The AAS Ethics Committee held its first annual Artwork and Essay Contest in 2021 – the topic for the essay contest was “What is the most challenging ethical issue, personal or professional, you have encountered in the COVID era?” The winning essay and artwork were selected by the Ethics Committee and will be published in the October issue of the Journal of Surgical Research. But we also want to share many of the powerful entries we received for this contest, so look for more of these essays to post as blog articles between now and the 2022 ASC – thank you to everyone who participated in the contest!
Krista Haines, AAS Committee Chair & JJ Jackman, AAS Executive Director
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“Do you want me to?” Lucy asked, with her helpless innocence.
I had just informed my eight-year-old daughter of a Phase 2/3 clinical trial investigating the safety of SARS-CoV-2 vaccination in children aged six months to 12 years, which was opening for enrollment at a local academic medical center. Of course, I hadn’t presented it to her in that language. Instead, I had told her, in a way that she might best understand, that there was an “experiment” going on: an opportunity for her to potentially receive the vaccine early and, in the process, to determine whether the vaccine was effective in kids.
“But there would be a chance that you wouldn’t get the actual vaccine right away, and that you might have to wait until the experiment is over to get the real vaccine.” How does one explain the merits of placebo injection to a child who hates needles?
“I don’t know if I want to be in an experiment,” she contemplated, hurtling herself toward sudden adolescence. “Is it safe?”
I froze. I had told many patients, many family members, and many friends that vaccination is safe. I had received the vaccine myself. As a surgical oncologist, I have told many patients in general that clinical trials that they are eligible for would be safe, save for any known risks of certain treatment arms and certain procedures. I have designed and served as an investigator on clinical trials myself.
Yet, when it came to discussing the possibility of my own daughter enrolling in a clinical trial, I was completely paralyzed. How could my wife and I make that decision for her? If she were a baby, there would be no discussion: the decision would arise from a single party, without regard for her input, her concerns, her fears. But she is eight. She is increasingly enlightened, responsible, independent.
“Well, no one would force you to do it. You can make the decision for yourself.”
But could she? We limit the allowable screen time in our household to what we feel is reasonable. We put a limit on sweets. We mandate helmets when rollerblading or riding bikes. We go through a lot of sunscreen. We promote a culture of safety and personal well-being. We make decisions regarding her health constantly. If the vaccine were already approved for children, we would be signing her up for a shot without hesitation. Why should this be different? At what age should she be able to decide whether she does or does not enroll in a clinical trial? At what age should she be able to decide whether she does or does not get vaccinated? How much should we as her parents guide her in her decision, or force her decision, or disregard her decision? As with many other aspects of this pandemic, SARS-CoV-2 vaccination is raising difficult ethical questions that I and others have not anticipated, and about which my wife and I, as fervent vaccine supporters, did not expect to harbor uncertainty.
In the end, Lucy opted against enrolling in the trial, and we think that’s perfectly reasonable. It’s up to her.
This essay was originally written in April 2021, before COVID vaccination was approved for children, and when safety and efficacy data regarding vaccination were still somewhat in evolution. Lucy is now gratefully awaiting her second dose.