Ethical Dilemma


Awell-known description of Immunization as defined by the World HealthOrganization (WHO), entails the procedure in which an individual ismade resistant to a particular infectious disease throughadministration of vaccines. It is commonly undertaken to makeindividuals stronger or rather more resistant to particular diseases.Examples of immunization include Polio, Influenza, Hepatitis andmeasles among others. Health care practitioners on the other handentail nurses, dental professionals, lad technicians, nursing andmedical students, physicians, pharmacists, emergency medical persons,administrative staff and hospital volunteers. Generally, health carepractitioners involve all staff workers working within and around thehealth care facilities. In that respect, the procedure of immunizinghealth care workers involves all the employees working within andaround the premises.

Thereare numerous challenges facing mandatory immunization of healthworkers especially on the ethical ground. Immunization of healthworkers is deemed vital since most of them are at risk of beingexposed to severe or even deadly ailments. They are mostly in directcontact with patients who can spread the infections. Additionally,the handle equipment that can deemed dangerous. In that regard,vaccinations are crucial to protect or rather prevent themselves oreven their families from acquiring such diseases. However, though theexercise looks noble, major ethical issues arise. The issues mainlyinvolve the act of making the exercise mandatory i.e. forcefullyvaccinating health workers. These challenges bring about dilemmaswithin the facilities. This paper will look to outline how theethical dilemma affects health workers like nurses. It will discussthe major moral issues brought about by the situation. Discussing twobioethical principals and there relation to the ethical dilemma willalso be a major undertaking within this paper.

Theethical dilemma

Mandatoryvaccinations are deemed to contravene rights of every free individualto care for his/her own health in a manner suited to themselves. Inother words, vaccinating health workers forcefully tends to beagainst the employees freedom to care for his/her own body. However,immunizations are important in preventing spread of infectiousdiseases. As portrayed by studies, rates of volunteer immunizationamong health care workers are quite low. When the exercise is leftopen for health workers, they rarely go for them. Due to thisnumbers, regulations to mandate health workers undertake theprocedure have been devised. The regulations force health workers toundertake the procedures with penalties involved whenever such ordersare contravened [ CITATION Gal13 l 1033 ].This acts raise the big question, should immunizations be mademandatory among health workers? If indeed every person is entitled tocare for his/her own health, then why should health workers bemandated to take vaccinations? An ethical dilemma hence arises.Propositions for the act are quite many just like opponents with eachciting various reasons. A consensus on the practice is quite hard toachieve and tends to vary across different States within the UnitedStates. With some States making immunization a compulsory requirementfor employment within the health care facilities, considerableconcerns over civil rights have been raised. Compulsory practicestend to contravene people’s rights to freely practice his/herreligion, right to privacy and right to make personal medicaldecisions [ CITATION Alv10 l 1033 ].

Thedilemmas are quite detrimental to the nursing practice since it tendsto derail activities within the facilities. A good example is theAugust 2009 activity mandating vaccinations of health care workersfor seasonal as well as H1N1 influenza in the New York Hospital. Aspurported by the State’s health care commissioner, a mere 40 to 50percent of staff came out for voluntary vaccinations. The activitymandated all health care workers to undertake vaccinations by themonth of November or else face termination. However four nurses amongother bodies came out strongly voicing their disagreements on thecompulsory vaccinations. They believed such forceful acts wereagainst employees’ rights and should not be undertaken. Arestraining was granted but the process later fell through due tolack of enough vaccines [ CITATION Dan11 l 1033 ].It therefore poses greater challenges to the nursing practice oncesuch dilemmas exist. Sometimes a nurse is torn between adhering tothe directives or following what he/she purports is suitable.

Mainethical issues

Aselaborated above, the major moral concern entails rights to personalhealth decisions. Arguments arise suggesting that forcefulimmunization are against employees’ rights to make personaldecisions on health matters. It is considered unethical to mandatesomeone to adhere to certain perspectives entailing own health.However, not having vaccinations makes the health workers a threat toa larger community. This is because once an infected patient comes inand spreads the infection to the healthy worker, the worker in turncan pass it through to other healthy individuals such as families. Inaccordance to the utilitarianism theory, actions are consideredmorally wrong or right depending on the effects. If for instance, aparticular decision benefits a wider group of persons, then it isconsidered morally right. In this case, if mandatory vaccinationsbenefit the general public, it can be considered morally right [ CITATION Joh01 l 1033 ].

Thereis also a sense that health workers are mandated to ensure or ratherprevent diseases from infesting the general public. In accordance tothe deontology theory, morality ought to be judged on the adherenceto rules. Morally stable personalities are obligated to the rules andregulations. In that respect, it is the duty of health workers toensure a healthy society. They should be on the forefront inpreventing infectious diseases from spreading to a larger scope. Anyactivities that contravenes their duty to champion healthy living canbe considered unethical [ CITATION Mic01 l 1033 ].


Thetwo bioethical principals relating to this ethical dilemma includeNonmaleficence and beneficence. In accordance to the Nonmaleficenceprincipal, health care workers should not develop harm to thepatient. Whether it is by omission or commission of an act. Somepeople may deem it as negligence, carelessness or unreasonable risks.The principal generally calls for competence in the health carefacilities curbing mistakes. It articulates a core commitment ofhealth care workers to protect or rather prevent their patients frombeing harmed. With regard to this ethical dilemma, the principletends to insinuate that health care workers have the obligation ofpreventing patients from harm. In that respect, immunization isregarded the best ethical procedure since it prevents health workersfrom causing harm to their patients. When a worker undertakesimmunization, he/she prevents certain infectious diseases fromspreading to other persons through them. A health worker providessafety or rather ensures protection of patients from harm, whenhe/she partakes immunization. If an infectious disease spreads to awider group through health workers, it can be considered asnegligence. The health workers in that case are liable for anydamages emanating from the activity [ CITATION Tho13 l 1033 ].

Theprinciple of beneficence suggests that health care practitioners havean obligation to be beneficial to patients. They also are obliged totake necessary steps so as to avoid harm on the patient. Theobligations are seen to be quite rational as well as self-evident andare broadly acceptable as logical aims of medicine. For instance,appropriate health of certain patients is the aim of medicine.Prevention of diseases by employing research and administration ofvaccines portrays the appropriate goal of health care facilities. Inrelation to the ethical dilemma in discussion, the beneficenceprincipal encourages health care workers to take the necessarypositive steps to avoid causing harm on patients. The scope is notonly limited to patients only, instead, it also encompasses healthyindividuals. Health workers are obliged to prevent infectiousdiseases from spreading to other persons through immunization. Forexample, whenever an infectious disease arise, like H1N1, it is vitalfor health workers to take vaccinations since they come into contactwith various kinds of people. In the process they may acquire thedisease unknowingly and spread it to many other people includingfamily members. This may be regarded as negligence in accordance tothis principle. However, if the health workers takes thevaccinations, they may end preventing the disease from spreading to awider scope. Though the principle does not mandate health workers toundertake immunization, it highly encourages the same [ CITATION Lau14 l 1033 ].

Thetwo principles tend to correlate in encouraging health workers toundertake immunization. As portrayed by the principles, it is theduty of health care workers to protect patients from harm or eveninjury. This could be done by accepting immunization. It should notbe forcefully instilled within the health workers, but voluntarilyundertaken.


Ethicsor morality can be generally described as concepts that define rightor wrong. I consider it morally right to observe respect within thesociety. Respect broadly involves preventing harm and injury onothers. It is quite unethical to cause harm within the society in anyway. A good example entails spreading of infectious diseases or evencausing injuries through fighting. Disrespect portrays unethicalbehaviors since it can lead to broader aspects of harm. If forexample, people do not respect one another within the society,societal harms could arise such as wars that can lead to injury oreven deaths.

Inrelation to the current society of residence, this values are highlyadhered to. People have seen the sense to obtain immunization as ameans of protecting themselves and the entire society as well. It isconsidered respect when an individual undertakes certain measure soas to protect other people from harm. Respect is considered core toachieving harmony within the society. As the ethical dilemma posedabove suggests, sometimes attaining appropriate ethical standardstend to be quite intricate owing to the aspects involved. Itsometimes requires one to relinquish some of his/her rights for thebetter good.


Mandatoryimmunization of health workers is one intricate activity. The viewson the acts tend to vary substantially with opponents viewing it asdetrimental to the human rights. In other words, compulsoryvaccinations of health workers are against personal rights wherebyone is entitled to make personal decisions concerning own health.Health workers should not be forced into taking vaccination if theyare not willing to undertake them. However, proponents argue thathealth workers serve many people and are exposed to greater risks. Inthat case, whenever an infectious disease spreads, health workersrisk boosting the spreading. It is therefore, important to takevaccinations so as to prevent the spreading. Voluntary vaccinationsdo not seem to yield much hence the adoption of mandatory mechanisms.As the principles of nonmaleficence and beneficence suggest, healthworkers are obliged to take steps that prevent patients from harm.Though they do not enforce the acts, it is considered morallyappropriate to take steps that ensure patient safety. In this case,immunization of health workers can be considered vital. It should bethe aim of health workers to protect their patients. It should not beforcefully instilled in them, instead should be natural.


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