness. Consequently, the achievement of a public health intervention should involve the least restrictive means. Prior to legally enforcing participation in public health interventions, the target population has to be provided with incentives, in order to obtain an adequate participation rate. Mandatory programs are justified, only when the voluntary measures prove unsuccessful (Marckmann, van Delden, Sanktjohanser, & Wicker, 2013, p. 211). Fifthly, the decision making process has to be fair and transparent. The cost to benefit ratio has to be acceptable and the benefit to harm ratio has to weigh in favor of benefit. These conditions necessitate assessment and the balancing of risks, costs, burdens and benefits. This exercise does not possess an objective norm that can be derived from a ubiquitously accepted moral theory (Marckmann, van Delden, Sanktjohanser, & Wicker, 2013, p. 211). This also holds good with respect to the morally acceptable extent to which individual autonomy can be influenced. A major ethical challenge comes to the fore, when the risks and burdens of an intervention do not affect the individuals who are to derive the maximum benefit from it (Marckmann, van Delden, Sanktjohanser, & Wicker, 2013, p. 211). Public health can be described as the collective action of society to ensure the conditions that render individuals healthy. Individual Wellbeing as opposed to the Public Good On occasion, public good may affect the wellbeing of individuals. Decision in the realm of public health frequently have to discriminate between the various spheres of interest. Some instances of these are; professionals, societies or individuals. In the incipient stages, these distinctions can have an abstract nature. However, during the process of policy making; such as, in the context of vaccination programs, quarantine, or prohibitions on public smoking, it becomes indispensable to introduce greater specificity into terms, such as public and individual interests (Hirschberg, Littmann, & Strech, 2013, p. 7). Presence of Mercury and other Harmful Substances in Vaccines The presence of harmful substances, such as mercury in vaccines can prove to be harmful to the inoculated. For instance, it has been established that the presence of mercury in vaccines can increase autism. The present day children are required to undergo around 25 doses of vaccine. Although, the quantity of mercury has been dramatically decreased, Aluminum and other substances tend to be present in vaccines, and this has proved to be a cause for concern (Morin, 2008). The Executive Director of the Association of American Physicians and Surgeons, Jane Orient, has expressed the opinion that physicians and parents are embroiled in a difficult situation. This association is not in favor of compulsory vaccination. It contends that children are being exposed to the possibility of severe long term effects or death, on account of the obligatory vaccines (Morin, 2008). Several of these vaccines tend to be unnecessary or provide a modicum of benefit. Her group has announced a resolution that calls for the termination of compulsory vaccination. Moreover, a physician who is required to enforce vaccine mandates will be unable to assess parental concerns regarding the appropriateness of vaccination for their child. Loss of Public Confidence in Vaccines Due to a number of reasons, people have lost confidence in the vaccination policies. When vaccination was first introduced, it had been hailed as a savior and benefactor nonpareil. What commenced as a ground breaking public health intervention gradually lost its preeminence, and has now come to be regarded with distrust. This crisis of confidence can be attributed to the overenthusiastic governmental policies to vaccinate indiscriminately. People, in the present day, tend to question the necessity of vaccination, without regard for any actual necessity (Larson, Cooper, Eskola, Katz, & Ratzan, 2011, p. 526). Policies pertaining to vaccination are the outcome of a number of considerations. In fact, a combination of political, sociological, cultural and psychological concerns shapes the character of these policies. It is now well recognized that the trust reposed by the public in vaccines tends to be flexible to a considerable extent. Creating trust, in this context, involves comprehension regarding the perceptions of vaccines and the risk that they incorporate historical experiences, religious or political affiliations, and socioeconomic status (Larson, Cooper, Eskola, Katz, & Ratzan, 2011, p. 526). Accurate scientific evidence regarding the risks and benefits associated with vaccines has to be made available. Evidence Based Decision Making Vaccination programs have to be evaluated on the basis of the related evidence. Evidence based decision making analyses, with respect to vaccines, should have an ethical basis that derives from a systematic process. The pertinent features should be cataloged, as a first step of this process. In addition to measure of health outcomes, this catalog should include apply features of vaccination programs that implement the principles of beneficence, justice and autonomy (Field & Caplan , 2012, p. 1012). Moreover, the likelihood of adverse effects with respect to the severity of the target disease tends to have a major impact, while balancing responsibility towards the community to undergo vaccination against the right to autonomy of decision that is founded upon one’s self interest (Field & Caplan , 2012, p. 1012). For example, during a measles outbreak in the Neath and Swansea area of the UK. Around 39 cases of measles were reported. The Public Health Wales made a strident call for adopting aggressive control measures to contain this outbreak. Some of the measures envisaged were to inoculate a greater number of children and to invoke the public law to prevent infected children from attending school and thereby infecting their class mates (BBC NEWS South West Wales, 2013). A study conducted in Philadelphia, Pennsylvania states that evidence based decision making facilitates the evaluation of the worth of medical interventions. It achieves this commendable objective by balancing costs and health outcomes. This tool has been applied to vaccines with increasing frequency. All the same, several of the ethical consideration that favor evidence based decision making, on being employed in the evaluation of therapeutic care, do not recommend prevention (Vaccine Weekly, 2012, p. 31). Consequences of this disparity are policy decisions that lead to unexpected negative outcomes, such as public resistance to a vaccination program. Several ethical concerns come to the fore, which are unique to vaccines. A vaccine program necessarily has to depend upon widespread compliance, if it is to be effective. This can restrict individual autonomy, attach greater importance to population effects compared to individual effects, challenge strong social standards and necessitate an equitable process of allocation in populations (Vaccine Weekly, 2012, p. 31). The proclivity to forcibly inoculate the populace, is not restricted to the US. For instance, India has been making all possible endeavors to vaccinate its residents mandatorily. The erstwhile thinking that only the susceptible populations were to be vaccinated has been supplanted by the policy of inoculating universally. The objective is to benefit the billion dollar private vaccine industry of the nation. The welfare of the people is of no concern for the highly corrupt government that rules in India (Madhavi, 2013, p. 263). Exemptions from Interventions People may be exempted from health care interventions, on the basis of medical or non – medical reasons. The public health officials of the US have been provided with substantial freedom, by the US Supreme Court, in their endeavors to safeguard the health of the community. All the same, a number of human rights organizations and distinguished scholars have cited ethical norms and suggested to the health authorities that they should employ the least possible force, whilst achieving health objectives. In this context, it was suggested that voluntary programs with high levels of immunization achievement were to be promoted and implemented (Peckham & Hann, 2010, p. 174). It cannot be gainsaid that the majority of the general public supports vaccination programs. Nevertheless, some individuals tend to seek exemption from such interventions. These exemptions are sought on the basis of medical, as well as non – medical reasons. It is essential for any public health program assessment to comprehend the motives behind seeking such exemptions. Some of these relate to mistaken beliefs regarding vaccination. In addition, individuals and parents tend to refuse vaccination on medical, philosophical, personal, religious or conscientious grounds (Peckham & Hann, 2010, p. 174). Vaccination programs routinely encounter several social hurdles. Some of the members of the target population refuse to participate on religious or other grounds. At the same time there are individuals who do not participate, due to the social barriers that prevent them from engaging in such programs. Instead of addressing these individual concerns and reassuring the non – participants, the public health authorities have adamantly preferred to engage in mandatory vaccination programs (Peckham & Hann, 2010, p. 183). Conclusion According to the above discussion, it is ethically unacceptable to penalize or imprison parents for refusing to have their children vaccinated. This is because people may refuse to vaccinate their children for various reasons. Moreover, immunization may, in some instances, prove to be more hazardous than the risks resulting from non – participation in the health programs. The presence of mercury and other toxic substance, in some vaccines, could prove to be harmful to children. In addition, public health policies may intrude upon the autonomy of individuals. This has been strongly opposed by the human rights organizations. Furthermore, individuals and parents may refuse vaccination on medical, philosophical, personal, religious or conscientious grounds. A successful implementation of the policies related to immunization demands that first, the vaccine’s effectiveness has to be proved. Secondly, there should be evidence of the benefits being greater than the harm caused. Thirdly, the benefits provided by the vaccination program should outweigh the cost involved. Fourthly, the individual should be inconvenienced to the least possible extent, on account of the intervention. Lastly, the decision making process relating to immunization should be impartial and obvious. As such, without adopting the necessary measures, to dispel misgivings regarding vaccination among the people, it would be incorrect to penalize or imprison parents for failure to vaccinate their children. Thus, it can be surmised that it would be ethically unacceptable to penalize parents for not vaccinating their children. List of References Babayan, S. A., & Schneider, D. S. (2012). Immunity in Society: Diverse Solutions to Common Problems. PLoS Biology, 10(4), 1 – 3. BBC NEWS. (2002, February 14). Jail threat for MMR refusniks. Retrieved January 19, 2014, from http://news.bbc.co.uk/2/hi/health/1820928.stm BBC NEWS South West Wales. (2013, November 13). Measles outbreak: 39 reported cases in Neath Swansea outbreak. Retrieved January 19, 2014, from http://www.bbc.co.uk/news/uk-wales-south-west-wales-24928221 Briem, H. (2011). The Ethics of Infection Control. In S. 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(2012). Liberty, Mill and the Framework of Public Health Ethics. Public Health Ethics, 5(1), 6 – 15. Universal Declaration of Human Rights . (1948). Paris, France: United Nations General Assembly. Vaccine Weekly. (2012, April 4). Investigators at Drexel University Release New Data on Vaccines. p. 1. Young, R., & Hobson, J. (2013, May 28). Should Parents Be Liable If Unvaccinated Children Sicken Others? Retrieved January 19, 2014, from http://hereandnow.wbur.org/2013/05/28/liable-unvaccinated-child Read More