John T Jacob, Dharmapalan Dhanya
Retired Professor, Christian Medical College, Vellore, Tamil Nadu 632004.,
Consultant in Paediatrics and Paediatric Infectious Diseases, Apollo Hospitals, CBD Belapur, Navi Mumbai 400614.,
Indian J Med Ethics. 2019 Jan-Mar;4(1):26-29. doi: 10.20529/IJME.2018.074. Epub 2018 Sep 21.
Medical ethics is invoked for immunisation of children as it involves an interaction between a healthcare professional and the child. Immunisation under the national immunisation programme is a public health intervention and the common belief is that ethics is not relevant. Two vaccines with contrasting safety and efficacy profiles were available against polio before the national immunisation programme was launched: the inactivated poliovirus vaccine (IPV) and the live attenuated oral poliovirus vaccine (OPV). India chose OPV and excluded IPV. We carried out an ethical appraisal of that choice. Principles of medical ethics comprising four elements-non-maleficence, beneficence, autonomy and justice-was already in vogue at the time. Applying each of them, a head-to-head comparison between IPV and OPV is made. The results clearly show that the choice of vaccine was made without using ethical principles, resulting in serious adverse effects in hundreds of thousands of children. We recommend that medical ethics must be applied to all choices of public health interventions.
医学伦理学被应用于儿童免疫接种，因为这涉及医疗保健专业人员与儿童之间的互动。国家免疫规划下的免疫接种是一种公共卫生干预措施，人们普遍认为伦理学与之无关。在国家免疫规划启动之前，有两种安全性和有效性截然不同的脊髓灰质炎疫苗可供选择：灭活脊髓灰质炎病毒疫苗（IPV）和减毒口服脊髓灰质炎活疫苗（OPV）。印度选择了OPV并排除了IPV。我们对这一选择进行了伦理评估。当时，包含四个要素——不伤害、有益、自主和公正——的医学伦理原则已经流行。运用这些原则，对IPV和OPV进行了直接比较。结果清楚地表明，疫苗的选择没有遵循伦理原则，导致数十万儿童出现严重不良反应。我们建议，医学伦理学必须应用于公共卫生干预措施的所有选择。
