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

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

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
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

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

Laws

Laws
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
According to American Academy of Pediatrics (2011), health survey:
Common concerns:
Number & timing of vaccines
Potential adverse effects or reactions (both short-term & long-term)
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
Patient Solution/Alternative:
Homeschool vs. Public school
Exempt due to religious beliefs
National Vaccine Injury Compensation Program (VICP)

Solutions
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
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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/
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