Education as a Public Health Measure

In Arguing for Bioethics, Issacs et al. look at the different arguments for and against compulsory immunization.  They come to a conclusion that compulsory immunization is justifiable but state coercion should be kept at a minimum because similar results can be achieved through education and inducements.  Australia provides the perfect example as they have achieved over 90% childhood immunization without compulsory immunization.  Earlier, I came upon an interesting case in Canada, where there is no compulsory immunization.

According to the Public Health Agency of Canada, “immunization is not compulsory or “forced” in Canada.”  Provinces can require children to have certain vaccines before they can enter school.  However, parents, or children who are old enough, can choose whether to be immunized or not.  If they choose to not be immunized, then the child must stay home from school if there is an outbreak.  Recently, there was a case in British Columbia (Canadian province), in which a couple’s 14-year-old daughter was vaccinated without their consent.  The girl was pulled out of class by public health nurses and received a vaccine against tenanus, diphtheria, and pertussis without checking her medical history or asking for the parents’ consent.  The parents had chosen not to vaccinate their children because they worry that the vaccine might cause an adverse reaction and cause death, which is what happened to their first daughter.

Under the British Columbia Infants Act, parents do not need to sign a consent form for children age 14 or older to be immunized, as long as the doctor or nurse believes the child is mature enough to understand and make a decision.  So legally, the nurses technically did not do anything “wrong.”  However, I think it becomes an issue when nurses are actively attempting to increase the immunization rates, which is 84% in Canada.  While the nurses are required to ask if there are any contradictions to the vaccine, could that be something that they disregard when they are only focused on increasing the numbers?  In this particular case, the girl said the nurses didn’t ask about any medical history of an adverse reaction.

Vaccines are important because they can potentially save a lot of lives.  Of course, there are people who are against vaccination.  While I completely understand the parent’s concern about vaccination, I think they should have taken extra steps to education themselves about the possible adverse reactions from vaccines.  The vaccine might have, or might not been the cause of their first daughter’s death.  The first daughter was also battling cerebral dysgenesis at the time, so was it the pre-existing condition or the vaccine?  As human beings, it’s easier to put the blame on something if there is a negative outcome, even if that one thing might not be the cause of it (Issacs et al.).  Furthermore, individuals react differently to vaccines.  Just because the older sister reacted to the vaccine does not mean the younger sister will as well.  The parents should have taken extra measures (if possible) to see if vaccination will actually harm their younger daughter instead of making assumptions.

The parents are not the only ones who should be attacked for not vaccinating their child and not taking extra measures.  Doctors and nurses should look at the issue of vaccines differently.  It should not be all about the numbers.  Instead, they should take the time to educate and ask patients about their concerns about the vaccine.  We can’t just give vaccines to everyone with no concern about how it might affect them.  It’s not someone’s fault if his or her body reacts badly to a vaccine.  The benefits of vaccines may outweigh the negative outcomes, but they should not be given blindly.  We need to make sure it is medically safe before giving vaccines.

While I don’t know the measures that Canada takes to education their people about vaccines, I agree with Issacs et al. that education is very important and should be something that doctors and public health officials should focus on.  In the case above, education might have allowed the parents to make a more informed or rational decision about immunization.  Simply attempting to force vaccines upon people may not be as effective as educating them about it.


Issacs et al. “Should Routine Childhood Immunizations be compulsory?” Arguing about bioethics. London: Routledge, 2012. 398-406. Print.

6 thoughts on “Education as a Public Health Measure

  1. Education is definitely one of the most important thing to increase the number of vaccination. Today, people still believe in false myths or base situation on one rare case. If people are educated appropriately about the vaccines, the immunization rate will increase. But the increase number isn’t the only thing we want. We want people who get the vaccines to be healthy afterward. Therefore, this leads to issue of informed consent and medical history. The doctors or the nurses should inform the patients and the parents that there are rare side effects and find out about the patient’s medical history to prevent unnecessary harmful consequences to the patients.

  2. I agree with you completely. I think that education is a huge important factor when it comes to making medical decisions. While we know (or assume) that our physicians and doctors already have this knowledge, we, the patients, probably do not. I think that it is both the doctor and the patient’s responsibility to make sure that the patient has the proper education in order to make medical decisions. Patients should ask questions and the doctors should answer them from an objective opinion, even if they may want to steer their patient towards a specific decision. This goes back to our previous classes about the doctor-patient relationship and communication. Communication between doctor and patient facilitates a relationship between the two, which leads to more information being discussed, which makes the patient more knowledgeable about the medicine, and the physician more knowledgable about the patient. Again, education is critical in the decision-making process, whether it comes to vaccines or other major medical decisions like surgery. Most medical decisions have their pros and cons. It is up to the physician and patient to come up with the “right” decision using all of the knowledge that they have learned from each other.

  3. This is an example of a terribly unbalanced paternalistic role. It almost seems that the nurse took advantage of the 14 year old girl’s new rights as an independent consenter for healthcare. It’s possible that the nurse took a paternalistic role because she may have disagreed with the parents’ decision to refuse vaccination. This is pushing beliefs onto people in an overly paternalistic way. Additionally, a 14 year old who may be uneducated about vaccines or the possibility of death should be required to have parental approval or notification, at least . Medical procedures of any kind need a healthy balance of paternalism and this incident is an example of a terrible inbalance that sometimes occurs within the loopholes of our healthcare system.

  4. I like that you bring up very specific example stories- in the case of the fourteen year old girl, while her nurses did nothing “wrong” the idea of the way they did it certainly opens the door to abuse of power by people in the health field. While overall it exists for the best of intentions, should this leniency continue it would only be a matter of time before the opportunity to coerce is in the hands of the less than caring health worker. Some well respected doctors have been public with their unpopular opinion, such as Andrew Wakefield and his anti-vaccination theory. This “educated” doctor had the wrong influence over so many people. I think it would be interesting to re-evaluate doctors every so often for their understanding of scientific evidence, in addition to simply informing the people of the general public.

  5. The action that was taken in the case discussed was out of line because they did not check the medical history. It makes perfect sense as to why she was worried due to the other incident. She was being very cautious to ensure the same mistake didn’t occur again. I agree that it is the doctor’s job to ensure that it is medically safe to give the patient a vaccine. If you don’t check the history or anytime of records then you risk someones’ life slipping through your fingers when the situation could be avoided by educating yourself on their history. Education is key, but the doctor that distributes the vaccine needs to also make sure they clearly communicate with the patient what is occurring. If both parties are aware of what’s happening then proper consent can be given, even for those vaccinations that may seem forced by society (ie. shots for school).

  6. It is incomprehensible to me now, but in general, the usefulness and significance is overwhelming.Thanks. Just continue composing this kind of post.

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