Exploring Moral, Ethical and Legal Implications of Vaccinations
In 2014, the United States recorded 644 cases of measles from 27 states. Through May 29, 21 states and the District of Columbia reported 173 people with measles, including one from Georgia. Of these cases, 68 percent or 117 resulted from the Disneyland outbreak, affecting 24 individuals who visited the amusement park in mid-December.
As recently as June 22, another measles case has been reported in Martha’s Vineyard, Mass.
States Tighten School Vaccination Requirements
In light of the recent measles cases, several states, including Georgia and California, are taking a critical look at vaccine mandates and potential measures to make exemptions more restrictive. Read more>>
According to the U.S. Centers for Disease Control and Prevention, in the United States:
- Before the DTaP shot was given routinely to infants, an estimated 8,000 people died each year from pertussis, or whooping cough. Today, that number has dropped to fewer than 40.
- An epidemic of rubella in 1964-65 infected 12.5 million Americans, killed 2,000 babies and caused 11,000 miscarriages. In 2013, nine cases of rubella were reported.
- Before the measles vaccination was introduced in 1963, an estimated 3 to 4 million people contracted the disease each year, and of those people, 400 to 500 died. In 2000, the CDC declared measles was eradicated in the United States.
The CDC says the United States has the safest, most effective vaccine supply in history. Before the U.S. Food and Drug Administration will approve a vaccine, scientists must perform extensive testing to ensure it is effective and safe. Vaccines are continually monitored for safety once in use. The effectiveness of vaccinations is scientifically documented.
Yet in recent years, many parents have chosen not to vaccinate their children for fear of vaccine injuries. The Disneyland measles outbreak has sparked a heated public debate about parents who decide not to vaccinate their children.
High vaccination compliance in previous years helped contain the spread of diseases, including measles, through a concept called the herd immunity. When a critical portion of a community is immunized, most members are protected because there is little opportunity for an outbreak. If there is one, it is more likely to be contained.
“Persons who are immunized against measles are themselves protected from the disease, but also protect others, so there is personal and social welfare at stake,” said Richard Rothenberg, Georgia State’s Regents Professor of Epidemiology & Biostatistics.
“Herd, or community immunity, can break down when not enough people in the community are vaccinated,” said Stacie Kershner (J.D. ’08), associate director of Georgia State Law’s Center for Law, Health & Society. “There are thresholds for each vaccine – the estimated percentage of the population that needs to be immune to the disease to interrupt transmission. If the rates dip too low, herd immunity will not protect, and diseases like measles can spread uninterrupted.”
The severity of measles lies in its epidemiology. It is a respiratory infection, caused by a virus. According to the CDC, when a contaminated person coughs or sneezes, the disease is spread through the air and remains viable for up to two hours after the infected person leaves. So even if someone does not come into direct contact with an infected person, he or she can still contract the disease.
People are contagious from four days before a rash appears through four days after it subsides. The incubation period is about seven to 14 days. Complications can include pneumonia, bronchitis, irritation and swelling of the brain, ear infections and death.
The toll can be especially severe among populations not eligible for certain vaccines—such as infants, pregnant women or immunocompromised individuals—and highly contagious diseases such as measles pose a significant threat.
Moral and Ethical Health-Care Considerations
While the legal issues related to state vaccination requirements for school entry and religious and philosophical exemptions have been at the forefront of public debate, there are other important legal and ethical issues to consider.
The ethical consideration that’s getting the most attention, primarily in the press, is the situation where doctors are refusing to treat unvaccinated patients.
“At this point, there aren’t any direct legal consequences if doctors accept unvaccinated patients. There isn’t an express law that holds a doctor liable if he or she chooses to treat an unvaccinated patient who may pose a risk to other patients, particularly infants who are too young to be immunized,” said Jessica Gabel Cino, associate professor of law.
“One side can argue that firing a patient is logical because of the unnecessary risk that unvaccinated patients pose for other patients, but I think the media has sensationalized a few extreme stories of doctors dumping patients,” Cino said. “There’s also ethical consideration – and legal if we are in a true emergency situation – that doctors will treat the person who walks in the door, and that includes those are unvaccinated.”
The American Academy of Pediatrics recommends doctors discuss with parents immunization and the risks of not vaccinating a child. If they cannot agree on what is in the best interest of the child’s health, the academy suggests referring the patient to another physician.
“Doctors face a moral dilemma when firing patients who refuse to vaccinate,” Kershner said. “They fear patients will not seek another medical home for their children, and that the children will then have untreated health issues unrelated to vaccination.
“There is an opportunity for doctors to fully explain the benefits of vaccinations and that any minute risk associated with an immunization is less than that associated with contracting a deadly disease,” said Kershner. “In the past, a doctor may have asked if you want the vaccine, versus saying it’s time for your vaccine. The manner in which information is presented can help influence parents’ decisions if they came in undecided.”
Rothenberg says the AAP recommendations in place are adequate to protect the public, but the problem is adherence to the recommendations. Education is instrumental is helping reduce the risk of another infectious disease outbreak, he said.