To Vaccinate or Not to Vaccinate: The Ethical Debate
Instructor: Gloria Simuel MSN, RN
To Vaccinate Or Not To Vaccinate
To vaccinate or not to vaccinate: this is an ethical debate that has been around since the 1700s. The debate in America can also be traced back to the 1700s, which was based on the right to be inoculated against smallpox. Currently the vaccination debate has evolved into the right not to vaccinate. Vaccinations are effective in eliminating many infectious diseases that are known to be harmful to the general public (Center Disease Control,[CDC] 2011). They are limited to their full effectiveness based on the percentage of the population vaccinated (CDC, 2011). Thus, another ethical dilemma: the people’s right to refuse versus the danger that they place the general public in. Through the history of the debate nurses have been at the front because ethics is a vital part in the foundation of nursing with its rich history demonstrating the concern for the welfare of the sick, injured and vulnerable and for social justice (American Nurses Association, [ANA] 2001). The strong influence by the nursing code of ethics is shown in the purposes they serve and what keeps nurses at the front of the debate on vaccinations.
“The code of ethics for nurses serves the following purpose: It is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It is the profession’s nonnegotiable ethical standard. It is an expression of nursing’s own understanding of its commitment to society” (ANA, 2001, p. 145)..
The ethical debate on vaccination is not a new topic. In fact it has been an ongoing debate for well over 100 years. The precursor to vaccination started with “inoculation which involved lancing open a wound and implanting dried scabs or fresh pus containing variola (the virus that causes smallpox) under the skin of a healthy, uninfected person” (Markel, 2011, p. D5). This was a common practice in China as well as used during the Ottoman Empire (Markel, 2011).
One such debate in the United States involved the Puritan minister Cotton Mather in 1721 when he was promoting inoculation in partnership with a Boston physician named Zabdiel Boylston. Mather’s efforts were opposed by none other than Benjamin Franklin’s brother James, the contrarian publisher of The New England Courant. James Franklin argued that beside the integral danger of the procedure those religious zealots such as Mather should not be allowed to practice medicine. James Franklin was not alone in his view; many colonists believed as he did that inoculation was a breach of the Sixth Commandment [“Thou shalt not kill”] (Markel, 2011, p. D5). After the death of his younger son Francis Folger Franklin from small pox at the tender age of 4, Benjamin Franklin took up the fight for inoculation.
One can see one of the reasons for his strong stance when you look at what he wrote: “In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way and that, therefore, the safer should be chosen (Markel, 2011, p. D5). Franklin backed his stance in the following decades by compiling and publishing quantitative studies on inoculation’s value, while working with several physicians at the Pennsylvania Hospital (Markel, 2011, p. D5).
Franklin was not only concerned with the need for inoculation but was concerned with the high cost of the procedure. The colonists’ small annual income made it impossible for them to afford the treatment. “In 1774, to counter this inequity, Franklin established the Society for Inoculating the Poor…