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To the editor - Do we have an ethics issue?

April 24, 2015
William Biddle
From the April 2015 issue of HealthCare Business News magazine
My intent in this letter is not to convince readers about what is ethically right or wrong, but rather to take a look at a tough ethical issue within health care and perhaps challenge their position by providing a different perspective.

There are many definitions of ethics, but here is one I like: that branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.

However, determining what is right or wrong is not always a straightforward process. Most have heard about the 2015 measles outbreak, which is thought to have started in Disneyland in southern California. At the time of this writing, there have been 84 measles cases spread across 14 U.S. states and Mexico from this one incident, according to the Centers for Disease Control & Prevention.

The outbreak has thrust the debate about vaccination into the headlines and into the “ethics arena.”

According to the CDC, during the decade prior to when the measles vaccine became available, nearly all children were infected with the measles by the time they were 15 years of age. It is estimated three to four million people in the United States were infected each year. Of those infected, an estimated 400 to 500 died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles.

In 1963 the first live measles vaccine was licensed. In 1971 the measles, mumps and rubella (MMR) vaccine was introduced and a second booster was introduced in 1990. The CDC noted that in 2000, 86 cases of measles were reported in the U.S. As a result of this decrease in cases, measles was declared eliminated – the absence of continuous disease transmission for greater than 12 months – from the United States. And, of course, today there is a vaccine against measles that is virtually 100 percent effective.

Now the CDC has reported that the United States experienced a resurgence in the number of measles cases during 2014, with 644 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases. This is the greatest number of cases since measles elimination was documented in the U.S. in 2000. Alongside the history of the measles vaccine, we must consider the history of the vaccination movement. Two distinct camps, pro and con, have formed around measles vaccination.

The pro-vaccination group argues that the incidence of measles is currently on the rise due to pockets of individuals who choose not to vaccinate their children. They also emphasize that in the recent measles outbreak, many of the infected have not been or were only partially vaccinated. They argue that the MMR vaccine for young children prevents them from experiencing a devastating illness and provides herd immunity that serves to protect individuals who cannot receive the vaccine because they’re too young, or for medical reasons, for example, if they have compromised immune systems due to the effects of chemotherapy.

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