Vaccination Ethics
Can the state force us to get vaccinated?
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The questions
You would think that the main issue with vaccines would be a straightforward one: can we force people to take them or not?
But when you look a little into the literature on vaccine ethics, it turns out that it is a surprisingly rich field of philosophical inquiry, and it covers issues from all major moral theories, reaching into world politics, poverty, the role of the state and the morality of taxation and car seat belts.
The US National Science Foundation has a very nice overview (PDF) of the main philosophical questions in relation to vaccines. Some of the more important questions are:
- Can vaccinations be mandated by law or is this violating the rights of individuals to decide for themselves?
- Is the public good more important than the freedom of choice of the individual?
- Does the state have an obligation to pursue the public good or to protect the freedom of the citizens?
- Who can give “informed consent” to a vaccination? What happens with those who cannot? (For example, dementia patients and infants). What is to be done about citizens who are not educated enough to judge for themselves?
- What are we to do with vaccination opponents who are generally able to decide for themselves, but whom we still believe to be mistaken about refusing to vaccinate? What about their children? Should a parent have the right to decide for their child if their decision goes against the accepted truth of the medical and state authorities?
- What about religious beliefs, which are inherently irrational but still generally respected and, in many countries, protected by law?
- What about vaccine safety? All vaccines, like all medicines, may have some (small) probability of harmful side-effects. Who has the right to impose such side-effects on others against their will? Are there specific probability limits for harmful effects beyond which the enforced use of a medicine becomes unethical?
- And, finally, we have all the questions related to access to vaccines: How should we distribute vaccines? Should the most vulnerable come first? The minorities? The youngest?
- What about international distribution, especially if vaccine availability is limited? Should poorer countries get the vaccines first? At the same time as richer countries? Or later? There are meaningful arguments to be made for all three options.
Obviously, it is impossible to discuss all these questions within the length of a blog post. But I will try to give you an overview of the main arguments and the approaches that seem most promising in dealing with these questions. Rather than talking about every question in detail, I will try to present a few high-level arguments that can be used to approach many of these problems. So we will concentrate on discussing general principles rather than specific answers.
The obligation of the government to keep its citizens safe
Let’s first look at the idea that the government has an obligation to keep its citizens safe. Where would this obligation come from? Why should the citizens’ safety be a concern of governments?
This idea goes back to the Social Contract theory of Thomas Hobbes (1588-1679), and later John Locke (1632-1704) and Jean-Jacques Rousseau (1712-1778). The three philosophers saw the role of the government in different terms, but the basic idea is the same for all of them: If we did not have a state, they said, it would not be possible to live a civilised and safe life.
For Hobbes, life in what he called the “state of nature” would be such that people would spend all their time fighting against others for resources, and nobody would have the time or energy to pursue any sort of culture or civilisation. In Hobbes’ famous words, the life of man in the state of nature would be “solitary, poor, nasty, brutish, and,” thankfully, one might add, “short.”
For Locke, things don’t look quite so bleak. He thinks that men are born with basic rights. They naturally own their own lives and the fruits of their work. But because there are always some “bad” people around who will try to take away these rights and possessions, governments and states are necessary in order to protect the citizens’ rights. But the power of governments must be carefully limited and balanced to make sure that they actually protect the original rights rather than threatening them or taking them away.
Rousseau, finally, is the least enthusiastic of the three regarding the necessity of a state. He thinks that human beings in the state of nature are originally free, equal and peaceful. It is only when people begin to claim property and take things for themselves that inequality, conflicts and war arise. The social contract then mainly has the function of protecting the original freedom of men. In order to avoid having a state that dominates the citizens and takes away their freedom, all citizens should directly take all decisions together — and the government should only be an administration that executes the will of the people.
Despite their differences, one can see that all three justify the government with the necessity to protect the interests of the citizens from being threatened by others. Of course, the main interest one has is in their own life and health, and this is what the government primarily has to safeguard. So whatever governments do, from surveillance to censorship to the imprisonment of citizens, they do because of the need to protect these basic, original rights.
You see now how this becomes difficult — and how easy it is for governments to threaten the very thing that they are supposed to safeguard. Listening in to citizens’ phone calls, reading citizens’ emails, forcing social media companies to provide the police with records of citizens’ past communications might seem, depending on one’s perspective, either as effective means of safeguarding the citizens’ freedoms — or as equally effective means of denying them just these same freedoms.
State paternalism
We speak of “paternalism” (from latin “pater”=father) when someone takes a “fatherly” attitude towards another person’s freedom — that is, when the other’s freedom is restricted in their own presumed interest. An article about vaccination ethics defines it so:
The core concept here is that when the state takes over the authority to make decisions in our name it must be for the purpose of promoting our own welfare. States often do that. A lot of legislation has no other purpose than to make sure that we, the citizens are kept safe, even if keeping us safe means reducing our freedoms.
Take, for example, car seat belts. A compulsory seat belt is a classic example of paternalism. The state enforces seat belts at many levels, from car production and certification to the actual moment of being in the car and driving around. But, generally, all this effort does not directly benefit the government in any obvious way. The transport departments who certify cars and oversee their manufacturing, the policemen and -women who enforce seat belt wearing, they all don’t profit from seat belts. Seat belts are clearly there to promote the welfare of the people in the car. The same is true of compulsory education for children.
And it is this altruistic streak that makes the paternalism of the state in these cases justifiable and bearable. We are willing to accept limited restrictions to our freedoms if we can clearly see that these are necessary for our own benefit.
Other forms of state paternalism are less popular. Prohibition of alcohol, tried a few times around the world, has never been very successful. Drug laws are now being relaxed in most places, the prevailing opinion being that strict drug regulations don’t actually help reduce drug use. And, in the US, the possession of guns seems to be seen as a right that the state is unable to touch, even though regular shootings and armed violence on the streets indicate that countries without this right seem to fare better.
So what about vaccines?
In a social contract context, compulsory vaccinations can be (and must be!) justified in the same way as seat belts or compulsory education: they are necessary restrictions of the individual freedom to choose, in the name of the clear benefit that they provide to the vaccinated person (whose rights have been infringed).
Human Dignity and Freedom
Erich Fromm and Richard Taylor on the perils of capitalism.
But is it important that the beneficiary is the same person whose freedom has been restricted? Could the state take away individual freedoms of person A in order to provide benefits to persons B and C?
This depends on which moral theory one follows. Utilitarianism would say that we need to maximise the benefit of all. So taking away one person’s freedom in order to benefit many would be okay. This is what we are doing with criminals, by the way, and nobody seems to object to that. A prison sentence for a criminal is a restriction of their own rights that benefits (primarily) others.
Utilitarianism is a moral theory that states that the morally right action maximizes happiness or benefit and minimizes pain or harm for all stakeholders. Proponents of classic utilitarianism are Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873).
(Kant would disagree, by the way, in both cases. With Kant, we would only be allowed to restrict a person’s freedom strictly for their own benefit.)
Another example is taxation. Taxes are restrictions on the use of a wealthy person’s money that benefit not primarily the wealthy person (because the wealthy have little need for free social services), but all others. Still, most of us feel that taxes are just and necessary, because those who have more money should also bear some more responsibility to support the welfare of society in general.
The Gift of Sinning. Autonomy, Surveillance and Freedom.
Surveillance, instead of forcing citizens to behave more ethically, in reality undermines the essence of morality. According to Immanuel Kant as well as the Bible, the free human choice is the basis for all moral behaviour.
Vaccinations could be compared to both seat belts and taxes. Assuming for a moment that vaccines work as advertised (which is the prevailing rational opinion in our societies at the moment), a vaccine protects both the vaccinated person themselves (like a car’s seat belt does) and also benefits others (like taxation does). Given this double benefit, we can justify compulsory vaccinations both on utilitarian grounds (public health is a public good and we all have to contribute to it) and in a paternalist way: like with compulsory education, if the subject does not see the point (of either vaccination or education) then they are objectively mistaken and can be forced, in their own interest, to comply with the state’s laws.
That’s it for the moment. Thanks for reading, stay tuned and we’ll go into more detail and more arguments next time! I hope that you found this interesting. If you’d like to contribute your own opinion to the discussion, please leave a comment below.
If you’d like to read on, the next part is here:
How should we go about distributing a scarce vaccine? Philosopher John Rawls formulated two principles of justice that we can use to guide our decisions.
