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Interview Question Time #2

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Nealie

Auckland MBchB
In addition, it's wildly impractical to forcibly vaccinate people. There must be hundreds of conscientous objectors atleast. There's 7 vaccinations by 4 years of age. WOuld the government take hundreds of children into state care 7 times before their birthday? Even if it could be done, the level of trauma would be high, for the parents, the children, and the society as well.
Happy to stand corrected, but this is not what compulsory vax entails. Compulsory vax in the example and as we widely know it, is tied to access to public schooling ie; if you want to take advantage of state schooling, you are obligated to vax. No access to public schooling is the only 'consequence' of refusal to vax under such a scheme.
 

JeremiahGreenspoon

Regular Member
Here is the opposing challenge

You are a GP

A mother brings in her child for her daily checkup, on looking at her record she has had none of the expected vaccinations. On furhter probing you find out that 3 years ago her other child died 12 hours after recieving a flu injection. Do you still maintain your stance?

Difficult to say without knowing the stats behind the risks associated with an under vaccinated population, and the stats for how many deaths are linked to vaccines. i.e. is it a ‘greater good’ argument that fuels the stance for compulsory vaccination, are adverse reactions in fact extremely rare? (Note this isn't what I would say to the visiting mother, but the interviewers)

I find the topic a bit difficult because if you are not equipped with the facts and sufficient background knowledge, your argument can appear a little weak. You can have a solid justifiable stance based on the information provided in the first question, and then they can provide more information/a challenge that in a sense negates the foundations of your argument, but which you would not be expected to be aware of.


(a bit off topic but I find it quite distressing reading stories like that about children and infant death/illness, and I begin to question if I would be able to deal with it emotionally myself if I was a GP, and then question if I would cut it as a doc. Is that uncommon?)
 

chinaski

Regular Member
I find the topic a bit difficult because if you are not equipped with the facts and sufficient background knowledge, your argument can appear a little weak. You can have a solid justifiable stance based on the information provided in the first question, and then they can provide more information/a challenge that in a sense negates the foundations of your argument, but which you would not be expected to be aware of.
You're getting tangled up - the role of these sorts of questions is not to test your factual knowledge. Indeed, if your reply to such lines of enquiry is predominantly contained to factual information, you would stand the chance of scoring badly, because the interviewers aren't interested in hearing you regurgitate facts and figures, however correct they may be. It's important not to miss the forest for the trees in these sorts of scenarios. Don't make the blunder of approaching them as you would an exam question.
 

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JeremiahGreenspoon

Regular Member
It's important not to miss the forest for the trees in these sorts of scenarios
Egads, that’s exactly what I hear at work when we’re scoping projects.

How do I change how I’m looking at this? :(

I feel like you’re initially presented with some information that suggests compulsory vaccination might be a good public health measure in order to get rates up to 80-90% and protect the population. You can then present your opinion on this, without delving into any facts. However if you are then challenged with additional information saying that Child A died because of a vaccination (or because of living in an under vaccinated area), your opinion can feasibly flip because you become ‘enlightened’ – is this ok?
 

chinaski

Regular Member
Let me answer that with another question: If you had to make just one point or impression in your reply, what would it be (ie What are the interviewers really asking you here?)?
 

JeremiahGreenspoon

Regular Member
I suppose I would want to express my confidence in what has become quite standard medical practice, together with an awareness of the broader ethical issues associated with making vaccination compulsory.
 

chinaski

Regular Member
I suppose I would want to express my confidence in what has become quite standard medical practice, together with an awareness of the broader ethical issues associated with making vaccination compulsory.
...So what do you think they're wanting to explore when they present you with additional information about the child who died?
 

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JeremiahGreenspoon

Regular Member
...So what do you think they're wanting to explore when they present you with additional information about the child who died?
Perhaps one or more of the below?:
- Your awareness that medical treatment is not without its risks
- your awareness of the impacts on the individual of wider scale public health measures
- The strength of your convictions

(thanks for your help teasing this thought process out btw, no matter how far off I may be)
 

chinaski

Regular Member
Perhaps one or more of the below?:
- Your awareness that medical treatment is not without its risks
- your awareness of the impacts on the individual of wider scale public health measures
- The strength of your convictions

(thanks for your help teasing this thought process out btw, no matter how far off I may be)
The structure of the question (in two parts) first requires that you think from a public health perspective - and indeed, you can do so without knowing anything about vaccinations per se. So, the points you initially raise, such as the rationale behind vaccination of an entire population, and the ethical issues of compulsory anything, are sound. When they follow up with the "human face" of this argument, they are narrowing the triangle down to its apex. They've asked you to think broadly on a population based perspective, now they're asking you to look at the issue from an individual perspective that is likely something you have never experienced yourself. As such, they are exploring your ability to empathise, to understand an opinion with which you mightn't necessarily agree, and to demonstrate an appreciation of the many shades of grey out there. To tackle this sort of a follow up question with dogmatic, statistical, cold facts alone, would be to ignore the subtextual question: where is the mother of the dead child coming from, and how can I understand her motivations better, in order to arrive at the best solution for everyone? How does the human point of the triangle affect its greater population base, and vice-versa?
 

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JeremiahGreenspoon

Regular Member
Oh my it helps plenty.

For me at least understanding the broader ideas of what the question is seeking to tease out may not create the most desirable response, but it would at least avoid me getting lost in the details as you said. Forest, not trees :)
 

Dr Worm

Regular Member
Happy to stand corrected, but this is not what compulsory vax entails. Compulsory vax in the example and as we widely know it, is tied to access to public schooling ie; if you want to take advantage of state schooling, you are obligated to vax. No access to public schooling is the only 'consequence' of refusal to vax under such a scheme.
No, that isn't so. You are obliged to either have your vaccinations up to date OR to have exempt status. The exempt status is for people with a medicalcontraindication, religous ojection OR conscientous objection. WHat is compulsory is having vaccination paperwork (such as the conscientous objection form, which requires you to have seen a doctor or nurse and told them that you aren't going to be vaccinated).
 

Dr Worm

Regular Member
Huh: is it just me, or is it a disadvantage to know about the issue?

I feel like I provided more of a defence for the current Australian vaccination policy than much thoughtful examination of the issue.

Can we have a new question? This one is worrying me :)
 

Nealie

Auckland MBchB
No, that isn't so. You are obliged to either have your vaccinations up to date OR to have exempt status. The exempt status is for people with a medicalcontraindication, religous ojection OR conscientous objection. WHat is compulsory is having vaccination paperwork (such as the conscientous objection form, which requires you to have seen a doctor or nurse and told them that you aren't going to be vaccinated).
Or what????? You talked about the govt removing children from their homes in the event of non vaccination???????? That is kinda whacky. That's not what compulsory vax means in relation to public schooling. That is the point I was making. Of course you can't FORCE people to vax (as your reply seems to mis-suggest). No one is suggesting that. But the govt can refuse access to school services for those that dont.

I don't mean to labour the point, but I thought your reply read as misleading in regard to what the consequences under a compulsory vax'ing system are.

You're not vax'd, you can't go to school. That's it. Nothing more.
 

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Dr Worm

Regular Member
Sorry Nealie, I think I wasn't clear, and I confused the point.

You mean that compulsory vaccination would mean not being able to attend public school unless you were vaccinated, and there would be no conscientous objection exemption?

ANd I thought you meant that that was the current situation in AUstralia.

I guess I was trying to make the (strictly hypothetical) point that we do allow parents wishes to be disregarded (by force) in some instances, but that while you could make the ethical argument for doing this with vaccination, it wouldn't be feasable. It was maybe not the most relevant approach, admittedly.
 

Dr Worm

Regular Member
wikipaedia:
States in the U.S. mandate immunization, or obtaining exemption, before children enroll in public school. Exemptions are typically for people who have compromised immune systems, allergies to the components used in vaccinations, or strongly-held objections. All states but West Virginia and Mississippi allow religious exemptions, and twenty states allow parents to cite personal or philosophical objections. A widespread and growing number of parents falsely claim religious and philosophical beliefs to get vaccination exemptions, and an increasing number of disease outbreaks have come from communities where herd immunity was lost due to insufficient vaccination.[10]
The American Academy of Pediatrics (AAP) notes the dilemma faced by many parents in that vaccines are a very safe and important health intervention, but are neither risk-free nor 100% effective. It advises physicians to respect the refusal of parents to vaccinate their child after adequate discussion, unless the child is put at significant risk of harm (e.g., during an epidemic, or after a deep and contaminated puncture wound); under such circumstances, the AAP states that parental refusal of immunization constitutes a form of medical neglect and should be reported to state child protective services agencies.[11]

http://en.wikipedia.org/wiki/Vaccination_policy#cite_note-10
There seems to be some confusion about what constitues "compulsory".
(NOw I'm just procrastinating to avoid the washing up...)
 

Season

Emeritus MSO Staff
Emeritus
Matt is a bit busy so I'm going to chip in some feedback. Feel free to disagree, we all have slightly different approaches to these questions.



Well, vaccination is - infact - compulsory in Australian in Australian schools (and I believe in accredited childcare), atleast in the sense that parents need to show proof of vaccination or exemption (for medical reasons, or for the reason of conscientous objection), and a centrelink payment (which may be called the maternity immunisation allowance?) is made to parents of 18 month olds and 4 year olds who either have their vaccinations up to date or have exempt stuatus.

In Australia, the penatly for non-vaccination WITHOUT exempt status (having a gp or maybe an NP in some areas complete an exemption form) is several hundred dollars which the parent would otherwise be entitled to, and this amounts to a fincial penalty, I think. Irrespective of the reason for non vaccination, non-vaccinated children may be excluded from school if there is an outbreak, which has costs of time and lost work hours and so forth for the parents, although i'm not sure how often this occurs in practice.

SO vaccination in AUstralia is something-close-to cumpolsory, vaccination in not only free, but there is a financial incentive to do it. In my experience, opportunistic vaccination and education seem to be offered routinely for non-vaccinated children who appear in health chilics and hospitals for other reasons. There is a significant deterent to not vaccinating, which is the inability to sent your child to school, which is illegal and has its own sanctions. SO non-exampt non-vaccination is only a step away from being illegal, in that sense. Essentially the situation is that it is compulsory to either vaccinate your child, or to attend a clinic/dr and discuss the issue with a health proffessional.

But the broader issue is wider. I am vaccinated, and my children are vaccinatecd. Putting aside conspiracty theories, there is a very small degree of risk involved in vaccination. I do think that the risks posed to both individuals and society from vaccination-preventable diseases are high (if the vaccination rate falls below a certain level). Infact, if vaccination levels are high in the community, if everyone else was vaccinated, I would avoid all risk by avoiding vaccination...but that only works in game theory, and assumes I am not responsible to the society in which I live. Vaccination asks individuals to assume a very small level of personnal risk to prevent a much greater risk to ourselves and others (if no-one was willing to be vaccinated).

By contrast, very few people who remember the polio epidemic don't support vaccination. But most people have no direct experience of polio, or measles or whooping cough as dangerous epidemics. If we know much about these things at all it's likley to be through isolated experience, or indirectly.

There is good reason to fear these epidemics, and there is good evidence that vaccination prevents them, and that if global vaccination is not promoted and pursued, there is a grave personal and public health risk. For which reasons, vaccination should be near-compulsory, certainly, as close to compulsory as we can make it without dramaticaly infringing on the rights of citizens, which is an approach which seems to have been effective in Australia.

As to conscientous objectors

...at the moment they are dealt with by being required to see a doctor and get an exemption certificate....if they do this, they are then able to recieve the centrelink benefit for immunisation, and start school. I am not sure that the former is a good idea, ethically, but as I suspect there would be legislative issues if it was stopped. WHat this system is doing is requiring conscientous objectors talk to a doctor about their decision. This system hopes to provide opportunities to pursuade parents who are mildly against vaccination to think otherwise, and perhaps aadress their concenrs. It is a burden on doctors, I think, but the reality is that doctors should hope to have some influence over peoples health-realted behavior.

I think, personally, that conscientous objection to vaccination is a poor choice, demonstrates terrible critical thinking skills and is broadly speaking, unethical. But the opportunity may exist, in the non-adverorial conditions of routine health care screening, to pursuade people otherwise. SOme people who are ostensibly conscientous objectors may have been mis-informed, may not understand the issue, may not realise that one can die of measles etc...They might, in short, be pursuadable.

There will, however, be a small number of people who cannot be pursueded. We need not consider them selfish muddle-headed game-theorists. It is very likely that they truly believe that vaccination is bad or dangerous. They may very well know someone whos child was diagnosed with autism after a vaccination (this is likely given that there are 4 or 5 vaccinations until 18 months, and autism is generally first diagnoses after a vaccination), or they may know a child who was allergic to a vaccination. These are errors of reasoning. It may be that - for example - they have lost a child to stillbirth, be overprotective and will brook no risk towards this one. In any case, the requirement that some health proffessional talk with them about vaccination with them is a good one, however flawed, and an undersrtanding of their reasoning may provide the opportunity to pursuade them otherwise - every effort should go into ensureing that GPs and ECH nurses are equipted to have these conversations.

However, the idea of compulsory vaccination in the sense of being mandatory and state enforced is abhorent to the ideals of democratic freedom, and the values of our society, and likely to cause both personal misery and civil unhappiness.

The present situation, of providing a strong incentive to vaccinate, endevouring to identify opportunities for opportunistic vaccination, and requiring some form of official exemption for conscientous objectors seems to me to be the option in the best interst of the public.

I do feel that global vaccination is a worthwhile cause, and the correct one, and I think that conscientous objection is misguided. HOwever, I think that there would need ot be extraordinary circumstances before there would be any worth in mandatorily imposing the will of the government - however well intended - on indiviuals agaist their liberty.
Dr worm, as someone who enjoys this topic, I really enjoyed this response, so thanks.

However this resposne is too long for an interview. The reality is that you wouldn't be able to say all of this and you would have been cut off before you'd had a chance to answer the question. You clearly know the topic well, however this doesn't mean anything if you don't end up answering the question.

What you want to do is to identify the issues, answer the question, elaborate on the issues that back your answer, acknowledge the ones that don't, say why they're bad, then answer the question again.

I'm not too worried though as your answer, in its entirety, answered the question well. You accurately identified the crux of the question that was public ethics vs individual ethics and how they infringe upon each other.

So although you should cut your answer in half, well done :)
 

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