Informed consent requires the voluntary authorization for an action based on the complete understanding of such action. Thus, one cannot perform a treatment or intervention on another without gaining permission to do so. However, O’Neill articulates that limitations to informed consent exist. For example, incompetent patients, public health interventions, personal information, and vulnerable populations do not require informed consent in order to proceed with an ethical practice (O’Neill 2003). Although some of the aforementioned exceptions, such as public health interventions, do not warrant informed consent for an ethical practice, other limitations, such as vulnerable populations, should require informed consent.
To begin with, public health interventions ignore the necessity to obtain informed consent, for they act on the principles of beneficence and nonmaleficence. For instance, vaccinations induce protection against a disease. Thus, by vaccinating a population, the risk of contracting a disease decreases. Unfortunately, many individuals in the United States are refusing to vaccinate their children against measles. Consequently, the prevalence of measles in the United States has greatly increased, as illustrated in Figure 1. Epidemiologists have traced the source of the outbreak to an individual in an amusement park in California (Centers for Disease Control and Prevention 2015). The source, an unvaccinated traveler, visited the amusement park while infectious (Centers for Disease Control and Prevention 2015). As a result of the abundance of unvaccinated individuals in the United States and the highly contagious characteristic of measles, herd immunity did not protect the seven-hundred individuals from the disease (Centers for Disease Control and Prevention 2015). Furthermore, the disease will likely spread to additional people in the United States, because individuals are refusing vaccinations against measles. Thus, the autonomy to give informed consent for an intervention does not adhere to the principle of nonmaleficence, for the unvaccinated individuals are causing harm to others. Therefore, public health officials should mandate the immunization of all individuals against the disease without requiring informed consent.
Figure 1.
Prevalence of measles in the United States.
Although vaccinations support O’Neill’s claim of limitations of informed consent, prisoners challenge her idea of vulnerable populations. For example, O’Neill explains that individuals under duress have the capacity to consent but the inability to refuse (O’Neill 2003). However, ethical practices can still occur despite the lack of informed consent (O’Neill 2003). Unfortunately, history does not display ethical behavior towards prisoners. For instance, during the Nuremberg Trials, Nazis performed experiments on the prisoners without their consent (Emanuel 2003). For example, Nazis infected prisoners with malaria to test antimalarial drugs, placed prisoners in low-pressure tanks to analyze length of survival with little oxygen, and burned prisoners with phosphorus bombs to examine consequent wounds (Emanuel 2003). Although the Nazis were performing the experiments for the amelioration of society, the principle of beneficence does not apply. Therefore, the Nazis were not engaging in ethical behavior. Moreover, modern scientists have generally accepted the Nuremberg Trials as unethical practices. However, based on O’Neill’s explanation of the lack of requirement for informed consent of prisoners, society cannot prevent experiments such as the aforementioned examples from occurring again. Although prisoners do not have freedom, they should not lose the autonomy over their own bodies; prisoners should give informed consent as well.
Thus, limitations of informed consent may exist, as illustrated with the public health interventions. However, treatment towards prisoners without informed consent does not equate ethical practice. Therefore, the context of the exception influences the limitation of informed consent and categorizes it as ethical or unethical.
Centers for Disease Control and Prevention. “Measles Cases and Outbreaks.” Centers for Disease Control and Prevention. February 02, 2015. Accessed February 02, 2015. http://www.cdc.gov/measles/cases-outbreaks.html.
O’Neill, O. “Some Limits of Informed Consent.” Journal of Medical Ethics 29, no. 1 (2003): 4-7. doi:10.1136/jme.29.1.4.
I really like the example of measles and vaccinations in the debate of informed consent. This is a hot topic in the news and media, and the angle is typically about the power of choice when it comes to vaccinations. With the power of choice (informed consent) comes the power of chance– chance that illnesses that can be prevented from vaccinations, like measles, will return, which it has. But removing informed consent from vaccinations and making it mandated could leave many feeling a loss of autonomy. It’s a challenging debate; Is your number one goal to protect health, or to protect autonomy? Is there a way to do both?
Brooke, I think you raise a fascinating question with your comment! I believe there is a way to do both. If parents decide not to have their children vaccinated, they should also pay for the consequences of that decision. Out of public health concerns, public schools, day cares, etc. would not allow unvaccinated children to use these public programs. By making these decisions, parents inadvertently remove the autonomy of their children’s peers, as they no longer have the choice to evade exposure. If parents make an autonomous decision, they should have to pay for the the consequences of that decision and limit the exposure of others.
With the issue of vaccination in the United States, parents and anti-vaccination groups use nonmaleficence as a defense against requiring vaccination. They argue that vaccines are harmful, and therefore wrong to require for children. It’s interesting that two sides of an argument can use the same moral ground for their defenses. Much of the debate against vaccines highly exaggerates the consequences of vaccines, though, as very few people have side effects from vaccinations, especially booster vaccines given during childhood. When examining this case, perhaps it is important to investigate which outcome produces less maleficence. While vaccines may have some risks, the people who experience these risks is probably much smaller than the number of people at risk of catching a disease because of the growing number of people not vaccinating children. This could be a point in the argument around vaccination requirements.