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Since
the advent of vaccination, it’s served as a powerful medical tool conducive to a
modern society. With its discovery, many diseases previously thought to be life
ending or debilitating have been inoculated almost entirely. Considering that the
circumstances required to make vaccines effective demand compliance of community
(herd immunity), what obligations do citizens and agents of authority have in accepting
and administering them? Also, what consequences exist when denying oneself or an
individual the opportunity to contribute to immunity? Now that vaccines are widespread,
established and readily available in developed countries, is it morally and
ethically permissible to opt out of them? The answers to these questions lie in
dictating whether the overall benefit (as determined by paternalist and utilitarian
principles) is objectively worth violating autonomy. This deliberation will
take place by examining the historical impact of vaccines and their
administration while also attaching moral and ethical justification from
various perspectives.

 

An
important case for investigating the efficacy of vaccines is a California measles
outbreak in 2015 where, “…the California Department of Public Health was
notified about a suspected measles case. The patient was a hospitalized,
unvaccinated child, aged 11 years with rash onset on December 28…As of February
11, a total of 125 measles cases with rash occurring

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during December 28,
2014–February 8, 2015, had been confirmed in U.S. residents connected with this
outbreak. Of these, 110 patients were California residents. Thirty-nine (35%)
of the California patients visited one or both of the two Disney theme parks
during December 17–20, where they are thought to have been exposed to measles,
37 have an unknown exposure source (34%), and 34 (31%) are secondary cases”
(Zipprich, 1). Regarding this case, it’s no doubt where fault lies. This
outbreak represents the consequence of a near negligent refusal to vaccinate. From
the perspective of a health professional, the results of the outbreak (and more
importantly the consequence of not vaccinating) has violated prima facie
duties. More specifically, any conscious involvement leading up to the events
previously described violates John Stuart Mill’s utilitarian philosophy. Refusing
vaccination could be considered an act of thoughtless self-interest since the
majority of detriment incurred is ultimately passed on to the community. As
described in the Stanford Encyclopedia of Philosophy regarding Mill’s work it’s
stated, “Actions are right in proportion to their promotion of happiness for
all beings, and wrong as they produce the reverse” (Beauchamp, 1). By using
this as a guideline for determining the standing of the case presented, it’s
safe to say any conscious involvement in such (specifically denying or refusing
vaccination) is ethically impermissible. Utilitarianism and the maintenance of public health provide sufficient
justification for mandatory vaccination, even though doing such will arguably infringes
on expression of autonomy.

 

From
the perspective of health care legislators and government controlled public
heath establishments other obligations to provide vaccination may be present.
Just as civil law has

 

parameters in place to protect
citizens via the denial of autonomy (seat belts, drug legislation, etc.) are
the philosophies that justify them also applicable to vaccination? This is
likely so, because similar to the previously mentioned examples, the intention of
immunity is to promote the well-being of an entire state. Justification of
intrusion can be substantiated by paternalist philosophy. Before paternalist
philosophy can be blindly attached to the justification of intrusion, the
burden of proof regarding the ethical measures taken to guarantee safe and
informed vaccinations must be satisfied. Furthermore, this position must be substantiated
from the perspective of a government or authoritative body rather than from
individual doctor-patient relations. I believe doing so will guarantee the proper
ethical fortitude necessary to support the claim that protecting a state from exposure
to a preventable disease via denial of autonomy is permissible. This will also dismantle
claims made by anti-vaccination positions that violate the standing to be set
forth by said proof. The following statement was written by Kevin Malone and
Alan Hinman of the Center for Disease Control where they state, “Through these materials, called Vaccine
Information Statements, parents are informed about the schedules for administration
of the vaccines, are alerted to contraindications that dictate against
administration to particular individuals, and are informed about potential adverse
reactions to look for to encourage timely medical intervention, as needed” (Malone
and Hinman, 268).  This statement satisfies
a fundamental principle regarding paternalism in medicine. Informed consent and
transparency are

 

 

 

required for allowing paternalist interventions. I’m sure in
providing such evidence of these measures being taken, even Gerald Dworkin
would agree that authoritative bodies hold the right to mandate vaccination.

 

            While demonstrating why the value of vaccination allows the
violation of autonomy, it’s also important to consider why pro-positions concerning
this are met with resistance. Some could argue that an anti-vaccination position
is supported by the idea that there’s simply not enough information to prove
the efficacy of vaccines one way or the other. This is simply not true. While
it can be observed that some individuals react poorly to vaccination (particularly
allergic reactions) the harm done in these fringe cases doesn’t supersede the
benefit of herd immunity nor are they as prevalent as some would like them to
seem. Another anti-vaccination position that’s often justified philosophically
is the right to bodily integrity. While this right is held in high regard and a
facet of autonomy, it still does not achieve the greatest possible moral
rightness. This being determined by utilitarian philosophy, specifically
consequentialist principles. The consequence induced by opting out of vaccines
to satisfy right to bodily integrity provides significantly less benefit to a
civil community than if that right were violated. Although many other anti-positions
exist, the ones mentioned are among the most prevalent that are supported by
genuine philosophical ideology.

 

 

 

Overall, the responsibilities
on the behalf of the mandating authority and health care professionals are
outlined in the philosophies of paternalism and utilitarianism respectively. Several
examples, hypothetical and documented, reveal instances where mandatory
vaccination is universally more preferred than otherwise. While right to
autonomy is highly regarded during all considerations, it still remains an
abstract concept that operates on a spectrum. Undoubtedly, in a civil community
the acts of an individual, regardless of motivation or belief, have
consequences for others. The harm reduced by such actions must be minimized and
benefits be distributed.

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