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Ethical Dilemma:

Freedom Vs. Control


through Vaccinations
By
Marvin Berueda, Heddy Cortijo, Analeissa Gutierrez,
Samuel John, Jennifer Mariano, Camille Salvador

Synopsis: to vaccinate or not to vaccinate- that is the


question
A new bill is in the process of being passed in the state of Hawaii which
states that 7th grade students (boys & girls) ages 11-12 are required to
receive at least one dose of the HPV (3-dose series) vaccination upon
attending Hawaii public schools. According to the CDC, HPV is the most common
STI, which can lead to cervical cancer and other diseases. In our dilemma, a
mother whose child attends public school refuses to vaccinate her child, but
insists her child should still be allowed to attend public school without the
vaccination.

Synopsis: to vaccinate or not to vaccinate- that is the


question
Under the ANA code of ethics, a nurse is required to show beneficence (by
supporting vaccination because its benefits on herd immunity) as well as
nonmaleficence (to do no harm by weighing that the benefits of vaccination
outweighs the risks), but because this bill violates the patient's right to
autonomy, the ethical dilemma as a nurse is: Do we continue to persuade
advocation for vaccinations to patients who refuse?

From a patient's view: ana


Autonomy: Personal freedom and the right to make choices.
Provides nursing care based on respect of patients rights
to make decisions about their health care.
Each parent should have the right of choosing what goes into
their childrens bodies.
Vaccinations have dangerous ingredients in it.
A child should not be refused the chance to go to school or
a get healthcare because we choose not to vaccinate.

Vaccine Ingredients

Through the eyes of a nurse: MArvin


American Nurses Association Position on Immunizations:
To protect the health of the public, all individuals should
be immunized against vaccine preventable diseases according
to the best and most current evidence outlined by the CDC
and Prevention and the Advisory Committee on Immunization
Practices.
-All can benefit from becoming immunized
-Nurses have a role in advocating and educating the benefits of immunization
-National Association of School Nurses (NASN) believe that immunizations are
essential for primary prevention of disease.

*ANA states only 2 exemptions:


1. Medical Contraindications
2. Religious Belief

Ethical Principles
1. Beneficence
2. Non-Maleficence
Code of Ethics
Provision 1.4: Patients have the legal right to be given
accurate, complete and understandable information
Provision 8: Nurses assist in educating the public and are
committed to promoting health, welfare, and safety of all
people.

Through the eyes of a nurse: MArvin


Bottom Line:
1. No, vaccines are NOT 100% risk free BUT the impact of
vaccines are evident can be seen in the decrease of cases of
preventable diseases including Diphtheria, Smallpox, and
Polio.
2. Cheaper to prevent a disease than to treat it
3. Vaccines can protect you and others around you including
family and friends (herd immunity)
4. Nurses DO NOT make the decision, but they DO educate

So, WHos in
control

Laws: JenN & Heddy


State vaccination laws include vaccination requirements for children in
public and private schools, and daycare settings as well as
college/university students.
State of Hawaii Laws Regarding School Vaccination Exemptions:
1.
2.
3.
4.

Permitting medical or religious exemptions only.


Allowing exempted students to be excluded from school during
outbreaks.
Establishing that exemptions might not be recognized in the event of
an outbreak.
Distinguishing between temporary and permanent medical exemption in
the exemption application process.

Laws: JenN & Heddy

Laws: JenN & Heddy


The Centers for Disease Control (CDC) estimated that 732,000
American children were saved from death and 322 million
cases of childhood illnesses were prevented between 1994 and
2014 due to vaccination.

Solutions: CAmille & Sam

According to American Academy of Pediatrics (2011), health survey:


Common concerns:

Number & timing of vaccines

Potential adverse effects or reactions (both short-term & longterm)


Vaccine ingredients

Solution: Patient Education.


Nurses can approach parents to recognize individual concerns and
provide them with additional information.

Vaccine Information Statements (www.cdc.gov/vaccines/pubs/vis) required by law


to be provided to each child's legal representative (parent/guardian) before
vacinne administration to any child.

Solutions: CAmille & Sam

Patient Solution/Alternative:
Homeschool vs. Public school
Exempt due to religious beliefs
National Vaccine Injury Compensation Program (VICP)

Solutions: CAmille & Sam

National & Local Immunization Programs


Maintain Vaccine-Friendly environment
5 Practical Areas of Focus

Review/evaluate current vaccination mandates in relevant health


jurisdiction

Increase use of non-compulsory vaccination strategies (e.g. Pt

recall/reminder system; Provider reminder system; *Australia stipends for families w/ fully-vaccinated kids...
Address parent/guardian vaccine safety concerns
Enhance publics awareness of vaccine-preventable disease risks
Promote a better public understanding of herd immunity

References
El-Amin, A. N., Parra, M. T., Kim-Farley, R. & Fielding, J. E. (2012). Ethical issues concerning
vaccination requirements. Public Health Reviews, 34(1). Retrieved from http://www.
publichealthreviews.eu/show/p/104
FAQS About Gardasil. (2015). Retrieved February 8, 2016, from
http://www.gardasil.com/about-gardasil/faqs-about-gardasil/
Human Papillomavirus (HPV), HPV -Related Disease, and the HPV Vaccine. (n.d). Retrieved
February 7, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492590/
Kennedy, A., Basket, M., & Sheedy, K. (2011). Vaccine attitudes, concerns, and information
sources reported by parents of young children: results from the 2009 HealthStyles
survey. Pediatrics, 127(Supplement 1), S92-S99
Post-approval monitoring of HPV vaccine side effects. (2009). Contemporary OB/GYN, 54(10), 18-18
1p.
Should the HPV Vaccine Be Mandatory?. (2007). Nutrition Health Review: The Consumer's Medical
Journal, (98), 19.
Solutions for Forced Vaccinations and Flu Pandemics. (2012). Retrieved February 7, 2016, from
https://www.organicconsumers.org/news/solutions-forced-vaccinations-and-flu-pandemics
State School Immunization Requirements and Vaccine Exemption Laws. (n.d.). Retrieved
January 24, 2016, from http://www.cdc.gov/phlp/docs/school-vaccinations.pdf
State School and Childcare Vaccination Laws. (n.d.). Retrieved January 24, 2016, from
http://www.cdc.gov/phlp/publications/topic/vaccinations.html
Vaccine Information Statements. (2013). Retrieved February 7, 2016, from
http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.pdf
Vaccine Ingredients. CDC. Retrieved February 15, 2016, from
http://www.cdc.gov/vaccines/parents/vaccine-decision/ingredients.html