Childhood immunizations is an important public health measure in the U.S. Each state establishes its own vaccination requirements for children attending school and day care. The moral issue lies within the mandatory and compulsory nature of giving immunizations. There are many health-related benefits with immunizations, but compulsory immunization distorts parent autonomy in making decisions about their child’s health. After reviewing the principles of beneficence and autonomy in this case, we can determine which principles outweighs another.
Beneficence is the “moral obligation to act for the benefit of others” (Beauchamp and Childress 203). In this case, the physician is administering a vaccination that will result in an immunization from a disease. Thus, the physician contributes to the patient’s welfare. Furthermore, immunized patients benefit their community and “protect the common good of society” (Isaacs 394). Patients protect other individuals from contamination from diseases and possibly death. An idea of protecting the common good of society is also cogent to the issue of smoking. One of the arguments against smoking is the negative consequences of second-hand smoke. Beneficence comes into play when an individual has the duty to promote patient and community health.
A principle under beneficence is utility, which “requires that agents balance benefits, risks, and costs to produce the best overall results” (Beauchamp and Childress 202). Benefits are risk reduction, and risks prevent patients from interest in life, health, or welfare. In the case of childhood immunizations, the benefit outweighs the risks. Specifically, the probability and magnitude of vaccine-related injury is less of a risk than the probability and magnitude of a wild-type disease. Paralytic poliomyelitis, for example, occurs “once in every 2.4 million doses of oral poliovirus vaccine” (Isaacs 393).
Another principle of beneficence related to the immunization case is precaution. Scientists and physicians understand the magnitude of the possible negative outcomes from not administering vaccinations. We determined this from the smallpox epidemic in 1775-1782. Immunizations are a process rather than a genuine principle or gesture. Immunizations will prevent less disease and less suffering.
However, routine and mandatory procedures override the freedom of the parents and their choices. Parents act as surrogate decision makers for their children because they are not fully autonomous. Physicians are declining the parents right to make decisions about child rearing. They have responsibility over the child’s future wellbeing and act in the child’s best interest. In most cases, physicians do not have the authority to overrule the parents’ decisions.
State coercion is another ethical dilemma to parent autonomy. Immunization is required by law in the U.S., and there is no room for alternative considerations. For example, parents are unable to reject immunization based on their thoughts on vaccine-related injury if they want them to continue in school.
Overall, I believe the principles of beneficence outweigh the principles of autonomy in the case of immunizations. The benefit to the individual child and the community overrule the small risks of vaccines and disregard for parent autonomy. There is no compelling evidence on all types of risks. Physicians may overrule parent autonomy if they deem the parent’s decision harmful to the child.
Citations
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2001. Print.
Fenn, Elizabeth. “Small Pox.” Small Pox. ESRI, n.d. Web. 23 Mar. 2017.
Isaacs, D., HA Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Journal of Paediatrics and Child Health. Blackwell Science Pty, 22 June 2004. Web. 23 Mar. 2017.
Sylvie,
I really like your argument here about immunizations and I one-hundred percent agree with you. From a beneficence standpoint, vaccinating your children is not only good for the child but also good for the people and children around him/her. When it comes to something that is imperative to protecting your health and other people’s health, as a parent in that position, one should always choose to protect. In comparison to smoking in public and secondhand smoke effects, the health risks are almost entirely different and far less severe than the health risks associated with not vaccinating. When we’re talking about not vaccinating, we’re talking about life altering and sometimes even life threatening diseases, while with secondhand smoke, you’re far less likely to contract a life-threatening disease. Especially when it comes to vaccines, where you can contract a disease even if you’ve already been vaccinated, it is far more important to avoid the health risks.
As far as parent and even patient autonomy goes, yes, we could technically say that it is being violated, but in the grand scheme of things it is helping other parents and their children. When evaluating which principle, autonomy or beneficence, trumps the other, we really need to look at which is helping and protecting more people. In this case, beneficence is the obvious choice in principle to follow as we are essentially protecting every adult and child that a vaccinated child comes into contact with. It is frankly irresponsible and reckless for a parent not to vaccinate their children and the benefits outweigh the costs in this situation.
Just as how there is now a tax on tobacco as well as constant commercials and advertisements that encourage people not to smoke, I think there should be an equivalent for not vaccinating your child. While it may be hard to tax people who do not vaccinate their children, I strongly support the sponsoring of advertisements that educate parents on the risks to their children and other children when they chose not to vaccinate. We may never be able to legally force parents to vaccinate their children, but we can encourage them through educational propaganda.
Works Cited:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2001. Print.
Isaacs, D., HA Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Journal of Pediatrics and Child Health. Blackwell Science Pty, 22 June 2004. Web. 27 Mar. 2017.
Sylvie,
Finding the correct balance for beneficence and autonomy is difficult, in fact, “some of the most common and difficult ethical issues to navigate arise when the patient’s autonomous decision conflicts with the physician’s beneficent duty to look out for the patient’s best interests” (Pantilat). I agree with your conclusion that in this case, beneficence overrides autonomy. I believe that the benefits of immunizations, not only to the individual receiving the vaccination but also his immediate community, greatly outweigh the restriction of the parents’ autonomy.
In my opinion, when an individual’s action has a significant effect on their surrounding community, it is justified for beneficence to outweigh autonomy. For example, in class today and as you mentioned, there are laws against smoking and tobacco in the United States. Companies purposefully make it harder for individuals to buy tobacco products by putting them in cases in which the customer must ask for assistance in order to buy the product. This is a precautionary measure to try to decrease the amount of people that smoke in the United States. Not only does smoking deteriorate the individual’s health, but also those around them through second-hand smoke.
I believe that it is justified for an individual’s autonomy to be restricted if the act they wish to perform negatively impacts those around them. However, I do not believe it is fully justified for companies to increase the price of their soda, for example, and claim that beneficence outweighs autonomy. An individual does not harm others when they choose to drink soda. As a result, I find it difficult to find a reason that supports the claim that beneficence should outweigh autonomy. I think that the individual choosing to drink soda should be held accountable for their actions and to know that soda is bad for their health. Beneficence should not override autonomy in this situation because it is the individual’s responsibility to be able to choose for themselves whether or not they should drink a soda. There has to be a line drawn regarding where beneficence stops overriding autonomy, or else society would dictate every action taken by an individual. For example, should beneficence outweigh autonomy in situations regarding suntanning since it has been proven that it increases your risk of getting skin cancer? Do you agree that beneficence does not outweigh autonomy in the soda example? Why or why not? Where do you think the line should be drawn in regards to beneficence overriding autonomy?
– Morgan
Works Cited:
Pantilat, Steve. “Autonomy vs. Beneficence.” Autonomy vs. Beneficence. University of California Regents, School of Medicine, 2017. Web. 27 Mar. 2017.
Morgan-
Weighing the principles of autonomy and beneficence is difficult. The process varies in different cases. For example, I believe the principles of beneficence outweigh the principles of autonomy in the case of immunizations. In the case of a soda tax, I ultimately agree with you that it is hard to overrule the principles of autonomy. An individual has the right to make good or bad choices about his or her health.
However, there are some things to consider in the case for a soda tax where the principles of beneficence overrule those of autonomy. First, drinking soda causes some negative consequences on the third party. Consuming soda contributes to obesity, which in turn raises health insurance costs for everyone. This social cost helps the argument for beneficence, which is the moral obligation to act for the benefit of others. Second, although the tax is directly affecting the choice of the consumer (his or her autonomy) to purchase the soda, the tax revenue may ultimately go to a more useful purpose. For example, the revenue could go towards campaigns that increase awareness about the harmful effects of soda. These campaigns are designed to promote beneficence and help consumers understanding of the harmful effects. Increasing understanding will promote consumer autonomy. In this situation, those who implemented the tax can make up for it by promoting consumer autonomy in the long run.
In the end, it is difficult to draw a line in regards to beneficence overriding autonomy. In most cases, the line is drawn when people’s autonomous choices are negatively affecting a third party. The line depends on the degree of the negative consequence.
-Sylvie