Vaccines are among the leading achievements of public health that are responsible for the successful eradication of diseases such as smallpox and a notable reduction in other infections such as measles. Vaccines are readily available in the contemporary world with governments, nonprofit and religious organizations aggressively campaigning for vaccination against different diseases. Regardless of the success associated with vaccines, there have been extended and valid debates surrounding their diverse ethical controversies. A primary ethical discussion related to vaccine regards informed consent during their administration (Zagaja, Patryn, Pawlikowski & Sak, 2018). For example, critics of vaccines on the grounds of informed consent argue that a recipient of a vaccine should unreservedly be educated on the benefits and risks of a vaccine before administration. Around the world, immunization programs continue to increase, especially those targeting young children and teenagers between 6 and 17 years of age. People within this age group are likely to be present for vaccination, even if their parents or legal guardian are absent. It is also important to note that in most countries, the legal age of consent is eighteen years (“ World Health Organization," 2013 ). Legally, a child within this age cannot provide valid consent, and thus, the approval of their parent or guardian must be sought. The requirement for consent must also be applied to all adults earmarked for vaccination. Any medical interventions should be preceded by informed consent, which is an ethical requirement that maintains the balance between personal autonomy and choice and protection of an entire population.
Vaccination involves the administration of weakened microorganisms, viruses, or toxins into the body of human beings to help the body develop immunity against a disease. People often subscribe to beliefs, religious groups, or philosophies whose teachings can disagree with the requirement for a vaccine. In such scenarios, the regulations by public health on vaccines may infringe on the autonomy and liberty of an individual (Giubilini, Douglas, Savulescu, 2018). An individual may want to exercise their rights or those of their children by refusing vaccination. The debate around the issue of autonomy regards whether it is right for the public health department to allow such individuals the right to enjoy their autonomy and liberty. Understanding the reasons why individuals would oppose the administration of a vaccine lays the foundation for how those in authority would approach the ethical issue. For instance, according to Smith (2017), most people are misinformed that vaccine overwhelms one's body and that natural immunity is superior to that of vaccines. The dilemma arises when the objectives of public health conflict with that of some members of the targeted population. Fundamentally, ethics deals with the options available, decisions based on the alternatives and duties, and obligations of public health personnel who are required to act in the best interest of an individual.
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Emmanuel Kant, in his deontological theory of ethics, maintains that some rights can be foregone even if they would bring pleasurable results. The deontological theory, which is based on the tenets of duties, obligations, and rights, argues that one should prioritize right over good (MacKinnon & Fiala, 2018). Relating deontological theory to the issue of informed consent in vaccination, one notes that Kant's theory permits the public health department to administer a vaccine irrespective of the needs of autonomy and liberty of an individual member of a population. Further, (MacKinnon & Fiala, 2018) notes that the divine command theory requires one to execute commands irrespective of the consequences. For example, in the case of mandatory vaccines, there is bound to be a conflict between autonomy and public health directives on vaccination. According to Zagaja et al., (2018), although informed consent is a prerequisite in executing a medical intervention, for mandatory vaccines, it is untenable to satisfy this requirement. The authors nevertheless recommend that the body mandated with vaccine administration should have a mechanism of dealing with any unforeseen after-effects of a vaccination.
The cumulative actions of individual people in pursuing their happiness can significantly diminish the satisfaction of an entire population or society. The utilitarianism ethical theory is founded on the principle that the outcomes of action define the means and the most significant benefits projected out of specific actions (MacKinnon & Fiala, 2018). In this theory, John Stuart Mill argues that the anticipated benefits to the highest number of people influence the decisions to be made. In this consequentialist approach, the total outcome can be sacrificed for the maximum benefit of a larger group. According to the utilitarian philosophy, the objective is not guided by the measured or predicted benefits, but the actions are based on preformed rules based on evidence (Mandal, Ponnambath & Parija, 2016). Thus, an ethically right decision is an action that conforms to the moral codes, which lays a foundation for better results. Concerning informed consent in vaccination, rule utilitarian provides that a public health officer can decide on behalf of patients who have conflicting beliefs or information to be vaccinated. The established rules will guide such actions, and decision making will be expeditious. Therefore, those tasked with implementing the program will be able to reach many people within the set time.
Both the utilitarian and deontological theories converge on the point of enabling the public health department to achieve herd immunity. The two, however, differ on the issues of informed consent and the related elements of autonomy and liberty. The deontological approach encourages those tasked with vaccinations programs to provide information on risks and benefits associated with a given vaccine even though duty precedes consequences. Differently, the utilitarian theory assumes a universal approach that places the benefits or outcomes of a vaccination program before individualistic aspects of autonomy and liberty. Giubilini et al. (2018) write that a high percentage of people refusing to be vaccinated will consequently affect the goal of attaining herd immunity. As mentioned above, the utilitarian theory advocates for group magnanimity and indiscernible contributions. According to this theory, each member of a population should contribute to the betterment of the entire group. Acting for the good of a whole group is informed by the principle of utility maximization since the best result is the one where most people have benefitted. Thus, the utilitarian theory does not prioritize the need for patients’ autonomy and liberty. The deontological approach, on the other hand, is based on universalism, such as everybody refusing vaccination (Giubilini et al., 2018). However, Kant's theory provides for a full description of the benefits of a given action, including details about circumstances surrounding the action.
In conclusion, vaccination programs are often faced with an ethical dilemma associated with informed consent. In any medical intervention, informed consent is an undeniable right to patients, which requires that the medical personnel inform their client of the benefits and risks with a given treatment procedure. However, informed consent rouses individual needs of autonomy and liberty, which is the source of the dilemma. Deontological theory is hinged on the need to prioritize duty and obligations over consequences. Hence, the duty of every partner is ensuring that mass protection is achieved regardless of individual responsibility. Contrarily, the utilitarian theory of ethics is founded on the significance of consequences and the most significant benefits to the subjects. Regarding this, the philosophy advocates that any action or program that has the best-perceived benefit for the larger society should be enforced. These two theories seem to defy the needs for autonomy and liberty, although each assumes a different perspective. The utilitarian approach is more inclined to consequences and the benefits to a group while deontological philosophy regards duty and obligation to the wellbeing of the society.
References
Giubilini, A., Douglas, T., & Savulescu, J. (2018). The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Medicine, Health Care, and Philosophy , 21 (4), 547-560.
MacKinnon, B., & Fiala, A. (2018). Ethics" Theory and Contemporary Issues (9th ed., pp. 93-137). Boston, USA: Cengage Learning Solutions.
Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology , 6 (1), 5–7. doi:10.4103/2229-5070.175024
Smith, T. C. (2017, July). Vaccine rejection and hesitancy: a review and call to action. In Open forum infectious diseases (Vol. 4, No. 3). Oxford University Press.
World Health Organization. (2013). Considerations regarding consent in vaccinating children and adolescents between 6 and 17 years old [Ebook] (1st ed., p. 115). Geneva, Switzerland. Retrieved from www.who.int/immunization/programmes_systems/policies_strategies/consent_note_en.pdf
Zagaja, A., Patryn, R., Pawlikowski, J., & Sak, J. (2018). Informed Consent in Obligatory Vaccinations?. Medical science monitor: international medical journal of experimental and clinical research , 24 , 8506–8509. doi:10.12659/MSM.910393
