Medical Ethics

Date: June 22, 2005. A 27-year-old man is brought into a New York City emergency room
with a 101-degree fever, and what he believes is chickenpox (Varicella). After a brief
examination, the 35-year-old physician is puzzled because the pox do not appear to be
typical of the varicella-zoster virus. Worried, he calls in another physician for her opinion.
She takes one look at the patient, determines he has small pox, and immediately orders him
to be quarantined. She notifies the Centers for Disease Control and Prevention (CDC) and
asks them what should be done. 

While doing background on the patient, he tells the physicians that he is a flight attendant
and that he has flown to Orlando, FL, Los Angeles, CA, Chicago, IL, and Seattle, WA in the
past few weeks while working. Though he is given excellent treatment, and had been in
perfect health a few days earlier, the patient dies 7 hours after admittance to the hospital.

The CDC decides that mandatory small pox vaccines will be administered to all workers in
the NYC hospital, and to all patients who were in the ER. His co-workers are all given
mandatory vaccines as well, as are all people living in his apartment complex. They also ship
stored quantities of the vaccine to all of the cities where the man had flown to for work. The
vaccines are offered to citizens of these cities. Finally, all people, along with their families
who had been on the man's flights in the weeks preceding the appearance of the disease
are forced to receive the vaccine.

Questions:
Note: The flight attendant was most likely given small pox by a bio terrorist who flew on his
plane sometime during the past week/week and a half. The terrorist would have been
contagious but would not have shown symptoms. Virtually every person the man came into
contact with would have gotten the virus.

·         Is it ethical for the CDC to force people to get the vaccine?

·         An LA woman on the flight is religiously opposed to vaccines. Under California law she
can normally refuse vaccines on religious or personal grounds. However, the government
says she must receive the vaccine or face mandatory quarantine. What do you think of this?

·         Do you think that for more common diseases, for example measles, that it is ethical
for the state to allow people to refuse vaccines (even for religious grounds)? What if their
refusal can harm others who cannot have the vaccine, such as people who are
immunocompromised like AIDS patients?

·         Is it ethical for someone to refuse the vaccine?

·         You had driven down to Los Angeles 5 days ago to visit a friend for the weekend.
While in town, you visited many tourist attractions. You are worried and you try to get the
vaccine, but are denied it because of limited resources. What do you think of this?

·         Citizens begin calling for the mandatory quarantining of people directly exposed to
the victim, i.e those living in his apartment complex, those working in the ER, those who flew
on the plane in the prior week. What do you think of this?

·         The smallpox vaccine, like many other vaccines (example: oral polio vaccine) can
actually transmit the virus to others. In light of this, is it ethical for people to get the
vaccine? (Note: they are vaccinating those who may not want to be vaccinated)

Today, should health care workers be allowed/forced to get the smallpox vaccine? What
about non-health care worker citizens?