title: Influenza vaccination in Dutch nursing homes: is tacit consent morally justified?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A survey among nursing home physicians.
  
  
  METHODS
  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 < 0.03).
  
  
  CONCLUSIONS
  In our discussion we focus on the question whether tacit consent procedures can be morally justifiable. Such procedures assume that vaccination is good for residents either as individuals or as a group. Even though this assumption may be true for most residents, there are good reasons for preferring express consent procedures.
authors.affiliation: Ethiek Instituut, Utrecht University, Heidelberglaan 2, NL-3584 CS Utrecht, The Netherlands. m.f.verweij@ethics.uu.nl
authors.forename: M F
authors.initials: MF
authors.lastname: Verweij
authors.forename: M A
authors.initials: MA
authors.lastname: van den Hoven
mesh_terms: D000368:Aged; D026690:Ethics, Clinical; D006707:Homes for the Aged; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control*; D007258:Informed Consent / Q000941:ethics*; D016743:Mental Competency; D028681:Moral Obligations; D009426:Netherlands; D009735:Nursing Homes; D010818:Practice Patterns, Physicians'; D014611:Vaccination / Q000941:ethics* / Q000706:statistics & numerical data