Ethics and vaccination.

BACKGROUND: Immunization programmes are ethically defensible and society has a significant role to play in providing vaccination against measles and safeguarding herd immunity to optimize its individuals' capabilities. Since preventive actions interfere with individuals who consider themselves as healthy, public health strategies - as distinct from advice in a clinical consultation - require something approaching certainty as to benefits and possible side effects of an intervention. The principle of individual autonomy, a fundamental value in bioethics, often makes discussions covering ethical issues in public health interventions difficult and non-productive as to practical solutions. In encounters intended to provide information on vaccination, discussions regarding risks tend to simplify the issue into an individual one: either the child gets measles or not, or is affected by side effects or not. METHOD AND CONCLUSIONS: A model is suggested for identification and analysis of the ethical conflicts in measles vaccination programmes, which contains two different dimensions: the affected persons and the relevant ethical principles. Justice as solidarity, not utility, should be paired with autonomy in ethical deliberations on preventive health interventions such as a vaccination programme for measles. If the goal is solidarity rather than conformity, the parents must be free to decide what they think is right, because that is what moral responsibility is all about. Solidarity, however, could never be accepted as an argument without parents trusting the messages from the health institutions and availability of reasonable societal support for those who claim an association between vaccinations and possible side effects.