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RUA: Ethical Dilemma Debate

Tara Bradley-Moderator

Emebet Demissie-Con Debater

Ellen Boateng-Pro Debater

Clara Tezoh-Researcher 1

Carine Njeh-Researcher 2

Anna Baity-Recorder

Should children be vaccinated for HPV?

Brief Description of the HPV Vaccine

Human Papillomavirus (HPV) vaccine is administered to protect the child before they are even exposed to a disease or certain types of cancers (CDC, 2019).

The CDC recommends that children between the ages of 11 and 12 years should receive the vaccine Gardasil but the vaccine can be given as early as 9 years old (2019).

HPV vaccines are given in two doses, one at age 11-12 years old and the second dose 6-12 months after the 1st dose (CDC, 2019).

Human Papillomavirus (HPV) vaccine is administered for the protection against the virus that causes cervical cancer. It is recommended that children between the ages of 11 and 12 years of age and even as early as 9 years old can receive this vaccination. This vaccine can be adjusted to two doses, one beginning at 11-12 years old and the second dose 6-12 months after the first dose initiated. The vaccines protect the child from at least 6 types of cancers, such as cervical, vaginal, vulva, penis, anus and back of throat. Every year in the U.S., over 14,000 men get cancers caused by HPV (CDC, 2019)

What is the Ethical Dilemma? Should an HPV vaccination be mandatory for children to attend school?

Pro Side

Protective impacts of immunizations apply to a whole nation because of group invulnerability

Vaccination can lead to life or death

The health of the community depends on the decision we make

Con Side

Parents who follow social practices must not be compelled to get immunizations before going to class

Children who have clinical contraindications do not require the vaccine to attend class

Failure to permit unvaccinated kids from going to class can cause separation among them

HPV vaccine is one of the most controversial health issue. While the vaccine protects against the deadliest cancers such as mouth, anus, penis, vulva, vagina and cervix, to parents the vaccine is a painful reminder that their children are transitioning to adulthood and may choose to express their sexual orientation (BMC Medical Ethic 2018). There are serious concerns that the vaccine may make young children become sexually active earlier than expected.

What is the ethical dilemma? Do the side effects of the HPV vaccination outweigh the good of the vaccine?

Pro Side

Side effects are mild and can't hurt the childs for life

There is no scientific proof to show vaccines can cause health problems

Lack of HPV vaccine can put the child at greater risk of being exposed to cancer

Con Side

Vaccines have harmful chemicals that can lead to kidney failure and cancer

According to CDC HPV vaccine has negative effect on children

Lack of HPV vaccine will not result in children getting cancer

The HPV vaccine has both pros and cons in terms of long-term effects to the child's health. While there is no proof to show that the vaccine has negative impact to health, it is made of chemicals which may cause significant health problems to the children. The vaccines has considerable side effects to children including headache, nausea, dizziness, syncope and plain and redness (Bartholet, 2020). This raises significant ethical concerns on its use.

What is the ethical dilemma? How effective is the HPV vaccine and does it really prevent cancer?

Pro Side

Proven to be 100% effective in the prevention of at least 5 types of cancers (Cancer.gov, 2020).

HPV strains 16 and 18 decreased by 83% among girls aged 15–19 years and by 66% among women aged 20–24 years at up to 8 years after vaccination began (Cancer.gov, 2020)

Precancerous lesions that can lead to cervical cancer decreased by 51% among girls 15-19 years and by 31% among women ages 20-24 years old (Cancer.gov, 2020)

Con Side

It’s only effective to individuals that have not been exposed to HPV. HPV vaccine does not treat existing HPV infections or HPV-associated diseases (CDC, 2016).

Women that have been vaccinated will still need to have regular cervical cancer screening because the vaccine only protects against most HPV types but not all types that is the cause of cervical cancer (CDC, 2016).

HPV vaccination is not currently recommended for women over age 26 years. Clinical trials showed that, overall, HPV vaccination offered women limited or no protection against HPV-related diseases (CDC, 2016).

Nearly all cervical cancers are caused by the Human Papilloma Virus. Preventative steps such as yearly Pap smears and examinations can prevent most cervical cancers. The health care provider will treat any precancerous cells before it turns into cancer by removal or treatment. As a result, cervical cancer rates have decreased within the United States (Cancer.gov, 2020). Most women diagnosed with cervical cancer in the U.S. have either never been screened, or have not been screened in the last 5 years (CDC, 2016).

Ethical Principles

Pro Side

Beneficence: When nurses educate about importance of HPV immunization, they are acting in the best interest of the patient

Autonomy: Nurses give parents the right to choose if they want to vaccinate or not by educating them

Non-maleficence: Nurses not inflicting harm is by giving HPV vaccine to prevent cancer

Justice: Nurses are being fair by vaccinating all children with HPV vaccine

Fidelity: Educating parents about the importance of HPV vaccine is way of being faithful with our right as a nurse

Veracity: Nurse must let parent know that vaccination help prevent cancer

Con Side

Autonomy: The right of the child been vaccinated is the decision of the parent.

Beneficence: Doing what is right, parents do the best for their kids

Non-maleficence: Giving vaccine is a way of inflicting harm because it causes pain.

Justice: Fairness. Nurses must not discriminate and should provide equal care if parents refuse vaccines.

Fidelity: Making a child sick is not a way of being faithful as a nurse

Veracity: Parents are concern about vaccinating their children

The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity. Justice is fairness. Nurses must be fair when they distribute care, for example, among the patients in the group of patients that they are taking care of. Any deviation from this principles amounts to unethical actions on the part of nurses and other healthcare professionals (American Nurses Association 2015).

Conflict in Ethical Principles

Deficient knowledge about HPV

The vaccine recipients and parents/guardians are not knowledgeable about the route of transmission of HPV.

Lack of autonomy and inform choices

HPV programs use implied consent procedure

No follow up plan for adverse effects in the long run

There may be long term adverse effects which cannot be recorded in the current EPI form.

The impact on female-only strategy

The HPV vaccine targets largely on the young female population (BMC Medical, 2018)

Sexual contact is the main route of transmission of HPV. But this is not openly disclosed to the recipients and their parents. This raises doubts among the recipients/duidients. Parent and guidance are informed about the vaccination through social mobilization or communication. They send their children to get the vaccine without any written consent. The EPI form only records short term side effects ot the HPV vaccine. There may be long term adverse effect of the HPV vaccine which provider may never be informed since there is no follow-up for this vaccine. The Center for Disease Control and Prevention recommend a follow up for recipients of HPV vaccine. The male population is the main source of the HPV transmission. But focus is highly directed on the female population (BMC Medical, 2018).

ANA Code of Ethics Provisions (3)

Pro Side

Provision 3.4

Professional accountability in fostering a culture of wellbeing

Provision 5.4

Conservation of honesty

Provision 8.2

Cooperation for health, human rights, and health diplomacy

Con Side

Provision 1.1

Respect for Human Beings

Provision 1.2

Relationship with our Patients

Provision 1.4

Our right to self-purpose

Provisions (3) of the ANA Code of Ethics dictates that The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. This involves the protection of the Rights of Privacy and Confidentiality and Protection of Human Participants in Research. In addition, thee provisions involve Performance Standards and Review Mechanisms, Professional Responsibility in Promoting a Culture of Safety and Patient Protection and Impaired Practice (Berry et al., 2017).

Possible Outcomes

Pro Side

HPV vaccinations drastically lowers cancer

HPV vaccinations substantially decreases ill health

HPV vaccinations significantly lower death rates

Con Side

HPV vaccinations can cause constant abnormalities

HPV vaccinations interfere with cultural beliefs and traditions

HPVvaccine does not protect against other sexual transmitted infections or diseases

There are both pros and cons of possible outcomes of HPV vaccinations. The vaccine can lower the chances of children developing common cancers and improve their overall wellbeing (American Nurses Association, 2015). On the other hand, the vaccine can result in constant abnormalities among young children and impact cultural beliefs and traditions negatively.

Plan to resolve the Dilemma

For Nurses:

Separate self bias

Respect the autonomy of the individual

Be confident, Knowledgeable and professional. when addressing ethical issues

For Patients:

Creating awareness on the mode of transport e.g sexual intercourse

Follow up plan for long term adverse effects of vaccines

Provide information on other cervical cancer strategies such as screenings

For Family:

Teach family about the means of transmission of HPV and importance of awareness

Use community resources as referral for support

Inorder for the nurse to effectively provide care for this patient, it is important to separate basis and assumptions that may cloud judgement (Rushton, 2018). In educating both parents and patients, it is important to talk about the mode of transmission since most often they are not told of sexual intercourse being the primary mode of transport (Salwa & Abdullah, 2018).

References

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: American Nurses Association

Bartholet, E. (2020). Homeschooling: Parent Rights Absolutism Vs. Child Rights to Education & Protection. Arizona Law Review, 62(1), 1–80.p

Berry, N. J., Henry, A., Danchin, M., Trevena, L. J., Willaby, H. W., & Leask, J. (2017). When parents won’t vaccinate their children: a qualitative investigation of australian primary care providers’ experiences. BMC Pediatrics, 17(1), 19

BMC Medical Ethic. (2018). Ethical Issues Related to Human Papillomavirus Vaccination Program. Retrieve from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019993

Center of Disease Control and Prevention. (2016). HPV Vaccine Information For Young Women. Retrieved from https://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young-women.htm

Holloman, T. (2018). The Human Papillomavirus Vaccine: a Requirement for all Children entering Middle School. ABNF Journal, 29(2), 42-45.

References

Human Papillomavirus (HPV) Vaccines. (2019, September 9). Retrieved October 08, 2020, from

https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sh eet

National Foundation for Infectious Diseases. (2020). 10 Reasons to get vaccinated. Retrieved from https://www.nfid.org/immunization/10-reasons-to-get-vaccinated/

Rushton, C. (2018, April 04). 10 Steps Nurses Take to Address Ethical Concerns. Retrieved October 11, 2020, from https://magazine.nursing.jhu.edu/2016/10/10-steps-nurses-take-to-address-ethical-concerns/

Salwa, M., & Abdullah Al-Munim, T. (2018, June 15). Ethical issues related to human papillomavirus vaccination programs: An example from Bangladesh. Retrieved October 08, 2020, from https://pubmed.ncbi.nlm.nih.gov/29945621/

US Department of Health and Human Services. (2016). Community immunity: Herd immunity. Retrieved from https://www.vaccines.gov/basics/work/protection

Vaccinating Boys and Girls Against HPV. (2019, August 15). Retrieved October 08, 2020, from https://www.cdc.gov/hpv/parents/vaccine.html