The smallpox vaccination of health care workers: Professional obligations and defense against bioterrorism

Hastings Center Report

Volumn 33, Issue 5, 2003, Pages 26-33

  May, Thomas ^a   Aulisio, Mark P ^a   Silverman, Ross D ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

SMALLPOX VACCINE;

ARTICLE; BIOLOGICAL WARFARE; ETHICS; HEALTH CARE AND PUBLIC HEALTH; HEALTH CARE PERSONNEL; HUMAN; MORALITY; ORGANIZATION AND MANAGEMENT; SOCIAL BEHAVIOR; UNITED STATES; VACCINATION; WAR AND HUMAN RIGHTS ABUSES;

HEALTH CARE AND PUBLIC HEALTH; WAR AND HUMAN RIGHTS ABUSES;

BIOTERRORISM; HEALTH PERSONNEL; HUMANS; MORAL OBLIGATIONS; SECURITY MEASURES; SMALLPOX VACCINE; SOCIAL RESPONSIBILITY; UNITED STATES; VACCINATION;

EID: 1542468789     PISSN: 00930334     EISSN: None     Source Type: Journal    
DOI: 10.2307/3528633     Document Type: Review

References (53)

1. C. Connolly, 2 large hospitals refuse smallpox shots. Washington Post, 18 December 2002, p. A02.
2. Report to the Chairman, Committee on Governmental Affairs, U.S. Senate, "Smallpox Vaccination: Implementation of National Program Faces Challenges," (GAO-03-578), United States General Accounting Office, April, 2003
3. C. Connolly, "Smallpox Shots Cause Worry: Experts Startled by Array of Side Effects," Washington Post, 5 December 2002.
4. Report to the Chairman, Committee on Governmental Affairs, U.S. Senate, "Smallpox Vaccination: Implementation of National Program Faces Challenges," (GAO-03-578), footnote 33.
5. See J.M. Neff, J.M. Lane, V Fulgini-ti and D.A. Henderson, "Contact Vaccinia-Transmission of Vaccinia From Smallpox Vaccination," JAMA vol. 288, no. 15 (2002), p. 1901-1905.
6. L. Parker, "Hospitals Balk at Smallpox Vaccine," USA Today, 20 January 2003.
7. H.R. 1770.
8. H.R. 1770, sec. 263. The determination will be made at a later date, by the Secretary of the Department of Health and Human Services, through the administrative rule-making process.
9. Report to the Chairman, Committee on Governmental Affairs, U.S. Senate, "Smallpox Vaccination: Implementation of National Program Faces Challenges," p. 19
10. Centers for Disease Control and Prevention websire, "FAQs about Smallpox," http://www.bt.cdc.gov/DocumentsApp/FAQSmallpox.asp?link= 2&page=bio
11. http://www.bt.cdc.gov/agent/small-pox/vaccination/cardiacrecentvaccinees. asp
12. Associated Press, "States Halt Smallpox Shots," 31 March 2003.
13. Report to the Chairman, Committee on Governmental Affairs, U.S. Senate, "Smallpox Vaccination: Implementation of National Program Faces Challenges," p. 11
14. Centers for Disease Control and Prevention, 2002. Smallpox Response Plan and Guidelines, Version 3.0, Annex 3, available ar http://www.bt.cdc.gov/agent/ smallpox/response-plan/index.asp.http://www.bt.cdc.gov/documentsapp/Smal/lPox/ RPG/index.asp
15. Ibid.
16. Ibid.
17. Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities. Thtive to questions concerning distribution of welfare between individuals. In principle, if persecuting a minority yields a higher aggregate utility than equal treatment, then the persecution is justifiable. As Rawls puts it, classical utilitarianism treats the political community as a single entity, thereby focusing moral and political deliberation on how best to maximize the overall well-being of this corporate individual (Rawls, A Theory of Justice, 22-33.). Thus it appears to target the corporate conception of the common good. Some versions of utilitarianism attempt to avoid this pitfall. David Brink's "objective utilitarianism" is intended to provide a contrast with subjective theories that reduce human welfare to mental states such as pleasure. Brink proposes a non-reductive, naturalistic account of human welfare whose primary components include the reflective pursuit and realization by agents of reasonable life projects and the development of personal and social relationships of mutual concern and commitment (D.O. Brink, Moral Realism and the Foundations of Ethics (New York.: Cambridge University Press, 1989), 230-45, 262-90). Brink argues that his account is distribution-sensitive because basic goods such as health, nutrition, and education, are either necessary conditions for the existence of value, or they are all-purpose means that enable individuals to pursue a wide range of individual life plans (272), and, claims Brink, this definition of welfare does not permit trade offs between access to basic goods for increases in social utility (D.O. Brink, "Mill's Deliberative Utilitarianism," Philosophy and Public Affairs 21, no. 1 (1992): 67-103). This is a generic interests conception of the common good, in the sense that it defines the common good in terms of a set of interests that members of the community share and have reason to promote both in their own case and with respect to every other member of the community as well.e Model State Emergency Health Powers Act. (Washington, D.C. Georgetown and John Hopkins Universities, December 21, 2001). Available at: http://www.publichealthlaw.net/. Last accessed 17 December 2002.
18. Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities. Model laws. http://pub-lichealthlaw.net/Resources/ Modellaws.htm. Last accessed 17 December 2002.
19. L.O. Gostin, J.W Sapsin, S.P Teret, S. Burris, J.S. Mair, J.G. Hodge Jr, J.S. Ver-nick. The Model State Emergency Health Powers Act: planning for and response to bioterrorism and naturally occurring infectious diseases. JAMA, Vol. 288, no. 5, (2002):622-8, at 624-5.
20. Ibid, at 627
21. Ibid, at 626.
22. G. Annas, Standard of Care. (Oxford, UK: Oxford University Press, 1993), p. 121.
23. Ibid., p. 121
24. T. May, Bioethics in a Liberal Society (Baltimore, Md.: Johns Hopkins University Press, 2002).
25. D.M.Bell, DM. "HIV infection in Health Care Workers: Occupational Risk and Prevention," in L. Gostin (ed.), AIDS and the Health Care System.( New Haven, Conn.: Yale University Press, 1990).
26. G. Annas, Legal Risks and Responsibilities of Physicians in the AIDS Epidemic. Hastings Center Report Vol. 18 no. 2 (1988):S26-S32.
27. Freedman B. Health Professions, Codes, and the Right to Refuse to Treat HIV-infectious Patient. Hastings Center Report 1988;18(2Supp):20-25.
28. Arras J. The Fragile Web of Responsibility: AIDS and the Duty to Treat. Hastings Center ReporVol. 18 no. 2 (1988):S10-S20.
29. D.M. Bell, "HIV infection in Health Care Workers: Occupational Risk and Pre-venrion," p. 15-124.
30. See R. Falkenrath, R. Newman, and B. Thayer, America's Achilles' Heel: Nuclear, Biological and Chemical Terrorism and Covert Attack, Belfer Center for Science and International Affairs Studies in International Security (Cambridge, Mass.: MIT Press, 2001).
31. G. Annas, "Standard of Care," p. 122.
32. Ibid., p. 120.
33. Report to the Chairman, Committee on Governmental Affairs, U.S. Senate, "Smallpox Vaccination: Implementation of National Program Faces Challenges," p. 17-18.
34. C. Connolly, Smallpox Campaign Taxing Health Resources. Washington Post, 10 March 2003, p.A04.
35. See A. Manning, "Public Confidence at Risk in Vaccine Plan," USA Today, 1 December 2002. http://www.usatoday.com/news/health/200 2-12-01-smallpox-usat-x.htm
36. See T. May, "Vaccines as Community-Oriented Therapy," Expert Review of Vaccines (June, 2003): 341-343.
37. See T. May, "Armed Services Smallpox Vaccination: Medical Research and military Necessity," Human Rights (forthcoming, Spring, 2003).
38. Report to the Chairman, Committee on Governmental Affairs, U.S. Senate, "Smallpox Vaccination: Implementation of National Program Faces Challenges," footnote 8.
39. See K.E. Lasser, P.D. Allen, S.J. Woolhandler, et al, "Timing of new black box warnings and withdrawls for prescription medications," JAMA vol. 287, no. 17 (2002), p. 2215-20.
40. See J. Cohen and M. Enserik, "Rough and Tumble Behind Bush's Small-pox Policy," Science Magazine vol. 298, no. 5602 (2002).
41. See W Foege, "Can Smallpox Be As Simple as 1-2-3?" Washington Post, 27 December 2002.
42. Report to the Chairman, Committee on Governmental Affairs, U.S. Senate, "Smallpox Vaccination: Implementation of National Program Faces Challenges," p. 12.
43. Ibid., p.25.
44. D. Milbank, "Bush Leans To Limited Smallpox Vaccination," The Washington Post, 23 November 2003.
45. The Global Infectious Disease Threat and Its Implications for the United States (Washington, D.C.: National Intelligence Council; 2000). Publication NIE 99-17D.
46. A. Jonsen, "The Duty to Treat Patients with AIDS and HIV Infection" in L. Gostin (ed.) AIDS and the Health care System. (New Haven, Conn.: Yale University Press, 1990).
47. T.A. Brennan, "Occupational Transmission of HIV: An Ethical and Legal Challenge" in L. Gostin (ed.) AIDS and the Health care System. (New Haven, Conn.: Yale University Press, 1990).
48. Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities. The Model State Emergency Health Powers Act. Washington, D.C.; 23 October 2001. Section 502(b). Available at: http://www.publichealthlaw. net/MSEH-PA/MSEHPA.pdf. Accessed 1 November 2001.
49. Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities. The Model State Emergency Health Powers Act. Washington, D.C.; 21 December 2001. Section 608(a). Available at: http://www. publichealthlaw.net/MSEHPA/MSEHPA2.pdf. Accessed 17 December 2002.
50. P. Davies, The Devil's Flu. (New York, NY: Owl Books, 2000), especially chapter 2.
51. D.M. Fox, The Politics of Physicians' Responsibility in Epidemics: A Note on History. Hastings Center Report vol. 18, no. 2 (1988): S5-S10.
52. K. Downey, "Nurses Brace for SARS," Washington Post, 10 June 2003, p. HE01.
53. May, "Vaccines as Community-Focused Therapy," p. 341-343.