Question

This article is about immunizations and health disparities as an ethical discussion. This is full of ethical concerns, identify an appropriate provision from the nursing code of ethics, and what you think should or could be done to address it.

Vaccine Research and Testing

Ethical discussions also surround the research and testing of vaccines, including discussions about vaccine development, and study design, population, and trial location.

To be licensed, vaccines go through many years of research and must pass rigorous safety and efficacy standards.^[1] The vaccine development and research process include diverse experts in many scientific and social disciplines, including public health, epidemiology, immunology, and statistics, and pharmaceutical companies. These stakeholders may have conflicting priorities and motives, which contributes to various ethical discussions.^[10]

Sometimes researchers disagree about whom to include in vaccine trials. To properly test a vaccine’s effectiveness, a clinical trial including a control group that does not get the test vaccine is usually necessary.^[1] Failing to provide any adequate preventive option can be a difficult decision when the vaccine can potentially prevent serious, untreatable, or fatal infection, however. For instance, TB vaccine researchers have struggled to devise ethical control group procedures. Existing TB vaccines, called Bacillus Calmette-Guérin (BCG) vaccines, are not always effective to prevent TB and can cause infections in people with compromised immune systems, such as people living with HIV/AIDS. When they test the effectiveness of new strategies, researchers debate over whether or not it is safe and ethical to give control participants these vaccines.^[11]

Additionally, it is important to understand a vaccine’s safety and efficacy in various populations, but testing a vaccine in vulnerable populations, such as children, also raises ethical concerns.^[12] Researchers must balance the need to protect children’s safety with the need to adequately understand how a vaccine will perform and protect children when administered.

Similarly, it is important to understand how vaccines affect people in developing countries. Yet, conducting vaccine research in developing countries includes a list of ethical concerns such as how to provide necessary screening or treatment if diseases are detected; how to meaningfully involve local communities in the research design process; how to ensure the trial and vaccine can be supervised by local ethical review panels; and how to ensure that participants understand consent.^[11] For example, participants in a malaria vaccine trial in Mali reported difficulty understanding several concepts including withdrawal from the study, side effects from the vaccine, and the difference between a research study and therapy,^[13] suggesting that better communication strategies are required to ensure proper consent across cultures.

Ethical discussions are a key component of HIV vaccine research and development because HIV vaccines pose numerous unique ethical challenges. For example, AIDS stigma may put vaccine trial participants at psychological risk if they encounter discrimination. In addition, researchers have to figure out how to provide appropriate and adequate medical care and protection from stigma for participants who screen HIV positive. And, researchers have to consider that if participants misunderstand the trial, they may think that they are protected from the virus and put themselves at risk.^{[1], [10], [14-15]} The complexity of these issues places ethics analyses at the forefront of HIV vaccine research.

Answer 1

ANSWER: CODES ARE IMPORTANT TO PROMOTE HIGH STANDARDS OF COMPETENCE AMONG ITS MEMBERS.CODE OF ETHICS IS DERIVED FROM THE DIGNITY AND RIGHTS OF THE PATIENT AS A PERSON.THESE ARE THE INDICATORS OF ACCEPTANCE OF THE TRUST AND HAVE THE RESPONSIBILITY THE PATIENT PLACES IN THE PROFESSION. THE CODE OF ETHICS FOR REGISTERED NURSES APPLIES TO NURSE IN ALL PRACTICE SETTINGS,WHATEVER THEIR POSITION AND AREA OF RESPONSIBILITY.THE CODE IS PARTICULARLY VALUABLE IN TODAY'S HEALTHCARE ENVIRONMENT BECAUSE IT CLEARLY AND ELOQUENTLY REITERATES THE FUNDAMENTAL VALUES AND COMMITMENTS OF THE NURSE [PROVISIONS 1-3], IDENTIFIES THE BOUNDARIES OF DUTY AND LOYALTY [PROVISIONS 4-6] ,AND DESCRIBES THE DUTIES OF THE NURSE THAT EXTEND BEYOND INDIVIDUAL PATIENT ENCOUNTERS [PROVISIONS 7-9] . TO SERVE AS THE MOST USEFUL AID IN CHALLENGING SITUATIONS,THE CODE'S INTERPRETIVE STATEMENTS PROVIDE SPECIFIC GUIDANCE FOR PRACTICE.THE STATEMENTS RESPOND TO THE CONTEMPORARY CONTEXT OF NURSING AND RECOGNIZE THE LARGER SCOPE OF NURSING'S CONCERN FOR SOCIETAL HEALTH.THE 4 MAIN ETHICAL PRINCIPLES IN NURSING ARE AUTONOMY,BENEFICENCE,JUSTICE,AND NON-MALEFICENCE.

   ETHICS ARE INVOLVED IN MAKING PUBLIC HEALTH DECISIONS

• CLINICAL MEDICINE .INDIVIDUAL LIBERTY,
• AUTONOMY,PRIVACY.BENEFICENCE,
• NONMALEFICENCE.DISTRIBUTIVE JUSTICE.
• PUBLIC HEALTH .RESPECT FOR PERSONS.
• INTERRELATEDNESS.SOCIAL GOOD,AVOIDING SOCIAL.
• HARM.SOCIAL JUSTICE,HUMAN RIGHTS.

RESEARCH ETHICS

• HONESTY
• OBJECTIVITY:..INTEGRITY:..
• CAREFULNESS:....
• OPENNESS:..
• RESPECT FOR INTELLECTUAL PROPERTY:....
• CONFIDENTIALITY:....
• RESPONSIBLE PUBLICATION:

INTRODUCING PUBLIC HEALTH ETHICS POSES TWO SPECIAL CHALLENGES.FIRST,IT IS A RELATIVELY NEW FIELD THAT COMBINES PUBLIC HEALTH AND PRACTICAL ETHICS.ITS UNFAMILIARITY REQUIRES CONSIDERABLE EXPLANATION,YET ITS SCOPE AND EMERGENT QUALITIES MAKE DELINEATION DIFFICULT. A SECOND CHALLENGE, THEN ,IS TO ARTICULATE AN APPROACH SPECIFIC ENOUGH TO PROVIDE CLEAR GUIDANCE YET SUFFICIENTLY FLEXIBLE AND ENCOMPASSING TO ADAPT TO GLOBALCONTEXTS.THE ETHICS OF RESEARCH RELATED TO HEALTHCARE IN DEVELOPING TO THE APPROPRIATE RESEARCH ETHICS COMMITTEES CONTROL OF HIV INFECTION REQUIRES NOT ONLY RESEARCH ON TREATMENTS AND POTENTIAL VACCINES,.. BROADER PROGRAMMES AS IN THE CASE OF GLOBAL ALLIANCE FOR VACCINES.