Influenza Vaccination in Dutch Nursing Homes: Is Tacit Consent Morally Justified?
van den Hoven, M.A.
Medicine, Health Care and Philosophy: A European Journal 2005; 8(1): 89-95
OBJECTIVES: Efficient procedures for obtaining informed (proxy) consent may contribute to high influenza vaccination rates in nursing homes. Yet are such procedures justified? This study's objective was to gain insight in informed consent policies in Dutch nursing homes; to assess how these may affect influenza vaccination rates and to answer the question whether deviating from standard informed consent procedures could be morally justified. DESIGN: A survey among nursing home physicians. SETTING & PARTICIPANTS: We sent a questionnaire to all (356) nursing homes in the Netherlands, to be completed by one of the physicians. RESULTS: We received 245 completed questionnaires. As 21 institutions appeared to be closed or merged into other institutions, the response was 73.1% (245/335). Of all respondents 81.9% reported a vaccination rate above 80%. Almost 50% reported a vaccination rate above 90%. Most respondents considered herd immunity to be an important consideration for institutional policy. Freedom of choice for residents was considered important by almost all. Nevertheless, 106 out of 245 respondents follow a tacit consent procedure, according to which vaccination will be administered unless the resident or her proxy refuses. These institutions show significantly higher vaccination rates (p
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