Introduction
Vaccination is associated with one of the most dramatic ethic controversies in the field of medicine when it comes to possible side effects and complications. The development and introduction of new vaccines throughout the 1960’s and 1970’s was a turning point in public health as it helped significantly reduce serious healthcare burden, largely dropping the infection incidence rate (Betáková et al. 92). Frequently, the injection of vaccines can lead to the occurrence of some mild side effects such as fever, rash, swelling, etc.
It is possibly worthwhile undertaking the risk of having those side effects when compared to possible severe flu- or measles-related complications including blindness, encephalitis, and so on. However, some researchers and parents express the concern that thimerosal used in several vaccines as a preservative can trigger the development of autism in vaccinated children (Colaizzo 1). However, this compound is still used in the production of some vaccines, e.g., flu vaccine, because researchers could not find a direct link between the exposure to it and the onset of autism in children. Thus, global and national organizations including the Academy of Pediatrics recommend using vaccines containing thiomersal because the benefits related to the procedure significantly outweigh any hypothetical safety risks.
Utilitarianism: overview
Due to the multidimensionality of the matter, there is no single answer to it, and it can be interpreted from different ethical points of view. From the utilitarian perspective, an action or decision may be considered ethical if it leads to the attainment of the greatest possible benefit. In utilitarianism, virtue does not depend on the conformity with morals and standards of behavior but rather on consequences. Moreover, according to Mill’s basic principle of utility, an action can be considered ethical when it contributes to the happiness of every party (or the public) involved in a situation, and unethical – when it interferes with the creation of happiness. Overall, such a consequentialist approach in decision making can “lead to harm to some individuals while the net outcome is a maximum benefit” (Mandal et al. 6).
The utilitarian solution to vaccination
When thinking about the thiomersal controversy in terms of epidemiology, utilitarianism seems to justify the administration of vaccines because the chances of vaccine-related complications in individual cases are significantly low compared to the chances of new epidemic development in non-vaccinated communities. For example, influenza can cause a few million cases of severe illness and lead to mortality in half a million cases per year globally, while flu immunization may provide nearly 80% degree of protection against the virus and its complications. At the same time, Colaizzo claims that the decades of research provide no evidence to verify the link between vaccination and autism development in children and states that the cases of any adverse effects in children remain relatively low (1). In this situation, healthcare institutions and practitioners will have the final say in decision making regarding immunization and will decide in its favor because it helps support public health. At the same time, parents will not be able to influence this decision substantially as the refusal to vaccinate their children may pose a threat to the community as a whole.
Paternalism
The utilitarian ethical stance raises the issue of paternalism when taking into account the situation in which a greater power to decide in favor of or against vaccination is given to the healthcare institution. Traditionally, paternalism is defined as “interference with a person’s liberty of action justified by reason referring exclusively to the welfare… of the person being coerced” (Buchanan 15). It means that authority figures may reduce patients’ autonomy when their behaviors or decisions are potentially harmful. The main purpose of paternalism is thus the prevention of mortality and morbidity either in individuals or in society as a whole. However, one should consider two of the primary criteria for the justification of paternalist attitudes, namely, the necessity, and the least infringement (Buchanan 16). The mentioned above evidence on risks for the harmful effects of vaccines and their avoidance implies that healthcare institutions’ insistence on immunization may be consistent with these when individual and collective benefits are compared. Nevertheless, from a patient and caregivers’ point of view, the paternalist attitude of healthcare organizations contradicts the ethical principle of utility because the procedure does not imply equal chances for living a happy life for all involved parties and provokes a risk of harm to children.
Mill’s principle of utility
When applying a utilitarian perspective to a situation when doctors promote vaccines and pharmaceutical companies share common financial interests and insist on immunization neglecting, vaccination cannot be regarded as ethically justified action as well because the practice of advertising in healthcare as such contradicts Mill’s principle of utility. In this case, an apparent conflict of interests between the industry and parents occurs, and parents may refuse to vaccinate children as having a financial stake in a pharmaceutical organization may contribute to doctors’ engagement in non-rational prescribing behaviors, which compromises their ethical obligation to benefit patients. Considering unbiased clinical decision making as one of the major rules in medical practice aimed to promote utility, i.e., maximum benefits for patients (parents) and the public, the promotion of drugs due to commercial influences can be regarded as a rule-breaking behavior that may entail multiple adverse effects at the individual, community, and healthcare levels. In this situation parents’ refusal of immunization is reasonable.
Deontological perspective
“In contrast to the utilitarian concept, deontology is ethics of duty where the morality of an action depends on the nature of the action, i.e., the harm is unacceptable irrespective of its consequences” (Mandal et al. 6). Therefore, the decisions made in the deontological context will instead benefit individuals and may not necessarily induce positive outcomes to the public. Public healthcare institutions are generally utilitarian ideologists because they try to achieve good for the greatest number of people, yet some members of the medical staff may be deontological ideologists and deviate from generalized utilitarian rules in some cases when potential harm to individuals due to intervention may arise. Thus, it is possible to say that parents have more power to contribute to decision making in deontological ideology than in the utilitarian one because if a doctor neglects the individual needs and interests of a patient, he or she goes against the professional duty and the principle of nonmaleficence.
Virtue ethics
The major idea in virtue ethics is somewhat similar to the one suggested from a utilitarian perspective. According to Aristotle, all human actions have the sole purpose of achieving happiness, and the behavior may thus be considered virtuous only in case one aims to attain this highest goal. At the same time, every individual has a personal understanding of happiness – it is a subjective notion. Virtue can be practiced only through activities, which reflect individual interests and preferences. Thus, ethical virtue can be regarded as a product of practical activity aimed at the individual’s happiness. It is worth noticing that in healthcare, each decision regarding interventions “results from the virtuous moral character of the doctor” (Kotzee et al. 1).
It means that emotional and motivational factors, as well as judgment abilities of a practitioner, can largely affect his or her decisions about immunization. If a doctor is motivated to promote public health, he/she will likely insist on the regular administration of vaccines. At the same time, when a practitioner is oriented towards benefiting each patient, he/she will aim to evaluate potential risks and advantages of every intervention. Therefore, in the context of virtue ethics, caregivers obtain a greater power to influence decision making regarding vaccination than in the utilitarian context. However, they can achieve different outcomes depending on the personal characteristics and values of doctors.
Conclusion
Vaccination is still considered the most effective and cost-efficient way to increase public health. Therefore, the use of vaccines tends to grow worldwide regardless of possible risks to patients’ health. Utilitarianism and the concept of utility were implemented to analyze the thiomersal issue from the epidemiologic perspective, as well as problems related to the promotion of vaccines by practitioners, and institutional paternalism. It was revealed that utilitarian ideologists will insist on immunization to generate collective benefits, while different ethical evaluation outcomes can be achieved when using utilitarianism to analyze vaccine promotion by organizations. Overall, to understand if immunization is ethically justified one should evaluate the thiomersal controversy from the perspectives of all involved parties and in distinct contexts, and even in this case, it is unlikely to formulate an unambiguous, straightforward answer to this issue.
Annotated Bibliography
Betáková, Tatiana et al. “Overview of Measles and Mumps Vaccine: Origin, Present, and Future of Vaccine Production.” Acta Virologica, vol. 57, no. 2, 2013, pp. 91−96.
In their study, Betáková et al. provide a comprehensive overview of vaccines against measles and mumps, highly contagious and “common viral childhood diseases that can cause serious complications” (91). They describe pathophysiological and clinical information about the viruses, as well as statistical data on their incidence and prevalence both before the invention of vaccines and after. According to the researchers, the increase in global vaccination coverage was the only reason for the reduction in measles and mumps mortality in recent years. Considering that influenza virus can be deadly to young children and infants, and the evidence from the study could be easily be applied to it as well, the given research provided an opinion in favor of immunization. The data largely supported the utilitarian perspective on the ethical dilemma.
Buchanan, David R. “Autonomy, Paternalism, and Justice: Ethical Priorities in Public Health.” American Journal of Public Health, vol. 98, no. 1, 2008, pp. 15–21.
The scholarly article is devoted to the investigation of ethical issues associated with paternalism in healthcare. Buchanan attempts to explore the justifications for paternalism exercised for the good of patients who may harm themselves in one way or another. However, he concludes that paternalistic attitudes have more limitations than positive effects because the evidence reveals that usually “people with the least amount of autonomy—the least amount of control over their work conditions or other major life circumstances—have the poorest health” (Buchanan 17). Paternalism is mainly associated with utilitarianism since it uses ends to justify means. The information retrieved from the sources was used primarily to explore the essence of paternalism and identify the primary relevant controversies concerning parental opinions and consent.
Colaizzo, Gina R. “Misinformed Parents, Unvaccinated Children and the Fabricated Vaccine-Autism Scare.” Paediatrics and Health, vol. 4, no. 1, 2016, p. 1
The short study is a historical overview of thiomersal controversy. Colaizzo states that it started with the publication of research evidence on the links between MMR vaccines and the onset of autism in small children in 1978. The study is now considered poorly designed and invalid yet it caused a significant turmoil in public and led to a reduction in vaccination rates. Colaizzo claims that the information about the links between autism and vaccination is rather misleading because high-quality research did not prove the initial assumption about it. Therefore, she considers that parental fears, adverse believes, and resistance to immunization efforts pose a significant threat to the public health by increasing the risk of infections. The given opinion supports the utilitarian perspective in the present paper.
Kotzee, Ben, Agnieszka Ignatowicz, and Hywel Thomas. “Virtue in Medical Practice: an Exploratory Study.” HEC Forum, vol. 29, no. 1, 2017, pp. 1–19.
The qualitative study is devoted to the investigation of medical virtue ethics and the identification of qualities, which a practitioner should have to resolve ethical issues within the given ethical framework. Kotzee et al. state that ethical practice in healthcare is merely a result of a virtuous character of a practitioner. The researchers also consider that virtue ethics is the only realistic approach to ethical dilemmas in medicine because it is practice-focused and implies an individualized approach. Considering that nurses and physicians more often act in order to protect the interests of their patients rather than the public and health institutions, this assumption seems valid. In this way, virtue ethics may provide an opposite solution to thiomersal controversy, which is explored in the given paper.
Mandal, Jharnaet al. “Utilitarian and Deontological Ethics in Medicine.” Tropical Parasitology, vol. 6, no. 1, 2016, pp. 5–7.
In their study, Mandal et al. investigate two opposing ethical approaches to decision making: deontology and utilitarianism. Mandal et al. reveal that deontology is usually associated with “empathy, religiosity, and perspective-taking” while utilitarianism is rather related to “moral concern and reduction in the cognitive load” (6). For this reason, deontological perspective is more applicable to solving individual and non-standard cases, while utilitarian approach can be effective in resolving general cases. The evidence provided in the research is directly related to the problem of interest and is used to substantiate the explanation of possible judgment outcomes from both utilitarianism and deontologist points of view.