Iatro

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Smallpox has been eradicated for decades now due to efforts in the 60s-70s. One of the final places that public health officials eradicated the disease was India, specifically a group that based on religious reasons, refused to consent to receiving the vaccination. Long story short, they forced this group to be vaccinated (after much failed deliberation) and we all know the result; the greatest killer in the history of humanity has ceased to exist on the face of the earth (save a few research institutes).

Medicine values the human life and the decision of the individual to do with his or her body above all else. This is especially true when it comes to faith. In your opinion, were the actions of the public health team in India acceptable? Would you have done what they did?
 

Goro

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I ask a couple of similar questions when I do interviews, but I am SO stealing this one to go into the bank!
:)


Smallpox has been eradicated for decades now due to efforts in the 60s-70s. One of the final places that public health officials eradicated the disease was India, specifically a group that based on religious reasons, refused to consent to receiving the vaccination. Long story short, they forced this group to be vaccinated (after much failed deliberation) and we all know the result; the greatest killer in the history of humanity has ceased to exist on the face of the earth (save a few research institutes).

Medicine values the human life and the decision of the individual to do with his or her body above all else. This is especially true when it comes to faith. In your opinion, were the actions of the public health team in India acceptable? Would you have done what they did?
 
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sobored

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This is not even a good ethical question. Of course you vaccinate. What you're asking is a public health dilemma - a failure to vaccinate may have devastating effects on plenty of people outside of oneself.

A far better ethical question has come up in the news lately...you have an organ that has recently become available, do you transplant a mentally disabled individual?
 
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justAstudent

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This is not even a good ethical question. Of course you vaccinate. What you're asking is a public health dilemma - a failure to vaccinate may have devastating effects on plenty of people outside of oneself.

A far better ethical question has come up in the news lately...you have an organ that has recently become available, do you transplant a mentally disabled individual?
What about the patients who didn't want to get the vaccine? Do they no longer have control of their OWN bodies? Do they no longer have a say in what goes into their OWN bodies? Is it really right to force someone to do something they don't want to?
 

sobored

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What about the patients who didn't want to get the vaccine? Do they no longer have control of their OWN bodies? Do they no longer have a say in what goes into their OWN bodies? Is it really right to force someone to do something they don't want to?
Uhh yeah, it's absolutely the right thing to do in this case. If someone is mentally incompetent and behaving in a threatening way, a physician can forcibly medicate that person by law. Why? because they are a perceived threat to others. This isn't an argument about autonomy. If you want to make that argument, euthanasia is a much more compelling thing to talk about.
 

Ismet

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Uhh yeah, it's absolutely the right thing to do in this case. If someone is mentally incompetent and behaving in a threatening way, a physician can forcibly medicate that person by law. Why? because they are a perceived threat to others. This isn't an argument about autonomy. If you want to make that argument, euthanasia is a much more compelling thing to talk about.
Are you saying the people with religious views against vaccination are mentally incompetent?
 

justAstudent

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Uhh yeah, it's absolutely the right thing to do in this case. If someone is mentally incompetent and behaving in a threatening way, a physician can forcibly medicate that person by law. Why? because they are a perceived threat to others. This isn't an argument about autonomy. If you want to make that argument, euthanasia is a much more compelling thing to talk about.
I don't believe the population we are talking about are mentally incompetent.
 

alpinism

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Are you saying the people with religious views against vaccination are mentally incompetent?
Heh pretty sure he was just using it as an example, but you could make that argument.

In any event, not being vaccinated constitutes a threat to others.
 
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Lya

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What about the patients who didn't want to get the vaccine? Do they no longer have control of their OWN bodies? Do they no longer have a say in what goes into their OWN bodies? Is it really right to force someone to do something they don't want to?

When the prompt says, "...due to religious reasons," it is very vague and needs further explanations.

Many times, it is rather due to misconceptions, such as another village told a woman that she will get the worst fever or will be cursed by some devils if getting vaccinated, so she decided not to have it. It is the right thing to convince or encourage to do something that they initially didn't want to, and the process it takes to get there should entail some respect, incentives, and understanding for those locals. OP already stated that many deliberations failed, so it would be interesting to see what exactly "many deliberations" mean, what went wrong and what could have been done differently. I think this is where medical professionals need to learn how to negotiate and persuade someone better. If you saw a lecture by Prof. Stuart Diamond at Wharton, you know what I mean there, and I think it's one of the most underrated field of study in general.

At the end of the day, it is ethically wrong to force any civilian to get vaccinated, but for the maximum goods overall (utilitarianism) it was a right thing to do. Was it acceptable? I think I would rather ask that question to that last group of unvaccinated people as a post-treatment survey. Ideally, as they live longer and see that they are not seeing anyone around with smallpox, hopefully they will understand and accept eventually.


Heh pretty sure he was just using it as an example, but you could make that argument.

In any event, not being vaccinated constitutes a threat to others.

Not being vaccinated does not directly cause threats (e.g., having an untreated, active tuberculosis to harm others directly might not be the same as not getting vaccinated), so even in the U.S., getting vaccinated in general is recommended, rather than mandated.



Uhh yeah, it's absolutely the right thing to do in this case. If someone is mentally incompetent and behaving in a threatening way, a physician can forcibly medicate that person by law. Why? because they are a perceived threat to others. This isn't an argument about autonomy. If you want to make that argument, euthanasia is a much more compelling thing to talk about.
Rather than talking about euthanasia, one of more similar examples we can discuss would be child neglect; parents refuse to offer medications because they believe in the power of praying. If the illnesses or symptoms worsen enough, physicians can override parental beliefs. This example might be more relevant, because both cases (child neglect and OP's case) indicate that religious beliefs prevent standard or modern ways of medical treatments. However, even then, child neglect is a more extreme case, so I think our discussions have to revolve around the vaccination.
 

Ismet

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Heh pretty sure he was just using it as an example, but you could make that argument.

In any event, not being vaccinated constitutes a threat to others.
Not sure it was the best example to give. For someone who is evaluated as mentally incompetent, then the physician absolutely can make the medical decisions for them. Religious/other personal beliefs in a mentally competent patient is where it gets hairy. The majority of states in the US actually allow for religious exemption from vaccinations, and many states allow exemptions based on personal beliefs. What about all these parents who aren't vaccinating their kids out of fear of autism etc? I agree that not being vaccinated is a threat to others, and I would try my hardest to educate and convince them otherwise, but ultimately I don't think this is something that can be forced.

I need to go to bed. :sleep:
 

sobored

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Not sure it was the best example to give. For someone who is evaluated as mentally incompetent, then the physician absolutely can make the medical decisions for them. Religious/other personal beliefs in a mentally competent patient is where it gets hairy. The majority of states in the US actually allow for religious exemption from vaccinations, and many states allow exemptions based on personal beliefs. What about all these parents who aren't vaccinating their kids out of fear of autism etc? I agree that not being vaccinated is a threat to others, and I would try my hardest to educate and convince them otherwise, but ultimately I don't think this is something that can be forced.

I need to go to bed. :sleep:
Not sure it was the best example to give. For someone who is evaluated as mentally incompetent, then the physician absolutely can make the medical decisions for them. Religious/other personal beliefs in a mentally competent patient is where it gets hairy. The majority of states in the US actually allow for religious exemption from vaccinations, and many states allow exemptions based on personal beliefs. What about all these parents who aren't vaccinating their kids out of fear of autism etc? I agree that not being vaccinated is a threat to others, and I would try my hardest to educate and convince them otherwise, but ultimately I don't think this is something that can be forced.

I need to go to bed. :sleep:
The example was supposed to illustrate that no matter what the circumstance, autonomy is lost when you become a serious threat to others. anyways, i can agree with you that its time for bed.
 

Launcelot

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Smallpox has been eradicated for decades now due to efforts in the 60s-70s. One of the final places that public health officials eradicated the disease was India, specifically a group that based on religious reasons, refused to consent to receiving the vaccination. Long story short, they forced this group to be vaccinated (after much failed deliberation) and we all know the result; the greatest killer in the history of humanity has ceased to exist on the face of the earth (save a few research institutes).

Medicine values the human life and the decision of the individual to do with his or her body above all else. This is especially true when it comes to faith. In your opinion, were the actions of the public health team in India acceptable? Would you have done what they did?
"If you want to make an omelette, you've got to break some eggs."
 

TooMuchResearch

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This is not even a good ethical question. Of course you vaccinate. What you're asking is a public health dilemma - a failure to vaccinate may have devastating effects on plenty of people outside of oneself.

A far better ethical question has come up in the news lately...you have an organ that has recently become available, do you transplant a mentally disabled individual?
"may have devastating effects."
 

Jabbed

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Smallpox has been eradicated for decades now due to efforts in the 60s-70s. One of the final places that public health officials eradicated the disease was India, specifically a group that based on religious reasons, refused to consent to receiving the vaccination. Long story short, they forced this group to be vaccinated (after much failed deliberation) and we all know the result; the greatest killer in the history of humanity has ceased to exist on the face of the earth (save a few research institutes).

Medicine values the human life and the decision of the individual to do with his or her body above all else. This is especially true when it comes to faith. In your opinion, were the actions of the public health team in India acceptable? Would you have done what they did?
India still infrequently has polio outbreaks. Once the outbreak is confirmed, teams of medical personnel deploy to innoculate the surrounding area. Parents are given the option of refusing the vaccination for their children. By and large any policies of forced vaccination have been removed, so it's pretty clear where society stands on this ethically.
 

NickNaylor

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This is not even a good ethical question. Of course you vaccinate. What you're asking is a public health dilemma - a failure to vaccinate may have devastating effects on plenty of people outside of oneself.
Yeah, well, both US law and the day-to-day practice of many physicians would disagree with you.
 

sobored

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Yeah, well, both US law and the day-to-day practice of many physicians would disagree with you.
That's fine, but we are discussing the nuances of an ethical scenario, not what is currently law. In my opinion, it's a scenario that has a clear answer, as opposed to many others that are much more debatable. Why do you think in most states it actually is required for children to have certain vaccinations before entering public school? Or why healthcare workers are required to have certain vaccinations if they are serving the public? http://www.cdc.gov/vaccines/vac-gen/laws/state-reqs.htm

Anyways, you are entitled to your opinion and to disagree. Agree to disagree.
 
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This question is deeply rooted in the type of vaccination being given. Is the diseases being vaccinated against very contagious? Is it a serious illness?

One example I immediately think of is chicken pox. Certainly, it can be a serious illness in adults, but children - including me - went on for generations, got the disease, moved on. In fact, getting chicken pox was a rite of passage at my school, an experience we all shared at one point or another. Plenty of us older SDNers probably remember chicken pox parties :)

Is it a big deal to allow someone to walk out without a vaccine...it depends. In the case of smallpox, I vote that public safety wins out over personal freedom. Should all vaccines be mandatory? Meh, that's a longer discussion.
 

DokterMom

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What about the patients who didn't want to get the vaccine? Do they no longer have control of their OWN bodies? Do they no longer have a say in what goes into their OWN bodies? Is it really right to force someone to do something they don't want to?
Only if they're female, apparently.
 
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NickNaylor

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That's fine, but we are discussing the nuances of an ethical scenario, not what is currently law. In my opinion, it's a scenario that has a clear answer, as opposed to many others that are much more debatable. Why do you think in most states it actually is required for children to have certain vaccinations before entering public school? Or why healthcare workers are required to have certain vaccinations if they are serving the public? http://www.cdc.gov/vaccines/vac-gen/laws/state-reqs.htm

Anyways, you are entitled to your opinion and to disagree. Agree to disagree.
Well... no. It's an opinion that has a clear answer if your primary indicator of success and your primary concern is public health. And even then, 100% immunization rates are not required. It's not a goal I disagree with, but the end all be all is not public health. That's how we get things like Typhoid Mary.

People seem to have this misunderstanding that if you get pertussis or any other preventable disease that you're going to die or be left with significant morbidity as a result. Just based on epidemiological data that's not the case (http://www.cdc.gov/vaccines/pubs/pinkbook/pert.html). That's not say that I think it's wise to not vaccinate your children; parents who choose to not vaccinate their children frustrate me to no end. But I think it's important to not get swept up in the hysteria of either side and look at things from a logical perspective. Even polio - probably the poster boy of success with respect to vaccination programs - presents asymptomatically in 95% of cases. Only 4-5% of cases develop symptoms, and only 1% of them develop paralysis. At the height of polio incidence in 1952 - prior to vaccination - there were 21k cases of paralytic cases of polio. Of that cohort, most patients do not develop permanent paralysis. Again, I don't mean to say that vaccination is not a good idea or an effective intervention. That clearly isn't the case. However, this sort of issue should be viewed in the context of data and be a little more realistic when it comes to the whole vaccination debacle. You should also recognize that being forced to do something you either don't agree with or don't understand is an excellent way to disenfranchise people from the healthcare system. Every time I see someone on SDN or otherwise say something along the lines of "I just wouldn't treat a kid who didn't receive required vaccines," I facepalm. To stop providing care to someone who needs it because of some ideological disagreement that, in all likelihood, will not make a difference one way or another is the height of absurd to me.
 

Goro

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I'm stealing this one too! I regularly mine SDN for interview questions.


A far better ethical question has come up in the news lately...you have an organ that has recently become available, do you transplant a mentally disabled individual?[/quote]
 

LizzyM

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To me, a better ethical question for interviewees is "what do you think of physicians who exclude from their practices those families who refuse to vaccinate their children?"
"What arguments can be made for and against this policy?"
"If it were up to you to make a policy for a group practice or free clinic, what would you do?"
 

lucitrea

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Is there any difference in the correctness of my answer if I answer "what should be done" and not "what I want to do" ?

Which gives the better answer in interviews? I seriously don't know.
 

nOchemallday

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Is there any difference in the correctness of my answer if I answer "what should be done" and not "what I want to do" ?

Which gives the better answer in interviews? I seriously don't know.
From the little interviewing advice I have received and have to give:

When answering an ethical dilemna, your opinion does not matter (significantly) in your response. What matters is the logical progression you've made in evaluating all the variables and coming to an informed conclusion. Doing so reflects your ability to provide an informed analysis of the situation (i.e. for explaining to future patients). It also is a test of your ability to reason. Lay out your argument, then say what you think about it. As for the distintion between "what should be done" and "what I want to do", I think it's safer to err on the side of caution, such as if you have a very extreme view. But you could very well present each as "what should be done" and "what you would do" as long as the reasoning behind each is well-represented an well-informed and one can come to the same logical conclusion for both answers (i.e. don't overwhelmingly endorse evidence to suggest vaccines are bad, then say you would definitely vaccinate, or vice versa).
 

sobored

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Well... no. It's an opinion that has a clear answer if your primary indicator of success and your primary concern is public health. And even then, 100% immunization rates are not required. It's not a goal I disagree with, but the end all be all is not public health. That's how we get things like Typhoid Mary.

People seem to have this misunderstanding that if you get pertussis or any other preventable disease that you're going to die or be left with significant morbidity as a result. Just based on epidemiological data that's not the case (http://www.cdc.gov/vaccines/pubs/pinkbook/pert.html). That's not say that I think it's wise to not vaccinate your children; parents who choose to not vaccinate their children frustrate me to no end. But I think it's important to not get swept up in the hysteria of either side and look at things from a logical perspective. Even polio - probably the poster boy of success with respect to vaccination programs - presents asymptomatically in 95% of cases. Only 4-5% of cases develop symptoms, and only 1% of them develop paralysis. At the height of polio incidence in 1952 - prior to vaccination - there were 21k cases of paralytic cases of polio. Of that cohort, most patients do not develop permanent paralysis. Again, I don't mean to say that vaccination is not a good idea or an effective intervention. That clearly isn't the case. However, this sort of issue should be viewed in the context of data and be a little more realistic when it comes to the whole vaccination debacle. You should also recognize that being forced to do something you either don't agree with or don't understand is an excellent way to disenfranchise people from the healthcare system. Every time I see someone on SDN or otherwise say something along the lines of "I just wouldn't treat a kid who didn't receive required vaccines," I facepalm. To stop providing care to someone who needs it because of some ideological disagreement that, in all likelihood, will not make a difference one way or another is the height of absurd to me.
Your points are valid and well-taken. But the last thing you wrote is nonsense. I never suggested that and thoroughly disagree with folks who choose to practice that way, so I don't know where you came up with that comment in the context of this discussion.
 

sobored

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To me, a better ethical question for interviewees is "what do you think of physicians who exclude from their practices those families who refuse to vaccinate their children?"
"What arguments can be made for and against this policy?"
"If it were up to you to make a policy for a group practice or free clinic, what would you do?"
Excellent questions.
 
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Smallpox has been eradicated for decades now due to efforts in the 60s-70s. One of the final places that public health officials eradicated the disease was India, specifically a group that based on religious reasons, refused to consent to receiving the vaccination. Long story short, they forced this group to be vaccinated (after much failed deliberation) and we all know the result; the greatest killer in the history of humanity has ceased to exist on the face of the earth (save a few research institutes).

Medicine values the human life and the decision of the individual to do with his or her body above all else. This is especially true when it comes to faith. In your opinion, were the actions of the public health team in India acceptable? Would you have done what they did?

The scenario is actually a good bit more complicated then that. While the village was refusing to be vaccinated on religious grounds, it was actually really on the belief held by the village leader (elder?I forgot his actual position). His refusal to take the vaccine kept others in the village from doing so. He and his wife were forcibly vaccinated in the middle of the night. After he was vaccinated, getting the rest of the village to agree to vaccinations was easy. While even this is a simplification, they were hardly forcibly vaccinating a whole village, just two people whose beliefs kept many more from seeking the vaccine.
 

NickNaylor

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Your points are valid and well-taken. But the last thing you wrote is nonsense. I never suggested that and thoroughly disagree with folks who choose to practice that way, so I don't know where you came up with that comment in the context of this discussion.
Agreed, I didn't mean to imply that you said that - it was more of an added comment given what we were discussing. I threw it in there because that's an opinion I often see floated in discussions around this topic in the pre-allo board.
 

mk04447

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This is a standard bioethics question. All of them are similar and are seemingly unethical from an individuals perspective. Societies make medical choices in much the same way they make policy decisions; i.e. the greater good utilitarian approach.

Other examples are abortion, genetic enhancement/cloning, and especially randomized clinical experimentation, that ones a mess that parallels slavery in many ways. Take a bioethics course if you like this stuff, it's a nice break from memorization and gives you a different view on many common medical topics.
 

Jabawocky

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Medicine values the human life and the decision of the individual to do with his or her body above all else. This is especially true when it comes to faith. In your opinion, were the actions of the public health team in India acceptable? Would you have done what they did?
I would answer this question with a Yes. It was an acceptable choice but a simple "YES" is not a good enough answer. You have to elaborate as to WHY. Although it is important in medicine to respect other people's decisions on what to do or what not to do with their bodies for whatever reason, the highest duty of medicine(IMO) is to protect the existence of man through medical treatment and diagnosis. Smallpox was infectious and threatened whoever came in contact with it. It is believed to have originated around 10,000 BC and ultimately, it claimed the lives of 300-500 million people in the 20th century alone(1/14 of the worlds population today). The disease had a mortality rate of between 20-60% and 80% of those were children. When the virus was eradicated, the world was in the middle of a huge population boom and India was/is at the epicenter of that boom. If this minority of people had been allowed to contract and spread this disease to highly population dense areas, millions more could have died.

This was a decision not made lightly by the medical community but it was one made with the intentions of protecting the lives of countless others. Feelings can be mended and offenses can be forgiven. How do you replace the lives of hundreds of millions if this has been allowed to continue?
 
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Spica

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Smallpox has been eradicated for decades now due to efforts in the 60s-70s. One of the final places that public health officials eradicated the disease was India, specifically a group that based on religious reasons, refused to consent to receiving the vaccination. Long story short, they forced this group to be vaccinated (after much failed deliberation) and we all know the result; the greatest killer in the history of humanity has ceased to exist on the face of the earth (save a few research institutes).

Medicine values the human life and the decision of the individual to do with his or her body above all else. This is especially true when it comes to faith. In your opinion, were the actions of the public health team in India acceptable? Would you have done what they did?
It's a difficult question, indeed. But it was not just actions of the public health team in India. It was the decision of WHO (the band...jk, World Health Organization, of course) to launch a world-wide eradication of small pox, and it is the only virus that has been completely eradicated. So it's not just a question of a small group in India, it was a significant enough problem world-wide. So the consideration was whether to respect the religious rights (which is important) of a small population in one country, or go through with the action that benefits the whole world population (which they found to be more important).
 
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