Last class Chris raised the ethical concern regarding vaccinations
and how obligation is totally non-acceptable. Although I, personally, totally
agree with that, I believe that the debate in this issue will remain for a long
time. During my study as a dental student, I learned about the code of ethics
for a dentist which is based on five main principles which are: patient
autonomy, non-maleficence, beneficence, justice and veracity. However; when I
was studying for my boards a couple of months ago, I realized that a new
concept was added which is: avoid paternalism (do not act as if you are the
parent of the patient and take his own decision). Although, I thought that this
concept is a further explanation of the concept of autonomy, I believe that such
an addition spots a light on the essentiality of the freedom of choice. Your
role, as a dentist, is to provide all information, then let the patient take
his own decision. Do not go for paternalism, otherwise this will be some sort
of epistemic violence.
Actually, I argue for vaccination in a similar way. We, as
public health professionals, should have the proper communications with the
public to target their concerns regarding vaccination. We should work hard to
provide all information in a way that they can understand well. If we fail, we
should be brave enough to return to ourselves and look for the cause not just
blame the people behaviors, cultures or levels of intelligence. We should apply
this reflectivity in order to identify the problem, know how to deal with it and
avoid epistemic violence. However; regarding vaccinations, there is usually an
argument about the validity of being a complete personal choice especially
during times of outbreak or for health care workers. During periods of outbreak,
herd immunity is broken and there is a national or even a global threat. Should
vaccines still be a respectful personal choice or we should move to protect the
whole population? In the same context, health care workers are considered as
reservoirs for infectious diseases. They act like a vehicle transmitting
diseases among patients and even to people outside the medical field. That is
why; if they are not taking care of their own health by deciding not to take
vaccines (personal choice), they must care about others’ health. I read before
that Johns Hopkins has an obligatory policy with their health care workers
regarding taking the flu vaccine in order to protect patients and the whole
community. Such a policy maybe ethically offensive to some but totally acceptable
for others. Explicitly, the personal choice should be always respectful.
However; vaccination debate will continue in some situations in which the clear
vision of whether it is a complete personal choice or it is more about the community
right to survive and keep healthy is still hazy.
Salma,
ReplyDeleteI worked at Hopkins when this policy was first initiated. I worked indirectly with patients but was still required to take the vaccination. Although I knew that it was for the protection of patients, I felt that my employer had taken away my autonomy as a person. We don't vaccinate family members and individuals who come to the hospital to visit loved one, it's not a requirement for safety of other patients and workers. Vaccination as a policy for protection is good, however vaccination as a forced means of protecting the population is ethically wrong. If people feel that they do not have autonomy or choice then they are not quick to change behavior and would make the situation worst. Anytime a person feels forced or coerced into doing something that they do not want to do, they rebel in micro and macro ways. I have a problem with the idea of the flu vaccine, because it is not definitive, as the vaccine is a combination of the flu virus from the last 4-5 years. This does not guarantee that I won't get sick, it just says that if the virus is like others that have come before before it and not a different strain that I will have immunity. This fact alone gives me pause because I want a guarantee in a vaccine. I understand that everything is not 100%, however I don't want to feel forced to participate in the unlikely event that I may or may not get sick. My body and what I put or do not put in it should be my right to do. I feel that we are not participating in preventative medicine but treatment medicine. Some ways to help workers would be to provide sick days without stigma and penalty, so that workers do not fear for their jobs in taking time to rest and recuperate. Our bodies were made to fight off certain things, but we don't give our bodies the chance to do that because of lack of time and scheduling conflicts. We over medicate then blame the medication. Our lifestyles may give us pause to stop and think and regroup, and decide our next course of action not only for our own well being but for the survival of the population.