Ethical concerns in the debate about pediatric vaccinations, with special reference to MMR (Mumps, Measles and Rubella)
Thesis (PhD)--Stellenbosch University, 2016.
ENGLISH ABSTRACT: This dissertation examines the ethical aspects of vaccination in children by focusing on vaccination against measles using the MMR vaccine. Applying a principlist ethical framework to the relevant medical and scientific facts, I articulate two ethical principles or action guides that can be used to formulate obligations resting on persons or institutions, as well as to guide measles vaccination policy. These ethical action guides are: (1) All children eligible for measles vaccination should be vaccinated against measles, at least to the point of sustained measles elimination. (2) Respect for parental decision-making and the parent-child relationship guide the response to parental vaccine refusals. Ethical action guide (1) describes the obligations of those who stand in significant relationships with children and of the just society – to protect children against measles using vaccination. Action guide (2) guides the individual and societal response to vaccine refusal, describing morally important considerations that should be kept in mind when responding to vaccine refusal. The dissertation proceeds as follows. First, the introductory chapter examines ethical tensions regarding measles vaccination in children, and identifies some deficiencies in the existing literature. Next, two chapters provide an overview of the scientific and medical facts regarding measles and MMR vaccination. Third, the principlist framework of Beauchamp and Childress is defended as an appropriate ethical framework for analysis of the problematic. Fourth, the individual case of measles vaccination is considered, using a medical decision-making framework based in the principlist approach. Fifth, the obligations of the just society with regards to measles vaccination is considered, using different conceptions of justice in turn. In the last section of this work, it is argued that action guides (1) and (2) bring all four principles into balance, a state of reflective equilibrium, and various ethical obligations and policy suggestions are derived from these two action guides.
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