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Childhood Vaccination: Ethical Case Study

The nursing practice in the USA is a demanding profession that consists of daily care about the patients. Given the responsibility for human health and lives, nurses have to perform within the strictly defined rules in different dimensions, including organizational, professional, and ethical. The problem of moral behavior of nurses in the situations of difficult choice, decision-making, or conflict is actively discussed in scholarly medical literature.

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Being guided by a system of rules and principles listed in nursing codes, the professionals often face ethical dilemmas which require instant decision-making in favor of a patient. The researchers agree that such frequent situations impose stress and anxiety in nurses’ staff that makes the profession very demanding (Robichaux, 2016; Scott, 2017; Hendrix, Sturm, Zimet, & Meslin, 2016; Robinson et al., 2014). The existence of multiple ethical dilemmas in nursing practice requires nurses to incorporate their knowledge, professionalism, and moral principles of the occupation to deliver just solutions in the circumstances of moral decision-making. It is important to study an ethical case to underline the essential stages of a decision-making process.

Ethical Dilemma

The priority of nurse’s practice is the quality of service that is capable of guaranteeing the well-being of a patient. In most cases, people perceive the demonstration of moral principles as those a person shows in a moment of crisis (Scott, 2017). However, when working with people’s lives, nurses must demonstrate their high morality in their behavior not only in the times of crises but in their everyday professional life. Regarding the highly responsible occupation of medical workers, they are obligated to work within a system of rules and ethical principles listed in the codes of nursing practice.

The provision of these rules is possible because of the active involvement of the American Nurses Association Center for Ethics and Human Rights which supports nurses in their work providing sets of rules. This information in the form of rules and principles is listed in the Code of Ethics for Nurses that “is the social contract that nurses have with the U.S. public” (American Nurses Association, n.d.).

Every nurse must follow the rules and carry out their common medical interventions according to the basic principles. There are four basic principles of nursing practice which serve as “guidelines for moral deliberation” that include autonomy, nonmaleficence, beneficence, and justice (Robichaux, 2016, p. 16). An ethical dilemma is a case when two ethical principles “are in opposition to each other in an ethical situation and only one can be chosen (Robichaux, 2016, p. 78). Thus, when facing a case of moral choice, a nurse has to evaluate the influences that caused such a collision of principles and the outcomes of possible solutions before making a decision.

Children’s Vaccination as an Ethical Dilemma in Nursing

To show the ways a nurse might resolve the moral issues, it is essential to present an example of a case scenario. The situation for analysis involves parents who do not want to permit their child’s vaccination and a nurse who realizes the necessity of such intervention for their child. According to the recommended measles vaccination, a nurse suggested the procedure for the five-year-old boy. The parents refused to do so making a surrogate decision for their under-aged son.

However, the child has been showing the signs of poor health condition and has been placed in a hospital with different minor illnesses for the last year. A nurse working with the family is aware of the boy’s unstable health condition and understands the importance of measles vaccination to avoid dangerous health outcomes harmful for the child.

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This case demonstrates a random situation in medical practice when nurses’ beneficial motivation is being verified. In such circumstances, a professional has to show an “enhanced ability to act to bring about change” (Robinson et al., 2014, p. 12). According to the definition of an ethical dilemma presented in the previous section, the choice for or against vaccination of children made by their parents is also regarded as a moral dilemma. In the analyzed case, two principles: autonomy and beneficence collide and impose a conflict that needs to be professionally addressed.

The overall question of immunization is a widely addressed issue in the American medical field. The childhood vaccination, in particular, imposes an imbalance between parents’ autonomy in deciding if they want to immunize their children and nurses’ interest in public health benefit from the vaccination (Hendrix et al., 2016). The principle of autonomy suggests that an individual capable of reasoning has a right to make his or her personal voluntary decision based on the understanding of risks, benefits, and alternatives (Robichaux, 2016). Since the child is incapable of making its own decisions, parents are responsible for surrogate decision-making.

At the same time, the principle of beneficence requires a care provider to act prioritizing the “benefit of other promoting their welfare” (Robichaux, 2016, p. 317). Thus, on the one hand, a nurse has to respect the parents’ right to be autonomous in their decision-making, and on the other hand, she must ensure the safety and future well-being of a child.

Decision-Making Model Applied to the Ethical Dilemma

When resolving an ethical issue, it is vital to have a tool that incorporates all the stages of the decision-making process by including all the risks and benefits from the outcomes. Regarding the principles that are involved in the case, the model chosen for solution finding has to be a beneficence model that presents several steps needed to make a necessary decision. Answering the listed questions, a nurse will be able to identify core issues and less important ones.

Initially, it is essential to identify who is involved in the process. The analyzed case suggests that there are a five-year-old boy and his parents who make decisions for their child, and a nurse responsible for care provision. According to the beneficence decision-making model presented by Robichaux (2016), the next question a nurse has to answer concerns the ways how he or she can help the patient’s health. Within the case framework, a nurse is capable of ensuring the boy’s physical health condition in the future with the help of immunization. The next question is “How does the proposed … action benefit the patient?” (Robichaux, 2016, p. 32).

The nurse observed the weak health of a boy for a year is aware of the danger an infectious disease might cause to the child’s health. The following stage asks about the positive outcomes of the proposed intervention. According to the case, the boy will be protected from being infected with measles and will not be exposed to dangerous complications.

Moreover, it is vital to address the possible adverse results of the intervention. When assessing the risks of any harm made to the child during the immunization, these chances are less influential in comparison to the possibilities of the boy’s infection (Hendrix et al., 2016). Ultimately, the nurse has to answer the question that seeks the best solution for the patient’s wellbeing regarded from the professional point of view. In this regard, the most effective way to resolve the issue is to immunize a child, thus protecting highly probable harmful outcomes. Upon addressing all the steps of the model, a nurse must create an action plan that justifies the proposed solution to the ethical dilemma by incorporating all the participants’ interests and the presentation of benefits.

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Action Plan on the Basis of the Decision-Making Model and the Best Ethical Outcome of the Ethical Dilemma

The plan of actions aimed at the resolution of a moral dilemma has to follow the basic principles and address the reasoning of those who do not agree with the suggested solution. Firstly, it is vital to clarify the reasons why the parents refuse to immunize their son. Secondly, when the reasons are clear, it is possible to proceed with the following actions. They might involve research and statistical data analysis proving the validity of the nurse’s suggested intervention. Thirdly, the plan of communication of the results to the parents has to be developed. The presentation of the findings will show the benefits of immunization and the acute necessity of it for the boy. Using professionalism and knowledge, a nurse will be able to ensure the parents that the risks they fear are less than the dangers of their son to be traumatized by the complications after an infection.

Also, it is crucial for the nurse to show the caring attitude to the patient and his family. The understanding of the professional’s concern might amplify the attention of the surrogate decision-makers to consider the advice. The moral dilemma has to be addressed with the presentation of ethical principles. Therefore, a nurse has to be persistent in delivering the message clearly for the benefit of a patient. Finally, when the consensus is achieved, the immunization intervention should be carried out to implement the decision to practice.

Under the circumstances described in the ethical dilemma case, the best outcome of the issue would be the parents’ agreement to do the vaccination. If a nurse utilizes the decision-making model effectively and builds an action plan according to the prioritized solution, it will be possible to achieve the best result. Undoubtedly, such a favorable outcome has to be a leading point for any nurse practitioner in their every day dealing with ethical issues. The health of a patient needs to be addressed with care and responsibility to protect and guarantee life safety.


To summarize the discussion, nursing practice is a constant dealing with ethical dilemmas which lie in the collision of two core moral principles. Many professionals encounter numerous situations that require instant decision-making and conflict resolution with a priority given to the benefit of a patient’s health. Such an intensive professional life imposes stressful environment for the healthcare workers in general, and nurses in particular because they directly interact with the ill on a daily basis.

The scope of literary materials, researches, and methodologies allow preparing for controversial ethical situations in practice and their solving. Accurately utilizing the decision-making models and planning the necessary actions, a nurse has all the opportunities to succeed in decision-making and provide a high-quality service.


American Nurses Association. (n.d.). Ethics and human rights. Web.

Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M. (2016). Ethics and childhood vaccination policy in the United States. American Journal of Public Health, 106(2), 273-278.

Robichaux, C. (Ed.). (2016). Ethical competence in nursing practice: Competencies, skills, decision-making (2nd ed.). New York, NY: Springer Publishing Company.

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Robinson, E. M., Lee, S. M., Zollfrank, A., Jurchak, M, Frost, D., & Grace, P. (2014). Enhancing moral agency: Clinical ethics residency for nurses. The Hastings Center Report, 44(5), 12-20.

Scott, A. (Ed.). (2017). Key concepts and issues in nursing ethics. Cham, Switzerland: Springer.

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