Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature
Abstract Background Parental refusal of routine childhood vaccination remains an ethically contested area. This systematic review sought to explore and characterise the normative arguments made about parental refusal of routine vaccination, with the aim of providing researchers, practitioners, and p...
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | BMC Medical Ethics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12910-023-00978-x |
| _version_ | 1797629985943453696 |
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| author | Kerrie Wiley Maria Christou-Ergos Chris Degeling Rosalind McDougall Penelope Robinson Katie Attwell Catherine Helps Shevaun Drislane Stacy M Carter |
| author_facet | Kerrie Wiley Maria Christou-Ergos Chris Degeling Rosalind McDougall Penelope Robinson Katie Attwell Catherine Helps Shevaun Drislane Stacy M Carter |
| author_sort | Kerrie Wiley |
| collection | DOAJ |
| description | Abstract Background Parental refusal of routine childhood vaccination remains an ethically contested area. This systematic review sought to explore and characterise the normative arguments made about parental refusal of routine vaccination, with the aim of providing researchers, practitioners, and policymakers with a synthesis of current normative literature. Methods Nine databases covering health and ethics research were searched, and 121 publications identified for the period Jan 1998 to Mar 2022. For articles, source journals were categorised according to Australian Standard Field of Research codes, and normative content was analysed using a framework analytical approach. Results Most of the articles were published in biomedical journals (34%), bioethics journals (21%), and journals that carry both classifications (20%). Two central questions dominated the literature: (1) Whether vaccine refusal is justifiable (which we labelled ‘refusal arguments’); and (2) Whether strategies for dealing with those who reject vaccines are justifiable (‘response arguments’). Refusal arguments relied on principlism, religious frameworks, the rights and obligations of parents, the rights of children, the medico-legal best interests of the child standard, and the potential to cause harm to others. Response arguments were broadly divided into arguments about policy, arguments about how individual physicians should practice regarding vaccine rejectors, and both legal precedents and ethical arguments for vaccinating children against a parent’s will. Policy arguments considered the normative significance of coercion, non-medical or conscientious objections, and possible reciprocal social efforts to offset vaccine refusal. Individual physician practice arguments covered nudging and coercive practices, patient dismissal, and the ethical and professional obligations of physicians. Most of the legal precedents discussed were from the American setting, with some from the United Kingdom. Conclusions This review provides a comprehensive picture of the scope and substance of normative arguments about vaccine refusal and responses to vaccine refusal. It can serve as a platform for future research to extend the current normative literature, better understand the role of cultural context in normative judgements about vaccination, and more comprehensively translate the nuance of ethical arguments into practice and policy. |
| first_indexed | 2024-03-11T11:01:37Z |
| format | Article |
| id | doaj.art-db026039fb374ebb855e39eb99305232 |
| institution | Directory Open Access Journal |
| issn | 1472-6939 |
| language | English |
| last_indexed | 2024-03-11T11:01:37Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Ethics |
| spelling | doaj.art-db026039fb374ebb855e39eb993052322023-11-12T12:29:26ZengBMCBMC Medical Ethics1472-69392023-11-0124111710.1186/s12910-023-00978-xChildhood vaccine refusal and what to do about it: a systematic review of the ethical literatureKerrie Wiley0Maria Christou-Ergos1Chris Degeling2Rosalind McDougall3Penelope Robinson4Katie Attwell5Catherine Helps6Shevaun Drislane7Stacy M Carter8Sydney School of Public Health, The University of SydneySydney School of Public Health, The University of SydneyAustralian Centre for Health Engagement, Evidence and Values, The University of WollongongMelbourne School of Population and Global Health, The University of MelbourneSydney School of Public Health, The University of SydneySchool of Social Sciences, Asian Studies & Politics, International Relations, University of Western AustraliaSydney School of Public Health, The University of SydneySchool of Social Sciences, Asian Studies & Politics, International Relations, University of Western AustraliaAustralian Centre for Health Engagement, Evidence and Values, The University of WollongongAbstract Background Parental refusal of routine childhood vaccination remains an ethically contested area. This systematic review sought to explore and characterise the normative arguments made about parental refusal of routine vaccination, with the aim of providing researchers, practitioners, and policymakers with a synthesis of current normative literature. Methods Nine databases covering health and ethics research were searched, and 121 publications identified for the period Jan 1998 to Mar 2022. For articles, source journals were categorised according to Australian Standard Field of Research codes, and normative content was analysed using a framework analytical approach. Results Most of the articles were published in biomedical journals (34%), bioethics journals (21%), and journals that carry both classifications (20%). Two central questions dominated the literature: (1) Whether vaccine refusal is justifiable (which we labelled ‘refusal arguments’); and (2) Whether strategies for dealing with those who reject vaccines are justifiable (‘response arguments’). Refusal arguments relied on principlism, religious frameworks, the rights and obligations of parents, the rights of children, the medico-legal best interests of the child standard, and the potential to cause harm to others. Response arguments were broadly divided into arguments about policy, arguments about how individual physicians should practice regarding vaccine rejectors, and both legal precedents and ethical arguments for vaccinating children against a parent’s will. Policy arguments considered the normative significance of coercion, non-medical or conscientious objections, and possible reciprocal social efforts to offset vaccine refusal. Individual physician practice arguments covered nudging and coercive practices, patient dismissal, and the ethical and professional obligations of physicians. Most of the legal precedents discussed were from the American setting, with some from the United Kingdom. Conclusions This review provides a comprehensive picture of the scope and substance of normative arguments about vaccine refusal and responses to vaccine refusal. It can serve as a platform for future research to extend the current normative literature, better understand the role of cultural context in normative judgements about vaccination, and more comprehensively translate the nuance of ethical arguments into practice and policy.https://doi.org/10.1186/s12910-023-00978-xVaccinationImmunizationVaccine refusalParentsSystematic reviewNormative literature |
| spellingShingle | Kerrie Wiley Maria Christou-Ergos Chris Degeling Rosalind McDougall Penelope Robinson Katie Attwell Catherine Helps Shevaun Drislane Stacy M Carter Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature BMC Medical Ethics Vaccination Immunization Vaccine refusal Parents Systematic review Normative literature |
| title | Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature |
| title_full | Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature |
| title_fullStr | Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature |
| title_full_unstemmed | Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature |
| title_short | Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature |
| title_sort | childhood vaccine refusal and what to do about it a systematic review of the ethical literature |
| topic | Vaccination Immunization Vaccine refusal Parents Systematic review Normative literature |
| url | https://doi.org/10.1186/s12910-023-00978-x |
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