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1Module 2Balancing Individual and Community Claims:Establishing State Vaccination Policies2Four Key Questionsto AlwaysAsk Yourself• What is the ethical question?• What are the relevant facts?• Who or what could be affected by the way thequestion gets resolved?• What are the relevant ethical considerations?See theIntroductionFor more information about thefour key questions, see theIntroduction, page 5.3Ethical Considerations Relevant to This Module*Respect for PersonsHarms and Benefits• Under what circumstances, and to whatextent, should we respect an individual’schoice not to be vaccinated (or not to havehis or her children vaccinated)?• What are the risks and benefits of vaccinationfor individuals?• What are the risks and benefits of vaccinationfor the larger community?See Module 1Students are introduced to thefour key questions and ethicalconsiderations in Module 1.Modules 2–6 assume this priorknowledge. We strongly recommendthat you complete Module 1first with your students, beforestarting any of the other modules.4FairnessResponsibility• Is it ever fair to allow some individuals not tobe vaccinated, recognizing that they will receiveprotection from a disease because others takeon the burden of getting the vaccine?• Are some reasons for opting out of vaccinationmore acceptable than others?• What responsibilities do individuals have totheir community?5*Bold items are emphasized in this module.2-16
Issues Explored• What are the best ways to balance respect for individual choices withcommunity needs?• Should individuals be permitted to opt out of vaccination initiatives thatpromote community well-being? If so, which exemptions should be allowed?At a GlancePurpose and RationalePolicies that tie public school entry to certain vaccinations can be highlycontroversial. While the policies have contributed to the elimination orgreat reduction of most vaccine-preventable illnesses in the United States,some people oppose them. It’s important to recognize and protect individualfreedoms and choices. States should, for example, protect parentalautonomy to the extent possible as they develop vaccine policies and buildcommunity consensus for vaccination programs. At the same time, it’simportant to safeguard the health of individuals and the community as awhole. To understand the issues related to vaccination policies, it is essentialto grasp the concept of community immunity—the protective effectsagainst disease that result when a critical percentage of a population isimmunized—and to know that community health is threatened whenimmunization levels drop below a certain threshold.This module can be used in conjunction with units on the immune system,the nature of infectious disease, and microbiology (bacteria and viruses).The Day 1 case study could be used to introduce any of those other units.The module can be expanded to include students’ researching differentdiseases and vaccines or how pathogens and vaccines interact with theimmune system.OverviewIn this module, students wrestle with the tensions among respect for persons,fairness, and community well-being. A case study involving the attemptsof a county and a school board to enforce a vaccination policy opens themodule. Students examine some of the facts behind the debate about vaccinationpolicies: the contributions vaccination has made to public health, thepotential risks associated with vaccines, the reasons people might not be vaccinated,and the different types of exemptions that states allow to their publicschool vaccination policies. On Day 2, a simulation introduces the conceptof community (or herd) immunity and its protective effect on large groups.Examples of the consequences of using coercion and force to vaccinate, or of2-2 Exploring Bioethics
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NIH CurriculumSupplement SeriesGrad
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Education Development Center, Inc.D
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This material is based on work supp
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About the National Institutes of He
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Introduction
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activity of assessing different rea
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teaching strategies that will help
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2. The ability to distinguish an et
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quence of choosing one path over an
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Table 1. Assessing Student Justific
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Challenges in TeachingBioethics and
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How Exploring Bioethics Can HelpFor
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Prompts to encourage students to re
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Table 2d. Students say they already
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Resources forTeaching BioethicsBeau
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Table 3. Ethical Issues and Curricu
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Each module is divided into three d
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Table 4. Alignment with NSES Life S
Page 39 and 40: About the Web SiteThe Web site for
Page 42 and 43: 1Module 1Bioethics Concepts and Ski
Page 44 and 45: • apply important ethical conside
Page 46 and 47: In Advance1Copies, Equipment, and M
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Page 50 and 51: new medication, she is able to stay
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Page 56 and 57: LE/LE/LLE/LPoint out that some of t
Page 58 and 59: Organizer for Day 1: What’s in a
Page 60 and 61: Day 2: Four Key Questions1PurposeDa
Page 62 and 63: 4. Emphasize that when bioethicists
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Page 68 and 69: Encourage students to share example
Page 70 and 71: Activity 7:Using Ethical Considerat
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Page 82 and 83: Round 4Q9Should embryonic stem cell
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Page 88 and 89: Carl’s CaseCarl listened to his t
Page 92 and 93: adopting vaccination policies that
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Page 96 and 97: Teaching Sequence1Day 1: Exploring
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Page 104 and 105: Day 2: Community Immunity1PurposeOn
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Page 110 and 111: ClosureRecap for students that the
Page 112 and 113: Tell only the students who were tag
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Page 122 and 123: Ask each member of the pair to read
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Page 126 and 127: Get Kids Vaccinated or ElseGet Kids
Page 128 and 129: Name(s)Station 2—Vaccine RisksDir
Page 130 and 131: Station 1: Vaccine-Preventable Dise
Page 132 and 133: MumpsBefore the mumps vaccine was i
Page 134 and 135: Station 2—Vaccine RisksNote: Like
Page 136 and 137: Smallpox VaccineThe smallpox vaccin
Page 138 and 139: Station 4—ExemptionsExemptions vs
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State Exemptions Allowed as of Fall
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Name(s)What are the ethical conside
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Vaccination Status CardsVaccinated
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Opting Out of a Vaccine—Variables
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Measles in DublinIn 2000, an outbre
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What are some of the different pers
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Issues Explored• What is the fair
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Day 3—What Is Your Recommendation
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Teaching SequenceNoteAssign this ho
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Teaching Strategies: Jigsaw Techniq
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Some students might think that the
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11. Explain to students that they w
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Inform students that they will now
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2. Tell them that one liver has bec
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6. If it does not naturally arise,
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Criteria relevant to allocating liv
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Organizer for Day 2: Identifying St
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Day 3: What Is Your Recommendation?
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Activity 9:Understanding Past and C
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ClosureReinforce to students that t
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Ask students whether they think the
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Liver Function and FailureHepatitis
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Name(s)Banting decided that he woul
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Name(s)The COC distributed the peni
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Name(s)The Admissions and Policy Co
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Liver and Liver-Transplant Fact She
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The Liver and Liver Transplants—C
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Patient ProfilesAnitaAnita is a 19-
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Additional Patient InformationAnita
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The United Network for Organ Sharin
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Comparing the Past and Current UNOS
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1Module 4Weighing Benefits and Harm
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An optional extension activity incl
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In Advance1Preparing the Envelopes
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Teaching Sequence1Day 1: Deciding t
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6. Explain that each student should
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Activity 2:Introducing Max’s Thyr
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See Teacher Support MaterialsSupple
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ClosureTo close the class, remind s
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1Activity 2: Introducing Max’s Th
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Activity 5:Who or What Will Be Affe
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Activity 6:Exploring the Relevant E
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11. Give each student a copy of Mas
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1Ask students, “What are some rea
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5. Have students, in pairs, quickly
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ReflectionDisplay the posters from
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1Reflection: Have students view the
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1Retinitis PigmentosaFoundation Fig
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Alzheimer’s Disease and Genetic T
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Name(s)Now, on your own, answer the
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Name(s)Max’s Family Tree on His M
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Genetic Testing—Key Concepts• S
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What Impact Would Max’s Newly Dis
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Your Tentative ThoughtsName(s)1. Do
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Ethical Questions• Who should dec
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Extension (Optional)About Retinitis
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Issues Explored• Why is it import
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Key Science Knowledge*• Nature of
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Teaching SequenceDay 1: Research wi
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13. Ask students, “Should I just
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Some students in the treatment grou
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it is ethically acceptable. For exa
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Students should recognize that rese
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ClosureAsk the class whether they t
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Organizer for Day 1: Research with
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Activity 4: Returning to Your Decis
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5. Discuss the results with the who
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5. Summarize two key points about r
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• The Belmont Report has served a
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Organizer for Day 2:Harms and Benef
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Day 3: Analyzing the Willowbrook Ca
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Deciding on and Recording Main Poin
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Organizer for Day 3: Analyzing the
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Willowbrook StudyCenters for Diseas
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Asthma Simulation OutcomesYou were
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Name(s)Reflection Questions1. Aside
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Letter to ParentsThis is the letter
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What Are the Relevant Ethical Consi
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Name(s)(Fill out with your partner.
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Name(s)(Fill out individually.)Your
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Issues Explored• Should there be
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Key Science Knowledge*• DNA, RNA,
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4. Ask students for their prelimina
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8. Tell students to come to the nex
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Day 2: Deepening Your Thinking—So
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You may wish to note that• Cases
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2. Direct students to turn to their
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Organizer for Day 2: Deepening Your
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Day 3: Making a Recommendation—Se
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Those cases where students do not t
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3. Ask a representative from each g
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Activity 9: Returning to Alba’s C
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1Ear MiceBBC News. 2002. Artificial
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Alba’s CaseSince the early 1990s,
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Dyed FeathersPeople dye bird feathe
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Giant Panda BreedingThe giant panda
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Mad-Cow-Disease CowsMad cow disease
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Purebred DogsHumans have geneticall
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Spider-Silk GoatsSpider silk is str
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VealVeal is meat from calves that i
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Assessing Harms, Benefits, and Pote
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Final Assessment of Alba’s CaseRe
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This curriculum supplementwas devel
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