As a medical assistant in a primary care office and vaccine for children coordinator, a big part of my job was to push for vaccines for our patients. Of the many vaccines, there is one in particular that is difficult to discuss with individuals, the HPV vaccine. This is a vaccine, depending on one’s age, given in a two-dose series (under the age of 15) or three-dose series (at or over the age of 15) to protect against Human Papilloma Virus which is the most common sexually transmitted disease (White, 2014). There are low and high risk strains associated with HPV. The low risk strains are mild, patients generally do not even know they have this, and it will resolve with time. However, high risk strains are known to cause cancer and/or genital warts in the expressed area. This means that contracting high-risk HPV strains can greatly increase our risk of anogenital, vaginal, penile, and oropharyngeal cancers (White, 2014). HPV infection is responsible for half a million cases of cancer and more than 250,000 deaths every year (White, 2014).
As a vaccine coordinator, it is easy for me to say get this vaccine and prevent the spread of the infection, prevent cancers, and genital warts, however there are also many arguments against the HPV vaccine. Many patient’s receiving the vaccine are young, around the age of 11-15 and so it is difficult to discuss a sexually transmitted disease with these teenagers and their parents. Most children do not want to discuss sexual activity with their parents, shocker! I would always try to foster this open discussion with the parent involved, but it’s a little easier to put it in the context of future protection. This vaccine will help protect the child when they are an adult and when they are sexually active. I also had to warn patients about how painful the vaccine is and then monitor response to the vaccine as it is known to cause dizziness and syncope (White, 2014). This is a big put off to many patients and parents as they simply don’t want the side effects. Religion is also something that comes into play. If one is to be celibate until marriage and experience sex for the first time with their one and only partner, then what is the point of getting this vaccine? It’s difficult to have the discussion of religion with children and their parents. Maybe their children do not become part of the religion or maybe they don’t follow celibacy, against their parent’s wishes.
I find the HPV argument interesting on either side. It ultimately comes down to beneficence versus autonomy. As a provider, you of course want to protect your patient against cancer, but you also want the decision to be up to them. Where do you stand? What will you say as a provider to your patient?
Reference:
White MD. Pros, cons, and ethics of HPV vaccine in teens—Why such controversy? Transl Androl Urol 2014;3(4):429-434. doi: 10.3978/j.issn.2223-4683.2014.11.02
Hi Tionna,
ReplyDeleteThis is a very interesting and controversial topic. When discussing about vaccines. Vaccines have been a controversial topic due to the research that came out saying that "it causes autism." When looking at the two scenarios of autonomy and beneficence, it is hard to decide. As a provider, I would for sure have to consider the parent's choice and their autonomy. Due to the child being under 18 and not able to make his own decision, it would have to be a conversation for the parents and to communicate with them. As a provider, I would make sure to disclose important details in which the side effects of HPV to the benefits is minimal. A research found that 92.4% of individuals don't have adverse events. In which they describe adverse events as life threatening or even death.(White) As a result, I would try to tell them the future benefits and see what they think after that.
Wheeler, R. (2018, October 24). The HPV vaccine: Why parents choose to refuse. Retrieved October 05, 2020, from https://hub.jhu.edu/2018/10/24/why-parents-refuse-hpv-vaccine/
White, M. (2014, December). Pros, cons, and ethics of HPV vaccine in teens-Why such controversy? Retrieved October 05, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708146/
My knee jerk reaction after reading this post is that everybody should get the HPV vaccine because the benefits to society and to the individual outweigh the possible implications. This however, is my own opinion on the vaccine and a very big part of being a healthcare provider is being able to consider the patients (and patient’s parents in this case) perspectives in order to not infringe on autonomy. The conflict between benefiscence and autonomy comes up often as they are both required to be upheld by a provider yet sometimes appear to be at odds with each other. Providers can object to any procedures that they deem would be harmful to the patient but patients also have the right to autonomy in medical decisions that should not be oppressed by medical professionals (Rouse, 2012). Regarding the HPV vaccine it is still my opinion that getting the vaccine is the decision that should be encouraged because the positives (decrease in cancer risks) outweigh the negatives (a painful vaccine that may lead to dizziness and fainting) (White, 2014). However since the vaccine is related to an STD there is naturally an aversion by the patients to discussing it, so often the easier choice would be to just say no and not think about the long term implications of this choice. As a provider I would definitely present both sides of getting the vaccine to my patients but also attempt to make sure they understand the serious ramifications that may occur in the long term if the decision is made not to get the vaccine. I would attempt to foster discussion, even though it is often uncomfortable, around STDs because to me the possibility of getting cancer far outweights the potential expectations that parents have for their children regarding certain life practices stemming from religion or otherwise. Of course, this is all my own perspective and it is interesting to consider the other side of the vaccine debate which I am sure I will encounter as a provider. In the end of course there will be no forcing the vaccine on anybody as a patients autonomy must be upheld but this debate seems to have an even deeper layer because it is with patients who are not autonomous from their parents but may have differing perspectives on what they want for their bodies and future which also need to be considered.
ReplyDeleteRouse, T. S. (2012). Professional Autonomy in Medicine: Defending the Right of Conscience in Health Care Beyond the Right to Religious Freedom. Sage Journals 79(2), 155-168. https://doi-org.dml.regis.edu/10.1179/002436312803571393
White, M. D. (2014). Pros, cons, and ethics of HPV vaccine in teens-Why such controversy? Translational andrology and urology 3(4) 429-434. doi: 10.3978/j.issn.2223-4683.2014.11.02