Week 3: The Ethical Impact of Healthcare Policy

Ethical Impact of Healthcare PolicyImage result for healthcare policy

To some the principals of ethics and politics may not always go hand in hand, however they are deeply intertwined in healthcare policy.  The definition of ethics is individualized by each person’s unique set of life experiences. Ethics can be viewed as descriptive (what is right and good), theoretical (what is the justification for what is right and good), and normative (how can we act in accordance with what is right and good) (Petrini, 2010). Health policy affects the public in a profound manner influencing many topics related to a person’s quality of life and even a person’s survival. When policy makers support a health policy, they must take into accordance the varying views of ethics and try to form policies that are ethical to most people. Because every person has a different ethical view, instating health policies may conflict with personal beliefs. The healthcare policy may force a person to act against their ethical standards in order to stay in accordance with the laws.

Role of Ethics Surrounding the Low HPV Vaccines Uptake Rates

Image result for hpv vaccine promotes promiscuitySince the wide spread public use of immunizations in the United States, there has been a profound decrease in the number of cases of vaccine preventable diseases which inspired vaccine policies. Nationally to address the ethical issue of the barrier of the cost of immunizations the Centers for Medicaid and Medicare Services started the Vaccines for Children (VFC) program. The VFC provides immunizations to eligible children at no cost (Centers for Disease Control and Prevention [CDC], 2016a). Although some guardians resist immunization policies, which not only places individuals at risk but also the community at risk. This has left the medical and public health advocates struggling to balance the ethics of honoring individual beliefs and the health of the community (Hendrix, Sturm, Zimet, & Meslin, 2016). This ethical struggle lead to the National Childhood Vaccine Injury Act of 1984, in which all healthcare providers are required to give potential vaccine recipients a Vaccine Information Statement. This document provides basic information about a vaccine risk and benefits and is intended to help guardians make an informed decision (CDC, 2015). Furthermore, the providers ethical predicament of handling vaccine hesitant parents influences the statewide health policies regarding public health announcements and funding for provider education regarding communication about immunizations.

Stacked bar chart showing the average number of new cases of cancer in parts of the body where HPV is often found, and the number and percentage of cancers that are probably caused by HPV.The HPV vaccines in particular have met public resistance from both guardians and healthcare providers because of the ethical conflict of recommending a vaccine that prevents a sexually transmitted disease (STD). Ethical obligations include religious concerns that a vaccine that protects against a STD contradicts abstinence-based messages and that the vaccine may encourage early sexual relations (The College of Physicians Philadelphia, 2016). Additional ethical concerns regarding the HPV vaccines are centered around the newness of the vaccine. All CDC recommended immunizations are subjected to years of research and must pass safety standards prior to the introduction of the immunization. Prior to the introduction of three HPV vaccines in 2006, the vaccines went through years of research testing that included thousands of male and female participants however because the immunizations are intended for a vulnerable population, some resistance is met (CDC, 2016b). Some argue that it would be unethical not to vaccinate all eligible adolescents because of the HPV proven efficacy. Four years after the introduction of the vaccine, the quadrivalent type of HPV infections decreased in teenage girls by 56% (CDC, 2016b). While others argue that the long-term consequences of the immunizations are still unknown therefore it would be unethical to administer the product to children. While many childhood immunizations are mandated in order for children to attend school, due to these ethical influences surrounding the HPV vaccine, there was language added to the footnote of the state budget stating the HPV vaccine will never be required to attend school in Arizona (D. Davis, personal communication, January 18, 2017).The ethical debate of the HPV vaccines in Arizona resulted in the vaccines only being recommended by adolescent’s healthcare providers and no state statutes regarding this vaccine. The role of ethics surrounding the uptake of the HPV vaccine in Arizona plays an influential part in the policy decision making regarding new immunization policies.

 

References 

Centers for Disease Control and Prevention. (2015). History of Vaccine Safety. Retrieved from: https://www.cdc.gov/vaccinesafety/ensuringsafety/history/index.html

Centers for Disease Control and Prevention. (2016a). Vaccines for Children Program (VFC). Retrieved from: https://www.cdc.gov/vaccines/programs/vfc/about/

Centers for Disease Control and Prevention. (2016b). HPV Vaccine Information for Clinicians. Retrieved from: https://www.cdc.gov/hpv/hcp/need-to-know.pdf

Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M. (2016). Ethics and Childhood Vaccination Policy in the United States. American Journal of Public Health,106(2), 273-278. doi:10.2105/ajph.2015.302952

Petrini, C. (2010). Ethics-Based Public Health Policy? American Journal of Public Health,100(2), 197-198. doi:10.2105/ajph.2009.181511

The College of Physicians Philadelphia. (2016). Ethical Issues and Vaccines. Retrieved from: http://www.historyofvaccines.org/content/articles/ethical-issues-and-vaccines

 

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4 thoughts on “Week 3: The Ethical Impact of Healthcare Policy

  1. This blog uses the policy on HPV vaccinations to demonstrate the intersection between ethics and healthcare policy. From the presentation, it is evident that ethical orientations play an important role in determining the uptake of healthcare policies by communities. The blog does well showing how these policies are always viewed using the lens of an individual’s ethical orientation.
    To effectively balance the ethics of honoring individual beliefs and the health of the community through implementation and uptake of varied healthcare policies, stakeholders need to do more than providing information about the potential benefits and risks of particular solutions. Although this may serve as the starting point towards winning the ethics war, it is important to not only keep the interests of communities in the forefront but also to ensure that the information and values informing healthcare policy directions are congruent professionally (Lanchman, 2016). Additionally, it is important to make consideration of the nature and timing of vaccine-related discussions within the community setting, and also to ensure deliberative and/or collaborative approaches to policy-making (Hendrix, Sturm, Zimet, & Meslin, 2016).

    Reference:

    Hendrix, K.S., Sturm, L.A., Zimet, G.D., & Meslin, E.M. (2016). Ethics and childhood vaccination policy in the United States. American Journal of Public Health, 106, 273-278. doi: 10.2105/AJPH.2015.302952

    Lachman, V.D. (2016). Ethics, law and policy: Ethical concerns in medical-surgical nursing. MEDSURG Nursing, 25, 429-432.

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  2. Thank you for your post on this topic. It is definitely a controversial one, and one that deserves a lot of ethical consideration. I remember when the first batch of HPV vaccine was distributed to our clinic in early 2007, and how challenging the discussions were with parents and their teenage daughters (when first released, the HPV vaccine was only indicated for females between 11-19 y.o.). I had only been a PNP for a couple of years, and I was still “finding my way” when broaching sensitive topics with families, especially those with whom I had not yet built a strong rapport. Yet even with the families I knew well, trying to convince parents to vaccinate their young daughters against a virus that is sexually transmitted was EXTREMELY difficult, especially in the situations where parents had not yet had the conversation about sex with their daughters. I remember counseling my young female patients and their families that the reason for vaccination at 11 or 12 years of age instead of 17 or 18 was that studies demonstrated the vaccine was more effective the earlier it was administered. However, it still raised a lot of questions from the parents, including those you mentioned in your post: will administering this vaccine give the message that it is now okay to have sex; what are the long term risks of such a new vaccine; and why is it necessary to administer a vaccine if it is not going to be required to attend school? Of course, there were many other questions and concerns raised, even with regard to Autism, infertility, and all the other strands of HPV that cause cervical cancer but are not covered by the vaccine. One by one I tried to answer their questions and convince them that it was in the best interest of their daughters to vaccinate (holding to the principle of beneficence), while reassuring them that the relative risk profile was low enough that the ethical principle of non-maleficence would not be violated (American Nurses Association, 2015). But it was not easy!

    Over the past 10 years, I have continued to promote the vaccine to all my patients, and I am very happy the indications for administration now include males through age 21 and females through age 26 (Centers for Disease Control and Prevention [CDC], 2017). I am a strong advocate of the vaccine, and truly do believe that every eligible person should receive it. Yet I can also understand the ethical challenges of mandating the vaccine, especially since HPV is not like most of the other diseases against which we vaccinate. Although HPV is one of the causes of cervical/penile cancer, it is not the only cause, and not everyone infected with HPV will end up getting cancer. Additionally, there are several strains of the virus that are not covered by the vaccine. Granted, they are not the strains most associated with cancer, but the argument is still valid. Even with the vaccine, we cannot promise our patients that they will not get cancer (although this is true of any vaccine – none are foolproof). There is also very little risk of an outbreak of HPV, which is why is why it is not currently mandated or required for school admission and attendance. So our duty to protect is different in this case, since we are not attempting to protect an entire population from an epidemic like we are with the pertussis, polio, varicella, measles/mumps/rubella, and several other childhood vaccines. Even with Hepatitis B, the childhood risk of exposure is much higher due to the transmission being via blood and not sexual contact (CDC, 2016). That being said, I am still hard-pressed not to want to mandate the vaccine myself because of my desire to protect each and every one of my patients from a form of cancer we can potentially prevent. I think that is what makes this such a difficult ethical issue. There are valid points on both sides, with no easy answer. I look forward to watching you develop this topic over the course of the semester, and I truly hope that you can find a way to advocate for this policy change while ensuring children and families that we are not violating their ethical rights of autonomy and liberty, nor forcing them to act against their personal religious beliefs (if applicable).

    References:

    American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Retrieved from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for- Nurses.html

    Centers for Disease Control and Prevention (CDC). (2016). Hepatitis B vaccination. Retrieved from https://www.cdc.gov/vaccines/vpd/hepb/index.html

    Centers for Disease Control and Prevention (CDC). (2017). Human papillomavirus (HPV). Retrieved from https://www.cdc.gov/hpv/index.html

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