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Values, Vaccination, and the End of Summer


With school starting, it seems an opportune time to consider debates around vaccination.  California recently passed a law that will come into effect next fall strengthening vaccination requirements for schoolchildren by eliminating personal and religious exemptions, such that any child who is not vaccinated and does not have a medical exemption must be homeschooled.  In a strict sense vaccination is not mandatory; it will not be forced on individuals whether or not they consent. Nonetheless, there are significant consequences attached to the choice not to vaccinate, both to influence choice and to protect others because the potential burdens resulting from one individual’s choice are not borne by the chooser alone. 

Vaccination is a divisive issue and this is not a debate that will be settled by evidence alone, despite evidence playing a central role.  Especially since evidence seems to be insufficient to alter behavior,  the decision comes down to ethics.   In this article I will focus primarily on the central values invoked in these discussions. As we look ahead to our conference on living at risk we will have the opportunity to explore questions about finding the balance when choices about which risks to accept and which risks to avoid have implications for others.

Given that this is a matter where positions on both sides of the debate can be ethically justified, politicians and lawmakers are forced to make a decision about which values should take precedence.  To put it starkly, it is a choice between emphasizing freedom and emphasizing safety and the price that we collectively pay for prioritizing one or the other.  Both of these values are given significant weight in legislation and public policy and are central to foundational legal doctrines, so there is no trump card in play.  This is not to say that a choice to prioritize one precludes consideration of the other; in public policy we often seek to give individuals as much freedom as possible while keeping them and others safe and keeping them as safe as possible when they and others make free choices.  This tension between freedom and safety plays out in various ways around seatbelts, airline security, online surveillance, helmet laws, quarantines, tobacco restrictions, food inspection, and e-cigarettes, to name a few.  In each of these cases, of course, we need to work out the nuances of what it means to prioritize freedom or safety, but the values at the core of the choice remain the same.

We endanger each other in many different ways on a daily basis – every time we get in a car, for example – and while we try to make these interactions as  safe as possible there is no easy way to eliminate the risk that other people pose. We accept these risks in light of the significant benefits that we gain from social cooperation.  The problem of vaccination refusal is often portrayed as one of free riding – enjoying benefits without accepting a share of the risks or being safe from threat of harm without a sacrifice of personal freedom. This, while rational in an individual instance, is arguably unjust and collapses on a large scale, as recent measles outbreaks attest.

So how are we to proceed?  Like both individuals and organizations, governments are sometimes forced to act in situations where it’s a matter of choosing the less bad option as opposed to pursuing the best choice or ideal. They are presented with an incredibly difficult choice and no obvious way to resolve the dilemma.  Ultimately it’s a decision about who we are now as a society and the values that we emphasize.  As much as an ethical analysis can identify the values at stake and the work they’re doing, at the end of the day we all need to decide what sort of society we want to live in and the values we believe should drive practice, and accept the costs associated with the decision – because at the end of the day, there are no free rides.

For more details about the California legislation, see for example:


1. In Canada, Ontario, Manitoba, and New Brunswick require evidence of vaccination for schoolchildren but allow exceptions for medical, religious, or ideological reasons.
2. Nyhan, B. et al.  “Effective Messages in Vaccine Promotion: A Randomized Trial.”  Pediatrics 133.4 (Apr. 1 2014): e835-e842.


NSHEN Annual Conference, October 21 & 22, 2015

NSHEN's annual conference, Whose Choice Is It? Ethics and Living at Risk will be held October 22, 2015 at the Best Western Burnside (Dartmouth). We are alos offering a pre-conference panel discussion on October 21, 2015 from 7pm-9pm. The title for this evening event is Social Media & Professionalism.

This panel is a free, public event. No registration is required.

Registration is now open on-line here and our conference brochure is available for viewing/downloading here
Deadline for registration is October 9, 2015 and space is limited so please register early to avoid disappointment

Advanced Consultation Workshop


NSHEN is please to offer the follwing workshop:

Values in Conflict and Conflict about Values: An Advanced Ethics Consultation Workshop

Facilitated by Paul Hutchinson, Mediator, Therapist & Director, Imagined Spaces

Thursday October 29, 2015 from 9am-12pm at the Hokiday Inn & Conference Centre, 437 Prince Street, Truro NS.

This workshop is intended to provide the opportunity for participants to discuss complex ethical cases in which conflict plays a significant role and to reflect upon strategies that might be effective in managing these sorts of consults.

• Attendance at at least one of our previous ethics consultation workshops

• Currently or previously active in ethics consultation

Registration deadline for this workshop is Friday, October 23, 2015.

Please click here for the registration form. Space is limitted to 20 particpants and will be allocated on first-come, first-served basis. 

There are no fees for this workshop. 

*As per the NSHEN Terms of Reference, workshops are offered first to staff from the Nova Scotia Health Authority, Dept of Health and Wellness and the IWK Health Centre. If there are available spaces once registration has closed, then we will accept registrations from Long-Term Care and Home-Care facilities.

Fireside Chats


NSHEN continues to post Fireside Chats online, with our most recent videos discussing "End of Life in the Pediatric Context" by Franco Carnevale and Mary Ellen MacDonald as well as "Ethics, Diversity and Inclusion in the Health Care System" by Tyro Setlhong and Mohamed Yaffa. These short video discussions, accompanied by discussion questions and resource lists, were developed as education tools for ethics committees and health care teams.

You can view these videos here,

National Health Ethics Week

Save the date! Next year's National Health Ethics Week will take place April 4-10, 2016.

Please contribute your ideas and share your feedback on this year's initiative by completing a short evaluation here:

For more info on National Health Ethics Week, please visit

Featured Articles Now Available!


NSHEN has developed a new educational resource: Featured Articles. We will be choosing articles from the recent health ethics  literature that we think will be of interest to ethics committee members and others working in our health care system. We will create a summary of each article for those too busy to read it in its entirety and, through our agreement with Access Copyright, will provide the full article to those who are interested.

The first article summary, The Ethics of Physicians’ Web Searches for Patients’ Information by Nicholas Genes and Jacob Appel, is available here. If you would like a copy  of the full article, please contact NSHEN.

Bioethics Book Club

NSHEN has developed the Bioethics Book Club as a resource for ethics committees, organizations and health care teams looking for a fun, creative, interactive way to facilitate discussion about health ethics issues and engage in ethics education.

We will select a variety of books with health ethics themes - both fiction and non-fiction - and develop a handout for each that includes a summary, some of the ethics issues addressed in the book and discussion questions.

Your group will select the book that is most relevant or of interest to you, give your group members time to read the book, and then use the discussion questions as a guide to facilitate a group discussion around the health ethics issues within each book and how they relate to your practice.

Some of these books are available in the NSHEN Lending Library and most are available through Nova Scotia's public libraries.

Please continue to check back here as we add more books to our list. Also, if you know of a book not on our list that would be a good fit for Bioethics Book Club, please let us know!

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Table of Contents

Book Library

 NSHEN currently has a library of books that may be of interest to

Recent additions include: The Ethos of Medicine in Postmodern AmericaWhat Patients Teach: The Everday Ethics of Health Care and The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.

 Please check our website for complete listing and contact the
 Administrator to arrange a book loan.

What Makes NSHEN Unique?

 While there are other  ethics networks and  centres across the  country, there are a  few features that  make NSHEN unique  within Canada.

 * Our collaborative    structure facilitates  dialogue between  partners

 * Our strategic goals  are collectively  established by the        collaborating      partners

 * NSHEN involves  academia,  government, and  health care  organizations in a  single network.This  results in a network  that is  innovative,  efficient, and  responsive to ethics  needs in Nova

You're receiving this newsletter because you have worked with or are a friend of the Nova Scotia Health Ethics Network.

For general NSHEN information contact the NSHEN Administrator directly:
Krista Mleczko-Skerry | (902) 494-4038
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Dept of Bioethics
Dalhousie University
5849 University Ave
Rm C313, CRC Bldg
PO Box 15000
Halifax, NS, B3H 4R2

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Nova Scotia Health Ethics Network · 5849 University Ave · Rm C313, CRC Bldg, Po Box 15000 · Halifax, NS B3H 4R2 · Canada

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