Though the presence of anti-vaxxers seems like a modern development, there has been hesitancy to retrieve vaccinations since their emergence in the early 1800s. Despite the evolution of vaccination techniques, the reasons for refusal to vaccinate have remained fairly similar throughout the two hundred years: fear of some form of mutation (bestiality was the red herring of the 19th century while today’s concern is developing autism spectrum disorder), conflicts with religious belief, and the infringement upon one’s freedom (Siddiqui et al.). However, parents who choose to withhold their healthy children (not restricted from innoculation due to autoimmune disorders or other certifiable health concerns) from vaccinations against possibly life threatening diseases, most notably measles or pertussis, are violating several of the foundational principles of ethics which cannot be justified by their right to determine their child’s healthcare.
Tom L. Beauchamp defines autonomy as “freedom from external constraint and the presence of critical mental capacities such as understanding, intending and voluntary decision-making capacity”. Because children, especially at the age when vaccinations typically begin, are not autonomous beings, their medical care is determined by their guardians. The parental right to govern their child’s care, just like an individual’s right to autonomy, may be overridden by a conflicting principle of ethics (Beauchamp 4). Three of Beauchamp’s “Four Principles” of healthcare ethics provide justification for the government to go against a parent’s wish to refuse vaccinations for their child (Field and Caplan 114).
The principle of nonmaleficence is commonly referred to as “do no harm”. This ethical principle condemns actions “that intentionally or negligently caused harm” (Beauchamp 5). Multiple studies have shown that children who do not receive the mandatory vaccinations are significantly more likely to contract the diseases that vaccines are meant to prevent (Siddiqui et al.). Refusal to provide their child with proper vaccinations, unless the child cannot receive the vaccine for medical purposes, is putting that child at undue risk for contracting a severe, possibly lethal disease. Aside from the risk placed on the individual child that is not vaccinated, additional risk is also placed on the community in which the unvaccinated child lives.
Nonmaleficence can also apply to the damage done by the unvaccinated child to the people surrounding them. Due to the normalization and mandation of vaccines over the recent years, many regions in the United States can be considered to have “herd immunity”. Herd immunity is a phenomenon in which 90-95% of the community have received vaccinations, and the remaining individuals who have not received vaccinations can receive the benefits of immunization without physically being vaccinated (Giubilini et al.). While this concept seems to lend to people reaping the benefits without contributing to the immunity of the community, the high percentage of community members with proper vaccinations required to achieve herd immunity puts a limit on how many people can refuse vaccinations and still exploit the herd immunity. The advantage of herd immunity is that it protects individuals who are incapable of receiving vaccinations for medical purposes from contracting the dangerous diseases. The refusal to vaccinate without medical restraints unduly increases the risk for diseases for the voluntarily unvaccinated child and for any child in the community that has legitimate medical concerns preventing their immunization.
Beneficence is often construed as paternalism, or the “doctor knows best” mindset (Field and Caplan 114). However, in the case of mandated vaccines, the doctors, government, and other health care officials typically do know best. Healthcare providers are equipped with an understanding of vaccinations that the general public may not have, especially considering the influx of misinformation circulating the internet. If parents are better educated on the mechanics of the vaccines, have the myths debunked by health care providers that are well versed in the topic, and realize that the benefits of vaccination far outweigh the possible side effects, then perhaps they would change their mindset and choose to immunize their children (Boom et al.). In a case involving the involuntary blood transfusion of young Jehovah’s Witnesses, it was deemed that “consideration should be given to parental views and treatment moderated when possible but if conflict occurs, the child’s interests always come first” (Conti et al.). For parents refusing to vaccinate their children for personal or religious reasons, the same conclusion can be drawn. If the parents are well informed and still do not wish vaccinate their children, then the enforcement of the mandatory vaccination should be carried out by the healthcare provider to do what is best for the child if the parents are not willing to.
Though it is not one of the four principles of healthcare ethics, the utilitarianism belief system offers strong support for the mandatory vaccinations of children. A facet of utilitarianism called “The Principle of Group Beneficence” expands the rationale of mandatory vaccinations as a means to promote well being beyond the individual being vaccinated and applies it to an entire community (Giublini et al.). Increased levels of vaccinations lead to herd immunity which provide the community with significantly decreased chances of contracted the diseases protected by the inoculations. The higher levels of safety and decreased childhood mortality rates that result from herd immunity are enough basis for utilitarians and the Supreme Court to promote mandatory vaccinations (Field and Caplan 114-115). Based upon the principle of Group Beneficence and the foundation of utilitarianism, which is to choose the course of action that “produces the greatest benefit for the greatest number of people”, it is not only morally permissible for mandatory vaccinations to be enforced against the parent’s will, but immunization is a moral obligation barring any medical complications that would deem inoculation unsafe (Rachels 15).
The fourth principle of healthcare ethics is justice (Beauchamp 6). It is Johan C. Bester’s belief that refusal to vaccinate children violates the principle of justice. He believes that the government owes children the safety of immunization and shifts the primary focus of the argument away from the parents’ rights and more towards the children’s rights. In a civilization that has access to vaccinations, “society is obligated to vaccinate in such a way that its children are protected against serious vaccine‐preventable diseases” (Bester). The government removes children from neglectful homes when necessary through the Child Protective Services. It should be noted that the government does not simply take children and place children in the foster care system as a preemptive measure to prevent abuse or mistreatment, they simply intervene when it becomes apparent that a child’s well being is at risk (English et al.). While not suggesting that parents’ should have their children taken from them if they do not allow them to receive the mandatory vaccinations, the concept of governmental intervention for the well being of children is applicable. If parents withhold their children from vaccinations, the government can rely on its precedence of intervention to protect children’s safety to ensure that children receive the mandatory vaccinations (Bester).
Herd immunity is a public good (Giublini et al.). The principle of justice promotes the idea that actions that promote the public good “…must be accomplished in a broadly inclusive…” way (Beauchamp 6). Bester provides statistics of measles infections that indicate “…the use of measles vaccine between the years 1994 and 2013 prevented over 70 million measles cases, over 8 million hospitalizations, and over 57,000 deaths” (Bester). Actions that lower rates of suffering and death undoubtedly promote the public good which is the principle of justice’s top priority. When such actions, in this case vaccinations, do not take place, the public may be harmed. Due to decreased levels of vaccinations, many outbreaks of previously eradicated diseases have broken out across the globe. Over 3300 individuals were diagnosed with measles in a span of six months in Italy. While the vast majority were unvaccinated or undervaccinated, almost two hundred cases involved people who were fully up to date on their vaccinations (Giubilini et al.). This massive outbreak eliminated the previously established herd immunity and failed to protect individuals who could not receive an inoculation due to allergies or compromised immune systems.
Herd immunity is achieved when approximately ninety percent of the population in a community has been immunized. Herd immunity provides all individuals of a community with a lower risk of contracting a vaccine-preventable disease which leads to less fear of contracting a vaccine-preventable disease (Bester). Due to the decline or complete erasure of certain diseases that can be prevented “…fear has shifted from many vaccine-preventable diseases to fear of the vaccines” (Siddiqui et al.). If parents had a better understanding of vaccines, they likely would not fear allowing their children to receive vaccinations (Boom et al.). Higher vaccination rates result in better health and less fear of contracting diseases, and improved education reduces fear of vaccination themselves. These improvements on well being then should be considered a positive function of justice. The negative function of justice would serve to protect the children whose parents did not ask for personal exemptions from vaccines from the inherent higher risk of disease due to other children’s lack of immunization (Bester).
In accordance with three of four principles of healthcare ethics and the concept of utilitarianism, government mandated vaccinations are indeed morally permissible. Though the argument in favor of the parents’ ability to choose their child’s healthcare remains, ultimately the safety of the child and the community are more important. In the forms of seatbelt laws, lowered speed limits in school zones, and mandatory vaccinations, the government has proven that it is willing to supersede individualism to protect the lives of children.
