Dhriti Jagadish, Nathaniel Mamo, Felicia Pasadyn, Arthur Caplan
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引用次数: 0
摘要
知情同意是医学伦理不可或缺的原则。然而,美国缺乏标准化的免疫接种同意程序,各州和私营公司只能依赖 1986 年《全国儿童疫苗伤害法案》引入的《疫苗信息声明》(VISs)。VISs 的制定并没有考虑到患者的自主权,而是为了应对过多的疫苗伤害诉讼和由此造成的疫苗供应短缺。VISs 并没有提供有意义的信息披露,其制作者--疾病控制和预防中心--自己也承认,VISs 不应被误认为是知情同意书。在内容上,VIS 的可读性过于复杂,没有将免疫接种置于公共卫生的背景下,也没有介绍所有的替代方案。VIS 的提供也不充分,给患者消化疫苗信息的时间有限,而且不需要任何文件来确保 VIS 的提供。简而言之,VIS 对引发深思熟虑和增加对疫苗的信心作用甚微。本文建议对 VIS 的内容、提供和问责机制稍作改进,以确保分发。作者认为,不应该浪费这些病人--提供者的时刻--让病人更好地了解自己的健康、疾病的威胁以及他们对公众所做贡献的分量。
Is informed consent correctly obtained for vaccinations?
Informed consent is an integral tenet of medical ethics. However, the United States lacks a standardized consent process for immunizations, with states and private companies instead reliant on Vaccine Information Statements (VISs) introduced by the 1986 National Childhood Vaccine Injury Act. VISs, rather than being developed with patient autonomy in mind, were a response to excessive vaccine injury litigation and resulting vaccine supply shortages. VISs do not provide meaningful information disclosures, with its producer - the Centers for Disease Control and Prevention - itself admitting that VISs should not be mistaken for informed consent forms. In its content, the VIS is too complex in its readability, does not situate immunization in a public health context, and does not present all alternatives. VIS delivery is also inadequate, with limited time given for patients to digest vaccine information and no documentation required to ensure that VISs were presented at all. Simply put, VISs do little to spark deliberation and increase vaccine confidence. This article recommends minor improvements to VIS content, delivery, and accountability mechanisms to ensure distribution. The authors argue that these patient-provider moments - for patients to better understand their health, the threat of disease, and the weight of their contribution to the public - should not be squandered.
期刊介绍:
(formerly Human Vaccines; issn 1554-8619)
Vaccine research and development is extending its reach beyond the prevention of bacterial or viral diseases. There are experimental vaccines for immunotherapeutic purposes and for applications outside of infectious diseases, in diverse fields such as cancer, autoimmunity, allergy, Alzheimer’s and addiction. Many of these vaccines and immunotherapeutics should become available in the next two decades, with consequent benefit for human health. Continued advancement in this field will benefit from a forum that can (A) help to promote interest by keeping investigators updated, and (B) enable an exchange of ideas regarding the latest progress in the many topics pertaining to vaccines and immunotherapeutics.
Human Vaccines & Immunotherapeutics provides such a forum. It is published monthly in a format that is accessible to a wide international audience in the academic, industrial and public sectors.