“Are there any side effects I should know about?” asked the young lady.
Explore This IssueACEP News: Vol 32 – No 03 – March 2013
“No, there aren’t,” answered the doctor.
It wasn’t the vaccine for influenza they were discussing. It was the vaccine being marketed by Merck under the trade name Gardasil. It is supposed to protect against the human papilloma virus, thought to be a common cause of cancer of the cervix.
I was hearing about this conversation after the fact. The patient was in her mid-teens, bright, well-educated, and well-read. The doctor was a family practitioner. Trying to be charitable, I told the young lady that the doctor was being paternalistic, although that is a behavior that should be passé among physicians.
She was saying there were no side effects that should dissuade the patient from accepting the vaccine, failing to understand that was the patient’s call to make, not the doctor’s. And she might have answered differently if the patient had been 10 years older.
From my perspective, having spent many years studying biomedical and professional ethics, I considered the doctor’s behavior to violate the ordering principle of medical ethics in Western societies: patient autonomy. The patient thought the doctor was just a liar.
Perhaps now that the patient is a college student, pre-med, who has learned a good bit about medical ethics already, she would be more charitable. But her reaction – which was to decide against accepting the vaccine and simultaneously to decide she would not be seeing that doctor again – illustrates the importance of honesty in the doctor-patient relationship.
That young patient was my daughter, and she knew that her very conservative lifestyle meant her risk of acquiring HPV was zero, that the risk of an adverse reaction to the vaccine was small but non-zero, and that therefore the risk-benefit analysis did not come down on the side of benefit.
For many years I have worked at hospitals that strongly encouraged employees, especially nurses, to get a flu shot every year.
The “pitch” was that it would protect the recipient from getting sick. Every time I read or heard the pitch, I bristled. They should be honest, I said. It is not at all clear that, for a young healthy person not in any high-risk group, the risk-benefit analysis favors benefit.
What is such a person’s chance of becoming seriously ill with seasonal flu? Very small. What about the risk of a serious adverse reaction to the vaccine? (Guillain-Barre syndrome, which causes paralysis, starting in the legs and moving up, sometimes temporary, sometimes not, is the most common serious reaction.) Also very small, but non-zero.