There currently exist no cure for Human Papilloma Virus (HPV). However, the use of vaccines can prevent the condition. However, the virus infects approximately 6.3 million individuals in the United States each year as new cases. According to the Centers for Disease Control and Prevention (CDC) the treatments that exist for HPV is for the related health problems associated with the virus (Mitchell, 2015). Furthermore, HPV has at least 30 strains which have infected almost half of the sexually active individuals once in their life. Besides, the nursing practice is guided by ethical frameworks that form benchmarks upon which the nursing practice should center around. The ethical considerations helps the nurses to act on a moral ground thereby avoiding conflict with the law and the society. This paper will address the ethical dilemma involved in the forced vaccination for HPV among girls as a requirement for school admissions.
Assessment of the situation
Cervical cancer is the leading killer among cancer-inflicted women in the world. HPV vaccination has been recommended as a way of preventing future cervical cancer cases among women. Therefore, many states in the United States have enacted bills that direct schools to provide mandatory immunization for girls aged 11-12 years. This is a move of immunizing the girls before they reach a sexually active age by vaccinating them with Merck's Gardasil and GlaxoSmithKline's Cervarix which are vaccines targeting HPV strains. This is because approximately 72% of cervical cancer reports and almost 92% of genital warts are associated with the HPV strains (Surry, 2016). States such as Columbia, Virginia and Rhode Island have issued requirements for HPV vaccination as a school attendance requirement. Therefore, some of the schools have staffed nurses to facilitate the immunization. However, the position places the nurses in an ethical dilemma since some of the students have reported developing complications after the vaccination. Besides, other students have claimed that they have already been vaccinated, but the administration sometimes rejects their claims citing their ploy to avoid the vaccination.
Diagnose the Ethical Dilemma
During the admission day at a local school, the nurses are faced with the task of immunizing the girls who are being enrolled in grade 7. However, the nurses are in a dilemma since some of the students have reported the complications they usually develop as a result of HPV vaccine injections. The nurses are struck between the ethical principle of autonomy and beneficence. Autonomy gives the student the discretion to make informed choices without due interference from others based on their beliefs and religious background (Keyko, 2014). However, the decisions have to be consistent with the nursing practice. Therefore, this gives the student the full control over information needed in making the informed decision. The student has read research in which it reveals the side effects of the HPV vaccination as compared to the significance of the vaccination. The student then decides that according to them, it is unethical to inject the vaccination basing on the kind of harm they are going to develop. Then she decides to tell the same to the nurse. The nurse considers that the student is informed and feels that the student`s autonomy on whether to get vaccine injection overrides her need to inject the vaccine to the student. Furthermore, the principle of beneficence takes into account the actions of the nurse which should always be targeted to promoting good among the patients they serve. The ethical principle encourages the act of doing what the nurse considers as the best option for the student. In the execution of the mandate, the nurse decides that it is prudent to inject the vaccination to the student. One is because, according to the nurse, it is the only way the girl can get admitted since it is the prerequisite condition. Besides, the nurse has not read the research that the student claims to have read that disputes the role of HPV vaccination. On the other hand, according to the nurse, the vaccine will serve its purpose by preventing the girl from getting exposed to cervical cancer
Implement and Evaluate Decision
As the nurse is reviewing the choices she is going to take, she has to decide what she is going to implement. Based on her evaluation and consideration of the ethical principles, the nurse makes a decision she considers worthwhile, both to the profession and for the benefit of the girl. The nurse injects the HPV vaccination to the girl, thinking its the best option for the patient. After the injection, the girl feels that her rights have been trampled upon and the nurse did not give her the right to exercise her autonomy. This is because she feels that she had explained everything to the nurse.
After the admission of students is over, and the students have focused on their education, the nurse receives the same student who comes citing severe complications on her body. She narrates that she has developed allergies. The allergies include redness and swelling where the injection was admitted, vomiting, nausea, and menstrual pain (Tomljenovic & Shaw, 2012). The nurse examines the student and notes that indeed it is true. Although the nurse had initially felt that the vaccine injection was the right decision to make for the girl, this time the nurse feels that she should have listened to the girl and evaluated the situation. She realized that she had made a wrong decision. She re-evaluates her choice on whether it had sufficiently addressed the ethical principles involved. This involved evaluating on whether she had sufficiently utilized beneficence and autonomy principles. She evaluated herself on whether she had acted with bias based on the conditions that were set by the school regulations.
After the evaluation, the nurse discovers that she had not acted upon full consideration of the situation. She realized that she should have proceeded with the objectivity of the situation, and on the autonomy of the patient`s decision. Denying the girl the opportunity to exercise her autonomy was wrong regardless of her age. Considering that the girl had explained the situation to her and even substantiated the claims with the research the student had just read. In fact, the nurse felt that she should have recommended the same study to the management for consideration and further action to the made regarding the choice to give mandatory vaccination.
Application to my Career
Nursing practice is governed by fundamental ethical principles that nurses are supposed to observe. The ethical guidelines have ensured that nurses make the right moral decisions so that they avoid conflict in decision making. However, sometimes the healthcare practitioners have faced diverse ethical dilemmas emerging from their profession of the various ethical principles. This is because, in a particular situation, several ethical frameworks may need to be applied. This, in turn, has brought dilemma with the nurses wanting to observe the principles for them to appear professional. However, the ethical principles need to be observed by every registered nurse. Any medical and nursing student has to learn and apply the applicability of the various ethical principles so that they make rightful decisions in future regarding the best choice to implement for the patients they will serve.
Keyko, K. (2014). Work engagement in nursing practice. Nursing Ethics, 21(8), 879-889. http://dx.doi.org/10.1177/0969733014523167
Mitchell, D. (2015). HPV vaccination and the prevention of oropharyngeal cancer: two steps forward and one to the side?. Faculty Dental Journal, 6(1), 14-17. http://dx.doi.org/10.1308/204268515x14174408395768
Surry, L. (2016). Mandatory HPV Vaccination: An Ethical Analysis. The Journal Of Healthcare Ethics & Administration, 2(1). http://dx.doi.org/10.22461/jhea.1.7169
Tomljenovic, L., & Shaw, C. (2012). Mandatory HPV Vaccination. JAMA, 307(3). http://dx.doi.org/10.1001/jama.2011.2020
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