The Vaccination Dilemma
The rights of individuals to refuse vaccinations, and the rights of parents to refuse their children vaccinations, has been increasingly called into question because of the way individual autonomy conflicts directly with the rights of the general public. For example, outbreaks of vaccine-preventable illnesses have increased, with serious outbreaks of measles in the United States being a prime example. Although the United States Centers for Disease Control and Prevention declared the elimination of measles in 2000 due to effective vaccine penetration, in 2014 a spike in measles cases raised the possibility of a “public health crisis” that also “reignited a historic controversy” in medical ethics (Gostin, 2015, p. 1099). Essentially, unvaccinated persons spread diseases that are preventable, as well as possibly deadly. The rights of one person to refuse a vaccination in the interests of patient autonomy might not outweigh the right of every other citizen to a disease-free environment. Yet the medical community generally remains committed to the promotion and preservation of patient autonomy, personal choice, and the right to self-determination. Therefore, the primary dilemma regarding vaccines is the conflict between parent or individual rights, and between the rights of the community.

Rights-Based Ethics

A rights-based ethical theory is the one best suited for addressing the complexities of the vaccination debate. On the one hand, patient autonomy is embedded firmly in the American medical tradition, as well as in medical practice in similar countries with strong support for individual rights and freedoms (Leask & Danchin, 2017). Compelling persons to do anything to their body without their express consent amounts to an infringement on rights, freedoms, and personal privacy (Gostin, 2015). Furthermore, healthcare workers have grappled with the rights of individuals to refuse medical treatments, interventions, or vaccines on religious grounds. Some parents have also expressed concern that vaccinations will have adverse effects on their children, and claim the right to refuse vaccinations on those grounds (Gostin, 2015). The rights-based ethical theory allows for a full treatment of each of these unique approaches to the individual rights of patients, or for those who speak on behalf of patients, such as parents and guardians.

Another reason why the vaccine controversy is best viewed from a rights-based perspective is that it highlights the rights of the community. While it is easy to imagine the rights of a person to refuse cancer treatment on personal grounds, their refusal for treatment does not impact the rights of their friends and neighbors. On the other hand, vaccinations can and often do impact other people because an unvaccinated individual can spread disease. “It does not take many unvaccinated individuals to approach the tipping point at which vaccine coverage levels are too low and are thus ineffective in preventing disease spread,” which is known as herd immunity (Hendrix, Sturm, Zimet, et al., 2016, p. 274). A rights-based perspective shows why the issue of vaccinations is controversial, by pinpointing the exact nature of the conflict. Essentially, a rights-based society promotes both individual and collective rights. A person has the right to act, but only insofar as it does not harm others—which amounts...…resolution to evolve. Hendrix, Sturm, Zimet, et al. (2016) advocate improving communication with patients and adopting a “non-adversarial” approach,” (p. 276). Yet the non-adversarial approach should still come with some strings attached for those who would choose to opt out of a life-saving vaccination. Persons who are not vaccinated are in fact potentially dangerous members of the community. Without unnecessary alarmism, nurses know that they need to tell schools which students have not been vaccinated, or to have some way of keeping track of the problem.

Conclusion

A rights-based ethical theory reveals multiple points of view in the vaccination debate, which is not a clear cut problem. All patients have the right to self-determination. Children are often bereft of the right to self-determination because their parents are legally in charge of their medical decisions. Nurses need to consider the vaccination debate from a rights-based perspective, keeping in mind the needs of their communities as well as the needs of their individual patients.

Healthcare workers also face additional ethical dilemmas with regard to vaccinations because of factors like cost. Vaccination-preventable diseases like measles costly and resource draining. Nurses have an obligation to do whatever it is in their power to reduce the prevalence of preventable diseases, including those that are preventable via vaccinations. Not only is treatment of preventable diseases a drain to limited healthcare resources; it can also be a drain on public health and epidemiology research resources. Finally, preventable diseases do kill. People who refuse vaccinations should remain aware that their decision could actually harm another human being.

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