Capella 4000 Assessment 3: Applying Research Skills

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Capella University

Capella 4000 Assessment 3

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Applying Ethical Principles

Healthcare organizations worldwide encounter various problems which must be addressed using ethical principles. These issues are known as ethical dilemmas in healthcare settings. To further understand, ethical dilemmas are described as those circumstances which are developed because of a conflict between two or more moral values and hence require an ethical committee to propose solutions (Giannetta et al., 2021). This article is focused on an ethical case study from Capella University’s Library. 

The Ethical Case Study – To Vaccinate, or Not? 

This ethical case study is about a child, Anna, who was born 5 days ago at a Community Hospital. The Smiths, Anna’s parents, decided after her birth to let her grow naturally without any foreign interventions which also included childhood immunizations. They were very sure about this as they decided after researching online by reading mommy blogs that vaccinations have several risks for children as compared to benefits. They provided the example of autism cases which are increasing because of childhood vaccines. All of their concerns were carefully heard by Dr. Kerr. She was Anna’s pediatrician and wanted her parents to allow vaccinate Anna. Dr. Kerr succinctly explained her point using various literature advice. She accepted the fact that vaccines have received various controversies in recent times, however, they have saved millions of lives as well. She provided the example of decreased incidences of Haemophilus influenzae type b and measles which are life-threatening infectious diseases in children. Moreover, she talked about autism disorder which was previously said to be caused by Thimerosal but recent studies deny this opinion. Dr. Kerr further established her points by sharing a reporting system that has been developed by governmental bodies to report adverse events from vaccines. This reporting system tends to aware governmental organizations about vaccines so that quality can be improved. To conclude her point, she tried to develop insight for Smiths regarding communal good by explaining Herd Immunity. After all the discussion, Dr. Kerr was sure that she will receive a positive response from the parents but the situation remained the same and became a moral issue for the doctor. 

Assessment of Facts from the Case Study

 The conclusion of the presented case study is that it is an ethical dilemma for Dr. Kerr to choose between medical recommendations and the wish of Anna’s parents. Childhood immunizations have several controversies and such cases are very common in healthcare settings where parents are reluctant to vaccinate their children and healthcare research is opposite to their opinions. Some of the facts from the case study that can be analyzed are parental refusal, the concept of detrimental effects of vaccines which include online blogs providing unreliable information, medical research about positive effects, and the concept of communal good.  

Parental Refusal

As mentioned in the case study, the Smiths were not in favor of vaccinating Anna and hence refused it. Literature supports this point by stating that in various parts of the world, parental refusal has been common in terms of vaccinating children. World Health Organization states that every year around 2-3 million children die because of being unvaccinated and one of the common reasons is parental perception (Saeed & Hashmi, 2021). Another source mentions that hesitancy by parents has been a major reason for various outbreaks of diseases that can be prevented by immunizations (Fernández-Basanta et al., 2021). 

Harmful Effects of Vaccines

According to the literature, the component used in childhood vaccines – thimerosal is considered safe and effective by the World Health Organization. Moreover, various peer-reviewed studies also indicate a “no risk” of autism from vaccines that have thimerosal. Hence, there is no evidence of a link between autism disease and childhood vaccinations (Gabis et al., 2022). As shared in the case scenario, online resources like blogs and videos on social media channels from people who are against vaccinations can be unreliable for parents. The European Centre for Disease Prevention and Control identified that digital media especially social apps and websites are primarily affecting vaccine reluctance in parents because they are easily captured by the myths and rumors which are shared online (Garett & Young, 2021). 

Positive Effects of Vaccines 

In the case study, Dr. Kerr elaborated on the benefits of vaccines. She focused on two infectious diseases (measles and Haemophilus influenzae). A research study identifies that globally around 66% of measles cases decrease from the year 2000-2018. The major reason behind this is routine vaccination that prevents measles disease (Gastañaduy et al., 2021). Talbird and colleagues (2022), mentioned in their study that vaccinations have proved to decrease the incidence of Haemophilus influenzae type B by 80% (Talbird et al., 2022). 

Communal Good – Herd Immunity

Another fact from the case study that Dr. Kerr mentioned about is herd immunity. It is defined as immunizing healthy individuals so that they can save immunocompromised people from infectious diseases (Ashby & Best, 2021). A study provides evidence that vaccines are ethically implied on healthy children so that other children in the community who are contraindicated from vaccines can be benefitted as well. This is called the “common good” (Rus & Goselj, 2021).

The reasons for using these resources are a) they explain vaccine reluctance in detail, b) they provide researched evidence against the unreliable resources available online, c) explicitly support the importance of vaccines to prevent diseases, and d) explain the concept of herd immunity as a common good.  

Communication Approaches and their Effectiveness 

The communication approaches present in the case study are; effective patient/family education for informed decisions and a therapeutic approach to rapport building. In healthcare settings, informed decision-making is highly important. It is defined as a two-way communication between the patient/family and healthcare provider about the advantages, hazards, and alternatives of medical treatment so that they make decisions with informed choices (Paterick et al., 2020). Patient/family education is one of the ways to achieve informed communication likewise in the case study where Dr. Kerr fully explained the risks and benefits of vaccines for Anna. Another approach to effective therapeutic communication is building a rapport with the clients. This is possible by gaining their trust, actively listening to their thoughts, and creating a comfortable environment for them to openly express their thoughts simultaneously trusting the physician’s facts as well (Lewandowski et al., 2021). Dr. Kerr’s positive attitude towards the parents and the approach of listening to their concerns carefully is an example of building rapport with the clients for effective communication. 

Some of the approaches that research recommends to be used frequently are effective non-verbal gestures like eye contact, posture, tone, language, empathetic expressions, and listening without any distortions (Vogel et al., 2018) while ignorance, constant disruptions, and agreement of the decision without providing further information should be avoided as it leads to ineffective decision making. 

Ethical Decision-Making Model 

According to Capella University’s resource, the ethical decision-making model comprises three components, 1) moral awareness, 2) moral judgment, and 3) ethical behavior. This model is used by any ethical committee to propose moral decisions (Capella University, 2023). The effectiveness of the approach used by Dr. Kerr in the case study can be related to the components of the ethical decision-making model where inappropriate knowledge of parents related to vaccines was considered an issue (moral awareness). After identifying the problem, the approach of Dr. Kerr provides sufficient research evidence to the parents according to their understanding and preferences so that informed choices can be made for the patient falls under the component of moral judgment. Using effective approaches can result in early identification of the problem, and informed and morally fair decisions (Haddad & Geiger, 2022). Effective approaches are used for making decisions that are patient-centered and which will either benefit or risk the patient only. Avoiding ethical principles and not making informed decisions are some of the non-effective approaches which will have negative consequences on the patient as well as the lives of communities living together. 

An ethical-based solution to the proposed case study

Four major ethical principles are obligatory for healthcare professionals to follow before making any decisions – autonomy, beneficence, non-maleficence, and justice. 

• One of the solutions to Anna’s case is to follow the principle of autonomy. Healthcare research identifies that in the case of minors, parental autonomy should be respected. The autonomy of parents should be accepted by providing them adequate evidence to decide for their child (Rus & Goselj, 2021), however, another research states that individual rights must be balanced with the rights of others and for the public benefit which is also the ethical principle of justice (Slotte et al., 2022). 
• Justice in healthcare is to safeguard the health rights of every individual thus, the concept of herd immunity is derived which fulfills this ethical principle of communal benefit. There must be family education programs developed that provide authentic researched information to parents so that informed and effective decisions are made (Garett & Young, 2021). 
• Another solution for Anna’s case lies within the medical boundaries of healthcare providers; to do no harm (non-maleficence) and to benefit patients (beneficence) (Varkey, 2020). Dr. Kerr should gain Smiths’ trust that vaccines are beneficial for Anna and effective management and monitoring will be done to ensure no harmful effects are produced. 

Conclusion

Vaccine refusal is a very common ethical issue faced by hospitals worldwide. Therefore, necessary interventions are needed to effectively spread accurate information to the mass so that families can make informed choices for their children. As a healthcare organization, there must be a patient/family education curriculum designed for nurses and doctors so that they can productively respond to the clients’ concerns. However, further research is needed for effective evidence-based strategies for this ethical dilemma. 

References

Ashby, B., & Best, A. (2021). Herd immunity. Current Biology, 31(4). https://doi.org/10.1016/j.cub.2021.01.006 

Capella University (2023). Ethical Case Studies. Capella Library Online. 

Capella University (2023). Ethical Decision-Making Model. Capella Library Online.

Fernández-Basanta, S., Lagoa-Millarengo, M., & Movilla-Fernández, M.-J. (2021). Encountering parents who are hesitant or reluctant to vaccinate their children: A meta-ethnography. International Journal of Environmental Research and Public Health, 18(14), 7584. https://doi.org/10.3390/ijerph18147584 

Gabis, L. V., Attia, O. L., Goldman, M., Barak, N., Tefera, P., Shefer, S., Shaham, M., & Lerman-Sagie, T. (2022). The myth of vaccination and autism spectrum. European Journal of Paediatric Neurology, 36, 151–158. https://doi.org/10.1016/j.ejpn.2021.12.011 

Garett, R., & Young, S. D. (2021). Online misinformation and vaccine hesitancy. Translational Behavioral Medicine, 11(12), 2194–2199. https://doi.org/10.1093/tbm/ibab128 

Gastañaduy, P. A., Goodson, J. L., Panagiotakopoulos, L., Rota, P. A., Orenstein, W. A., & Patel, M. (2021). Measles in the 21st century: Progress toward achieving and sustaining elimination. The Journal of Infectious Diseases, 224(4). https://doi.org/10.1093/infdis/jiaa793 

Giannetta, N., Villa, G., Pennestrì, F., Sala, R., Mordacci, R., & Manara, D. F. (2021). Ethical problems and moral distress in primary care: A scoping review. International Journal of Environmental Research and Public Health, 18(14), 7565. https://doi.org/10.3390/ijerph18147565  

Haddad, L. M., & Geiger, R. A. (2022). Nursing ethical considerations. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK526054/

Lewandowski, R., Goncharuk, A. G., & Cirella, G. T. (2021). Restoring Patient Trust in healthcare: Medical information impact case study in Poland. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06879-2 

Capella 4000 Assessment 3

Paterick, Z. R., Paterick, T. E., & Paterick, B. B. (2020). Medical informed choice: Understanding the element of time to meet the standard of care for valid informed consent. Postgraduate Medical Journal, 96(1141), 708–710. https://doi.org/10.1136/postgradmedj-2019-137278  

Rus, M., & Groselj, U. (2021). Ethics of vaccination in childhood—a framework based on the four principles of biomedical ethics. Vaccines, 9(2), 113. https://doi.org/10.3390%2Fvaccines9020113 

Saeed, R., & Hashmi, I. (2021). Pakistan ranks third globally with the most unvaccinated children: Is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. https://doi.org/10.7759/cureus.19751 

Slotte, P., Karlsson, L. C., & Soveri, A. (2022). Attitudes towards mandatory vaccination and sanctions for vaccination refusal. Vaccine, 40(51), 7378–7388. https://doi.org/10.1016/j.vaccine.2022.05.069 

Talbird, S. E., Carrico, J., La, E. M., Carias, C., Marshall, G. S., Roberts, C. S., Chen, Y.-T., & Nyaku, M. K. (2022). Impact of routine childhood immunization in reducing vaccine-preventable diseases in the United States. Pediatrics, 150(3). https://doi.org/10.1542/peds.2021-056013 

Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119 

Vogel, D., Meyer, M., & Harendza, S. (2018). Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC Medical Education, 18(1). https://doi.org/10.1186/s12909-018-1260-9 

Capella 4000 Assessment 3