Case Summary
Jenna and Chris Smith, the proud parents of their newborn baby Ana, are determined to nurture her in the most natural way possible. To achieve this, they have decided to exclusively breastfeed Ana and prepare her food using organic ingredients. However, they refuse to vaccinate their child because they believe that the potential harms of vaccination outweigh the benefits. According to their argument, the increasing prevalence of autism is evidence of the unanticipated danger associated with vaccination. Dr. Angela Kerr, Ana’s pediatrician, recommends that Ana becomes fully vaccinated, citing the safety and effectiveness of vaccines in saving millions of children’s lives and decreasing child mortality over the past century. She reminds the Smiths that vaccine safety profiles are regularly updated and transparent through the federal government’s Vaccine Adverse Event Reporting System. No vaccine has been proven to cause autism. Dr. Kerr explains the epidemiological concept of herd immunity and how unvaccinated children put susceptible children at significant risk of death or illnesses.
Although Dr. Kerr has explained, the Smiths persist in their refusal to immunize Ana. The situation perplexes Dr. Kerr as most states mandate vaccines for children before they can attend school, yet parents can opt out based on specific conditions that differ by state. It is crucial for the public’s well-being that routine vaccinations are administered during childhood since they offer direct protection to those vaccinated and create herd immunity that protects others. Consequently, Dr. Kerr suggests that the Smiths reassess their decision to immunize their child to safeguard the health and safety of their child and the community.
Dilemma
The focal point of the dilemma centers around the conflicting viewpoints of Jenna and Chris Smith, the parents of Ana, a five-day-old infant, and their pediatrician, Dr. Angela Kerr. While the Smiths advocate for naturally raising Ana, including exclusive breastfeeding, preparing homemade baby food from organic purees, and avoiding vaccination, Dr. Kerr advocates for complete vaccination for Ana. The Smiths’ decision to abstain from vaccinating Ana is rooted in their research, which claims that the potential negative consequences of vaccines surpass any advantages, including an increase in autism rates. Nevertheless, Dr. Kerr refutes their claim, citing that vaccines have played a significant role in reducing child mortality and have saved the lives of millions of children worldwide. She also stresses that vaccines are generally safe and that the risks of not vaccinating Ana include exposure to vaccine-preventable illnesses and decreased herd immunity. The dilemma for Dr. Kerr is how to convince the Smiths to vaccinate Ana, given their firmly held beliefs.
Ethical decision-making model
Composition
Dr. Kerr faces an ethical dilemma regarding whether or not to vaccinate Ana. She demonstrates moral awareness by recognizing the potential risks and benefits of vaccination and the severe consequences that this decision can have. Dr. Kerr also acknowledges that the Smiths have already decided not to vaccinate Ana based on their beliefs. To make a moral judgment, Dr. Kerr considers the risks and benefits of vaccination, safety, herd immunity, and state vaccination requirements. Based on her analysis, Dr. Kerr concludes that vaccinating Ana is necessary to protect her health and that of others. Dr. Kerr chooses to educate the Smiths about the benefits and risks of vaccination, ultimately acting ethically by providing them with the necessary information to make an informed decision. Despite her efforts, the Smiths still refuse to vaccinate Ana.
Contributing factors
The ethical dilemma in this case study arises from Jenna and Chris Smith’s refusal to vaccinate their daughter, Ana, despite Dr. Angela Kerr’s strong recommendation that she be fully vaccinated. The parents’ decision is based on their belief that the potential risks of vaccines outweigh the benefits, citing a rise in autism rates as proof. Dr. Kerr must balance the parents’ autonomy with her duty to provide evidence-based medical care that promotes the child’s well-being and public health. Failing to vaccinate Ana may reduce herd immunity and increase the incidence of vaccine-preventable diseases, putting other children at risk.
Literature analysis
The issue of vaccine hesitancy has been widely discussed in the literature, with scholars highlighting the importance of understanding the reasons behind vaccine refusal and engaging with hesitant individuals in a respectful and non-judgmental manner. Azarpanah et al. (2021) suggest that cognitive biases may play a role in vaccine hesitancy and highlight the need for better education and communication to address these biases. Bussink-Voorend et al. (2022) conducted a systematic review to clarify the concept of vaccine hesitancy and emphasize the need for tailored interventions that consider individual attitudes and beliefs. Additionally, Shen and Dubey (2019) stress the role of healthcare providers in addressing vaccine hesitancy and recommend strategies such as active listening and providing accurate information to build trust and promote vaccine uptake. These findings align with the World Health Organization’s report on global health hazards, which highlights the negative consequences of vaccine hesitancy and stresses the importance of better communication and engagement with vaccine-hesitant individuals and communities (Scheres & Kuszewski, 2019)
Communication
Communication is crucial in resolving the conflict between the Smiths and Dr. Kerr regarding vaccination. Despite Dr. Kerr’s efforts to emphasize the safety benefits of vaccination and herd immunity, the Smiths refuse to vaccinate their child. Communication involves the Smiths’ explanation of their decision and Dr. Kerr’s explanation of the benefits of vaccination. Effective communication can facilitate understanding between the parties and lead to a conclusion that is in the child’s best interest.
Effectiveness of the approach applied in the case study
The approach applied by Dr. Angela Kerr in addressing the conflict between the Smiths’ desire to raise their child naturally and the pediatrician’s recommendation to vaccinate the child is highly successful. Dr. Kerr attentively listens to the Smiths’ apprehensions and carefully expounds upon the benefits of vaccination, emphasizing the safety features of vaccines and the principle of herd immunity. Dr. Kerr also counters the Smiths’ claims that vaccines cause autism by citing studies and scientific data. She highlights the importance of routine childhood immunization in protecting children and the general public. However, the Smiths maintain their position of not vaccinating Ana. Effective communication could lead to a better understanding of each other’s perspectives, but Dr. Kerr needs clarification on what to do next.
Conclusion
Moral dilemmas are common in healthcare. Patients are at the center of medical practice, and ethical principles must guide healthcare professionals’ actions. Institutions should have ethical frameworks to manage moral dilemmas and make collective decisions.
References
Azarpanah, H., Farhadloo, M., Vahidov, R., & Pilote, L. (2021). Vaccine hesitancy: Evidence from adverse events following immunization database, and the role of cognitive biases. BMC Public Health, 21(1), 1686. https://doi.org/10.1186/s12889-021-11745-1
Bussink-Voorend, D., Hautvast, J. L. A., Vandeberg, L., Visser, O., & Hulscher, M. E. J. L. (2022). A systematic literature review to clarify the concept of vaccine hesitancy. Nature Human Behaviour, 6(12), 1634–1648. https://doi.org/10.1038/s41562-022-01431-6
Capella Media. (2020). Ethical case studies. Capella.edu.
https://media.capella.edu/CourseMedia/nhs4000element18655/wrapper.asp
Scheres, J., & Kuszewski, K. (2019). The Ten Threats to Global Health in 2018 and 2019. A welcome and informative communication of WHO to everybody. Zdrowie Publiczne i Zarządzanie, 17(1), 2–8. https://doi.org/10.4467/20842627OZ.19.001.11297
Shen, S. (Cindy), & Dubey, V. (2019). Addressing vaccine hesitancy. Canadian Family Physician, 65(3), 175–181. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515949/
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