Should vaccinations be mandatory? Measles outbreaks and recent remarks by presidential hopefuls Sen. Rand Paul of Kentucky and New Jersey Gov. Chris Christie that they should be voluntary have thrust this question into the center of American politics and policy debate. Perhaps mandatory vaccinations have become a surrogate for a broader view about freedom and the role of the state in society, similar to the one surrounding mandatory health insurance at the center of the controversy with the Affordable Care Act. Yet there is a powerful ethical case for why vaccines should be mandatory – with no opt-out for religious or personal conscience reasons.
There are a host of reasons some oppose vaccinations. There is the misinformed and discredited urban legend that vaccinations cause autism. Or some claim that the human body is stronger if it fights off disease on its own or that vaccines are not natural. These assertions amount to a broad-scale rejection of modern science that ignores human progress and the benefits that medicine has brought to the world in terms of increased life expectancy, decreased infant mortality, and improvements in the quality of life. But the core arguments rest upon libertarian grounds – that individuals have a right to reject vaccinations if they wish – or religious claims – that some procedures simply violate their right to free exercise of religion.
When it comes to choices by adults, John Stuart Mill’s “On Liberty” is perhaps the most articulate defense of personal liberty penned in the West. He argues against paternalism and makes the case that the state and others have no right to interfere in our lives to protect us against ourselves. Yet Mill held out an exception: Intervention is permitted to prevent us from committing harm to others.
Harming others, and other externalities
Vaccinations are not just about the health of a single individual; they are about preventing individuals from making choices that will harm others. Society, as British legal philosopher H.L.A. Hart once said, is not a suicide pact. Governments have a right to prevent the destructive actions of some from hurting others.
Mandatory vaccinations are only partially about paternalism; they are also about public costs and expenditures. A personal decision not to get vaccinated has externalities. Your decision not to get vaccinated means others and the government may have to bear the costs in terms of paying for additional health-care expenditures to treat themselves or deal with the societal costs of your decision. In reality, it is not about personal choice: It is about you asking society to bear the costs of your decision that you impose upon others. Personal choices not to vaccinate do not mean that individuals have internalized the costs of that choice.
From an economics perspective, mandatory vaccinations address a free rider problem. Maybe it is OK for me to eschew a vaccination and I am willing to take the risk of getting sick. A single choice by a single person is no big deal. But multiply that choice by millions and we get a public-health crisis. This is no different from one bank making one sub-prime loan to one person. Singularly it’s no big issue, but on a large scale we got the mortgage meltdown of 2008.
Parents who oppose vaccinations and opt not to inoculate their children are asking society to bear the costs of their choices in ways described above. But they are also imposing their ethical or religious views about vaccinations upon children who may have no choice over whether they wish to be vaccinated. In declining to vaccinate their children, they are potentially making an irrevocable and irreversible decision about the children’s health. We do not know what children would have consented to if given the choice as an adult, and therefore we are potentially, if not actually, denying them the ability to make a decision over how they would want to be treated if they were given the option to make their own health decisions.
Balancing religious views against the public interest
Finally, there are those who object to vaccines on religious grounds. When it comes to children, the law has long recognized that a parent’s religious views need to be balanced against the legitimate public interest and interest of minors in terms of the their health when it comes to procedures such as blood transfusions. There are limits to parental choices that must be balanced against the health and moral right of children to speak for themselves where they to make the choice as a rational adult.
When it comes to adults, the law once distinguished between religious belief and practice. While many discredit this distinction, it is still valid in many cases. The law can place some limits upon the extent of your religious practices to serve compelling secular interests. Laws against polygamy and rules that reject the right of individuals not to comply with civil-rights laws based on religious grounds are two examples. Those defending the right to refuse vaccinations on religious grounds ultimately are employing the same arguments used by those who are currently seeking legislation to give individuals the right to refuse to provide services to same-sex couples.
Additionally, because allowing individuals to refuse vaccinations on religious grounds imposes costs on others, such objections amount to society subsidizing religion, a violation of the First Amendment’s Establishment clause.
Personal liberty and the liberty of all
Mandatory vaccinations might intrude on some concept of personal liberty. Yet that personal liberty must be read in concert with the like liberty of all. Those rejecting vaccinations are social free riders — benefiting from practices they would expect all others to follow. One person can afford not to get vaccinated because others are.
Finally, personal liberty against a vaccination must be considered in light of the degree of bodily intrusion and state interests in promoting public health. Such a balance weighs in favor of mandatory vaccines.
David Schultz is a Hamline University professor of political science and the author of “Election Law and Democratic Theory” (Ashgate, 2014) and “American Politics in the Age of Ignorance” (Macmillan, 2013). He blogs at Schultz’s Take.
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