Connect
MJA
MJA

Childhood tetanus in Australia: ethical issues for a should-be-forgotten preventable disease

Paul N Goldwater, Richard G Power, Paul H Henning, Terence G Donald, Jon N Jureidini, Christine F Finlay, Annette J Braunack-Mayer and Mike S Gold
Med J Aust 2003; 178 (4): 175-177.

Summary

  • Refusal of a parent to have a child vaccinated against tetanus raised ethical issues for the treating clinicians.

  • The clinicians felt their duty to the child was compromised, but recognised that our society leaves the authority for such decisions with the parents.

  • As there was no reason, other than different beliefs about vaccination, to doubt the parent's care for the child, the clinicians limited their response to providing strong recommendations in favour of vaccination.

  • Other issues raised by this case include community protection, and the costs to the community of treating a vaccine-preventable disease.

Please login with your free MJA account to view this article in full

  • Paul N Goldwater1
  • Richard G Power2
  • Paul H Henning3
  • Terence G Donald4
  • Jon N Jureidini5
  • Christine F Finlay6
  • Annette J Braunack-Mayer7
  • Mike S Gold8

  • 1 Women's and Children's Hospital, North Adelaide, SA.
  • 2 Departments of Public Health and Paediatrics, University of Adelaide, Adelaide, SA.
  • 3 South Australian Immunisation Coordination Unit, Adelaide, SA.

Correspondence: 

Competing interests:

None identified.

  • 1. National Health and Medical Research Council. The Australian immunisation handbook. 7th ed. Canberra: NHMRC, 2000; 212-220. Available at: http://immunise.health.gov.au/metadata/handbook_7.htm
  • 2. Hlady WG, Bennett JV, Samadi AR, et al. Neonatal tetanus in rural Bangladesh: risk factors and toxoid efficacy. Am J Public Health 1992; 82: 1365-1369.
  • 3. Wassilak SGF, Orenstein WA, Sutter RW. Tetanus toxoid. In: Plotkin SA, Orenstein WA. Vaccines. 3rd ed. Philadelphia: WB Saunders Co, 1999; 441-474.
  • 4. Annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell 1999; 23: 296.
  • 5. Praharaj KC. Recurrent tetanus. J Indian Med Assoc 1972; 58: 11-12.
  • 6. Spenney JG, Lamb RN, Cobbs CG. Recurrent tetanus. South Med J 1971; 64: 859.
  • 7. Montgomery RD. Recurrent tetanus [letter]. BMJ 1968; 2: 829.
  • 8. Sahadevan MG. Recurrent tetanus [letter]. BMJ 1968; 2: 492-493.
  • 9. Wickramasinghe SY, Fernando M. Recurrent tetanus. BMJ 1967; 4: 530.
  • 10. Warter J, Mantz JM, Tempe JD, Otteni JC. Recurrent tetanus. Clinical, immunological and therapeutic considerations. Presse Med 1967; 75: 1223-1226.
  • 11. Jackson CL. State laws on compulsory immunization in the United States. Public Health Rep 1969; 84: 787-795.
  • 12. Dworkin G. The theory and practice of autonomy. Cambridge: Cambridge University Press, 1988; 85-99.
  • 13. Douglas JD. Cooperative paternalism versus conflictful paternalism. In: Sartorius R, editor. Paternalism. Minneapolis, Minn.: University of Minnesota Press, 1983; 174-200.
  • 14. Brock DW, Wartman SA. When competent patients make irrational choices. N Engl J Med 1990; 322: 1595-1599.
  • 15. Menahem S, Halasz G. Parental non-compliance — a paediatric dilemma: medical and psychodynamic perspective. Child Care Health Dev 2000; 26: 61-72.
  • 16. Faden RR, Beauchamp TL. A history and theory of informed consent. Oxford: Oxford University Press, 1986.
  • 17. Bradley P. Should childhood immunisation be compulsory? J Med Ethics 1999; 25: 330-334.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.