Introduction
Immunisation is a health procedure done on healthy persons that involves insertion of destabilized pathogens and other medical compounds into the bloodstream and cells of the healthy persons so as to generate an antibody reaction as a means to keep the body armed and ready to prevent a specific illness. The first immunization was established to prevent smallpox, and required the insertion of a strong and dangerous substance into an individual. This mode of immunization was coupled with an elevated risk of getting the disease that was being prevented i.e. Smallpox, and as a result a lot of parents rebuffed the idea of having their children subjected to this procedure.
Mandatory immunization plans for infants in Australia have contributed to the accomplishment of elevated rates of immunisation since the establishment of the concept. These mandatory plans are based require a citizen (or a section of the citizens) to be immunized so as to have the right to be a resident of in the jurisdiction in concern.
According to an annual report by Mahajan et al. (2010), chronic illnesses in the young population of Australia have increased radically in the last years. Figures about the situation in the report point out that a fivefold rise in acute food allergies has been observed in the last 10 years in youthful population and this coincides with the government’s policies aimed at augmenting immunization rates in Australia to 95%. The prevalence of 'whooping cough' (or pertussis) in Australian community has also risen. In 2011, 38,000 cases of the infection were accounted for countrywide, with the infant morbidity for children under 6 months who had been infected with the diseases being 1 in 200 (NSW Department of Health, 2011).
With these and many other complications arising from the mandatory immunization, Australian citizens are starting to raise their eyebrows on the ethical concerns of the programme. As a result this paper presents an ethical argument that refutes the notion that mandatory immunisation of infants is required for improved public health outcomes in Australia. However, it should be noted that the paper doesn’t argue against immunisation but only mandatory immunisation.
Ethical considerations
The ‘prevention problem’
Wood et al. (2012) pointed out that among the major ethical oppositions to immunization worldwide ‘prevention problem’ is considered the biggest. This is mainly founded on the distress regarding the purportedly unequal resultant advantages and hazards from the use preventive medicine. Dawson, (2004) elucidates this concern by articulating that the major aspects of the “prevention problem” are that:
a) Preemptive public health exercises are executed on asymptomatic persons;
b) All these public health exercises will hold a certain potential risk of injury;
c) The advantages of these exercises are at the level of all the participants, whereas any potential risks of injury are dependent on the individual recipients of the exercise.
Dawson (2004) asserts that the major triumphs of immunization plans are dependent on their aptitude to generate group immunity, and that group immunity bestows ‘public good’ on every person in the pertinent society. Furthermore, the immunized person should also be shielded from the illness which s/he has been immunized. Furthermore Herd immunity bestows shield on unvaccinated persons, as they will most likely not be exposed to contagion in that community because the other members are already shielded from the disease. Dawson reaffirmed (c) above to:
C. “Risks are subject an individual person but both the person and community gain where herd immunity subsists in the pertinent community.”
Drawing reference from Dawson’s argument, the mandatory immunization in Australia can be said to be indeed unethical because the adjuvant used in preventive drugs (aluminium hydroxide/phosphate) and antibiotics lead to allergic reactions and antipathy reactions in humans. The mandatory immunization policy in Australia infringes the ethical code of conduct because it advocates for insertion of antibiotics, adjuvant, thiomersal and other harmful chemicals into the bodies of children at the most susceptible period of their growth.
The mandatory policy also fails to recognize that most of the relentless and unpleasant responses to the preventive drugs vary in severity among persons owing to their genetic factors. Evidence shows that a person can be pre-disposed to an illness by having the genetic material for that illness. Environmental aspects that have the ability to stimulate these genes consist of heavy metals, compounds, viruses, bacteria, nutrition and psychological wellbeing most of which are found in vaccines . This means that just because preventive drugs have worked on many individuals, doesn’t mean that the trend will continue in all individuals. The mandatory immunisation of infants in Australia holds the perception that all the infants in the region have similar characteristics rather than considering the individual characteristics of the infants.
The underlying ethical principle in relation to this argument according to Gostin, (2010) is that the mandatory immunisation of infants has the holds a big potential of harming the infants. The government should provide irrefutable proof against this before coercive immunization is adopted and implemented. Tests should also be done on every infant to check on the compatibility to the drugs before administering the drug.
Respect for parental autonomy
Mandatory immunization is an ethical burden it contravenes the recipient’s autonomy and freedom of choice. In contemporary medicine the biomedical ethical standard of reverence for autonomy has a propensity to outweigh beneficence, non-maleficence and justice. Consequently, the resolution of an autonomous patient ought to be cherished by the practitioner, albeit the practitioner deems patient’s resolution as erroneous. If the recipient doesn’t have a well laid-out opinion regarding being immunized or not, limitations of individual autonomy and freedom of choice will be established and compulsory immunization could be considered especially if the decision not to get immunized could result in any kind of injury to the individual.
Young infants are however not autonomous and as a result their parents are taking the role of making their decision. Parents are believed to have the ‘best interests’ of their kids at heart and are therefore given the responsibility of making the proper resolutions for their children pertaining to their well being. To facilitate this, they should be provided with proper and accurate enlightenment. Incorrect and imprecise media and social hype on the subject of the security of preventive drugs has depressingly affected immunisation rates in Australia. In case the practitioner deems that the parents’ choice is not in the best interests of the infant, they can overrule the choice made by the parents (Macartney & Crawford, 2012). This would happen for instance in the case of rabies, where immunization could be life-saving for the infant
Gust et al. (2009) argued that one other scenario where autonomy of the recipient can be infringed or be considered morally wrong is when the lack of immunization of the infant holds a great potential threat to others and if immunization would appreciably trim down those threats.
Evidently, it would be ethically superior if higher immunization rates were attained through voluntary immunization plans. Involvement in immunization procedures ought to be voluntary except if compulsory immunization is needed to thwart an otherwise inexorable solemn injury and voluntary plans have proven futile (Marckmann, 2008). However, the mandatory immunisation of infants in Australia has proven to have a wayward moral compass as it fails to recognize the most superior ethical principle in the medical field i.e. the principle of autonomy. Even in cases where there is no imminent danger if the immunization isn’t conducted, mandatory immunization is still required this is not only highly unethical but also a disgrace to the medical field in Australia because the medical practitioners fail to respect the decision of their clients.
Beneficence and non-maleficence
I will cover these two ethical principles in relation to mandatory immunisation of infants in Australia jointly due to their close association and also because covering them separately will result to a duplication of the content. Beneficence can be explained as “doing good” and can incorporate the useful result of the superior good for the majority. In regards to immunization this could be considered as the ‘common good’ or ‘public good’ that is brought about by immunization process. Non-maleficence on the other hand is ‘to do no harm.’ Immunization drugs subject the recipients to risks, e.g. the pertussis vaccine might pose the threat of encephalopathy to infants with basic neurological impairments; in this case it might be defensible to hold back immunization from an individual infant (Quinn et al., 2011).
The advantages of immunization prevail over the incredibly small threat of unpleasant. However this doesn’t warrant the mandatory immunisation of infants because ethical standards don’t look at the general view of the matter but singles out every aspect of the matter to make sure the entire process is morally upright.
Justice
The Australian Constitution assures children ‘the right to basic health care services,’ which would take account of immunisation among other services. The allocation aspect of justice necessitates reasonable allotment of resources, and in Australia the immunisation programme is available to all but the administration sees it fit to even force it to individuals who do see its need.
Isaacs et al.(2009) affirmed that Decision-making by governments is obviously experiencing ethical challenges because the expenditure for new immunization drugs are increasing and the pharmaceutical firms are using disease support groups handle the situations for them. Global justice ought to make certain that everyone who can gain from immunization has access to it. This must comprise right to use safer immunization drugs, though they are more costly.
Larson et al. (2011) asserted that immunisation plans are a symbol of a small risk investment in capital growth. The notion of ‘justice’ also consists of human rights. It tries to answer the question, “what rights do infants and their parents have concerning mandatory immunisation, and how does this affect the rights of the society to be shielded from contagious infections? In Australia the parental rights as per the constitution are restricted by the best interests of their infants. In relation to immunisation, parents have no right to rebuff the mandatory rule to have their infants immunized even if the risk to the infant is extremely minute.
The society and the government shouldn’t stress so much about imposing obligatory immunization because the threat that an unimmunised baby creates to an immunised infant is extremely minute. The solution is for the society members themselves to voluntarily get vaccinated with the guidance of the government instead of instituting mandatory immunization for all.
The human papillomavirus (HPV) immunization drug has created fresh ethical dilemmas in the recent past (Balog, 2009). A number of nations have proposed mandatory immunization for young girls of 10-12 years in a bid to counter cervical cancer. However, there were arguments that said that this contravenes on the rights of the girls. The question that prevails to date on the matter is “Does a young woman has the right to ask for HPV drug but stipulate that her parents not be notified?” Various reactions have sprouted to the matter and to date there are still concerns on the matter even in Australia (Georgousakis et al., 2010)
Lastly, how is the code of justice in ethics relevant to virulent disease circumstances? Who is supposed to have access to immunization drugs during a virulent disease during an epidemic, if the quantity of the drug is limited? Mandatory immunization would go against proper allocation of vaccines at a time like this as some people who don’t need the vaccine might get the vaccine at the expense of others who are in dire need of it in the name of mandatory immunization.
Additional arguments against mandatory vaccination
There are alternatives to mandatory vaccination programmes
A number of suggestions have been articulated saying that that substitute programmes that include improved hygiene might be similarly efficient in plummeting morbidity and transience. Trials to check these hypotheses have not been conducted but they seem to have a great potential and if they worked they wouldn’t be harmful as they wouldn’t involve uptake of chemical substances.
Mandatory programmes may lead to opportunity costs
Countries like Australia who have instituted mandatory immunization might waste a vast pool of resources and capital with trailing individuals who do not act in accordance with the plan. These opportunity costs might lessen the affordability of assets to be used for instructions or worse reduce the required resources for acquiring the vaccines needed for the immunization process.
Conclusion
Bearing in mind the ethical issues corresponding to immunization, the autonomy of persons to choose has to been compared and balanced against the community advantage drawn from herd immunity. In general, the most parents think that immunization is advantageous and they do have their kids immunised. Importunate parental rebuff in spite of therapy should be cherished except if the infant is at risk, where the parental verdict on the matter could be countermanded by the system (Gerber, 2009)
Immunization is indisputably a potent instrument in stamping out worldwide virulent diseases, but in Australia mandatory immunization is expected to aggravate communal backlash. Besides advancing education to the public about immunization, an additional potential first step to progress immunization coverage further than their presently elevated rates would be to simply give monetary enticements for immunized families and those not medically capable of immunizing but not forcing people to get immunized because that would be primitive and barbaric.
Parents without a medical seclusion from immunization should not be given the enticement but should not be castigated as well. Consequently a number of these parents might re-evaluate, sadly even if it is for a more superficial motive than the safeguard of their infants by in this case the end would justify the means.
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