HEC Forum (2014) 26:1–3 DOI 10.1007/s10730-014-9236-6
Introduction: Moral and Political Issues in Vaccination James Stacey Taylor
Published online: 6 February 2014 Ó Springer Science+Business Media Dordrecht 2014
In 1998, The Lancet published a research paper by Andrew Wakefield that provided support to the formerly-discredited theory that the Measles, Mumps, Rubella (MMR) vaccine could cause colitis and autism spectrum disorders (Wakefield et al. 1998). Although this paper was fully retracted in 2010 after being exposed as fraudulent, it served as a catalyst for concerns about the safety of vaccination, both the MMR vaccine in particular and vaccination in general. While the scientific consensus concerning both the MMR vaccine and others that are routinely provided to persons in developed Western countries is that the benefits of receiving them far outweigh the risks, there is still serious concern on the part of some parents about the safety of vaccinating their children. Moreover, in addition to concerns about the safety of vaccination some parents are concerned about the effects that receiving certain vaccinations will have upon their childrens’ volitional actions. For example, the possibility of vaccinating against the (typically) sexually transmitted human papilloma virus (HPV), which is associated with the development of cervical cancer and genital warts has raised concerns that vaccinated adolescents will be more likely to engage in risky sexual behavior. These concerns—as well as others, such as the concern that vaccination is not as effective at preventing disease as it is claimed, and the concern that the long-term safety of vaccination is unknown—have led to many parents refusing to have their children vaccinated. Such refusals do not merely affect the children who are unvaccinated—they also affect other children through compromising herd immunity and hence putting everyone in the population in question at greater risk from communicable diseases. The medical practice of vaccination thus gives rise to a set of related moral questions. While it is generally agreed, for example, that parents have the moral right to decide what medical treatments their children should J. S. Taylor (&) Department of Philosophy, Religion, and Classical Studies, The College of New Jersey, 2000 Pennington Road, Ewing, NJ 08628-0718, USA e-mail: [email protected]
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receive, do they have the moral right to make decisions that place other persons at increased risk of disease? Or, conversely, do parents have a moral duty to ensure that their children are vaccinated—both for the sake of their children, and for others? These issues are complicated by the fact that some of the diseases that children can be vaccinated against are sexually transmitted. This raises the question of whether this mode of transmission places additional burdens upon parents to vaccinate their children—or lessens them? The papers in this Special Issue of HEC Forum address all these core issues. In the first paper, ‘‘A Defense of Compulsory Vaccination,’’ Jessica Flanigan argues that persons do not have the moral right to refuse to be vaccinated against diseases such as pertussis, measles, and mumps because such a refusal would harm innocent bystanders; namely, those persons whose risks of contracting these diseases are increased as a result of others’ failure to vaccinate. Since persons do not have the moral right to refuse to be vaccinated, Flanigan continues, compulsory vaccination is justified since non-vaccination can justly be prohibited. Moreover, claims Flanigan, her argument for compulsory vaccination could be acceptable by persons of any political stripe—including conservatives, libertarians, egalitarians, and even anarchists—since all agree that coercion is permissible to prevent one person from harming another against the latter’s will. While Flanigan addresses the question of whether persons have a moral right not to vaccinate, in his paper ‘‘The Sexual Ethics of HPV Vaccination for Boys’’ Jeroen Luyten argues that there is reason to believe that boys have a duty to become vaccinated against HPV. After arguing that the two most common arguments offered in favor of the view that boys have a moral duty to become vaccinated against HPV (based, respectively, on the duty not to harm others and the duty to contribute to the public good of public health) are flawed, a third argument that is based on the fact that HPV is typically a sexually transmitted disease provides reason to believe that boys do indeed have a duty to be vaccinated against it. The papers of both Flanigan and Luyten rest on the commonly-held assumption that the moral issues that surround childhood vaccination can be satisfactorily addressed through reasoned argument. This assumption is questioned by Tim Dare in his paper ‘‘Disagreement over Vaccination Programmes: Deep or Merely Complex and Why Does it Matter?’’ Dare argues that significant aspects of the debates over mass vaccination programs are ‘‘deep’’, in the sense that the parties in dispute ‘‘lack a background context of shared standards and beliefs from which rational argument might proceed’’. However, the deepness of the disputes over the moral permissibility of mass vaccination programs should not lead, argues Dare, only to passivity or to a resort to force. Instead, recognizing the depth of these disputes could lead to the adoption of strategies other than rational argument to make progress, such as accommodation, which might still avoid the use of coercive force. Yet, while Dare’s paper treats disputes over mass vaccination programs as being deep in the technical sense that he outlines, this does not undercut the usefulness of the type of rational debate over these issues that Flanigan and Luyten engage in. This is so for at least three reasons. First, it might be that some aspects of the disputes over vaccination programs are not deep in the sense described by Dare, and
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so could be amenable to rational resolution. Second, the disputes between some subset of the participants in these debates might not be deep in Dare’s sense, and so while the debate between this sub-set of participants and others might be a deep one, this does not preclude the disagreements among the members of the sub-set in question from being amenable to rational resolution. Finally, even if the disputes that Flanigan and Lutyen address do transpire to be deep in Dare’s sense, this could only be discovered by pressing rational argument to its end—and then determining if the disputes are still in place. Given these reasons, it is to be hoped that all of the papers in this Special Issue of HEC Forum will make notable contributions to the current discussions over some of the ethical issues that are raised by programs of childhood vaccination—even if aspects of the vaccination debates are indeed deep in Dare’s sense.
Reference Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., et al. (1998, February 28). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103), 637–641.
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Introduction: Moral and Political Issues in Vaccination James Stacey Taylor
Published online: 6 February 2014 Ó Springer Science+Business Media Dordrecht 2014
In 1998, The Lancet published a research paper by Andrew Wakefield that provided support to the formerly-discredited theory that the Measles, Mumps, Rubella (MMR) vaccine could cause colitis and autism spectrum disorders (Wakefield et al. 1998). Although this paper was fully retracted in 2010 after being exposed as fraudulent, it served as a catalyst for concerns about the safety of vaccination, both the MMR vaccine in particular and vaccination in general. While the scientific consensus concerning both the MMR vaccine and others that are routinely provided to persons in developed Western countries is that the benefits of receiving them far outweigh the risks, there is still serious concern on the part of some parents about the safety of vaccinating their children. Moreover, in addition to concerns about the safety of vaccination some parents are concerned about the effects that receiving certain vaccinations will have upon their childrens’ volitional actions. For example, the possibility of vaccinating against the (typically) sexually transmitted human papilloma virus (HPV), which is associated with the development of cervical cancer and genital warts has raised concerns that vaccinated adolescents will be more likely to engage in risky sexual behavior. These concerns—as well as others, such as the concern that vaccination is not as effective at preventing disease as it is claimed, and the concern that the long-term safety of vaccination is unknown—have led to many parents refusing to have their children vaccinated. Such refusals do not merely affect the children who are unvaccinated—they also affect other children through compromising herd immunity and hence putting everyone in the population in question at greater risk from communicable diseases. The medical practice of vaccination thus gives rise to a set of related moral questions. While it is generally agreed, for example, that parents have the moral right to decide what medical treatments their children should J. S. Taylor (&) Department of Philosophy, Religion, and Classical Studies, The College of New Jersey, 2000 Pennington Road, Ewing, NJ 08628-0718, USA e-mail: [email protected]
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receive, do they have the moral right to make decisions that place other persons at increased risk of disease? Or, conversely, do parents have a moral duty to ensure that their children are vaccinated—both for the sake of their children, and for others? These issues are complicated by the fact that some of the diseases that children can be vaccinated against are sexually transmitted. This raises the question of whether this mode of transmission places additional burdens upon parents to vaccinate their children—or lessens them? The papers in this Special Issue of HEC Forum address all these core issues. In the first paper, ‘‘A Defense of Compulsory Vaccination,’’ Jessica Flanigan argues that persons do not have the moral right to refuse to be vaccinated against diseases such as pertussis, measles, and mumps because such a refusal would harm innocent bystanders; namely, those persons whose risks of contracting these diseases are increased as a result of others’ failure to vaccinate. Since persons do not have the moral right to refuse to be vaccinated, Flanigan continues, compulsory vaccination is justified since non-vaccination can justly be prohibited. Moreover, claims Flanigan, her argument for compulsory vaccination could be acceptable by persons of any political stripe—including conservatives, libertarians, egalitarians, and even anarchists—since all agree that coercion is permissible to prevent one person from harming another against the latter’s will. While Flanigan addresses the question of whether persons have a moral right not to vaccinate, in his paper ‘‘The Sexual Ethics of HPV Vaccination for Boys’’ Jeroen Luyten argues that there is reason to believe that boys have a duty to become vaccinated against HPV. After arguing that the two most common arguments offered in favor of the view that boys have a moral duty to become vaccinated against HPV (based, respectively, on the duty not to harm others and the duty to contribute to the public good of public health) are flawed, a third argument that is based on the fact that HPV is typically a sexually transmitted disease provides reason to believe that boys do indeed have a duty to be vaccinated against it. The papers of both Flanigan and Luyten rest on the commonly-held assumption that the moral issues that surround childhood vaccination can be satisfactorily addressed through reasoned argument. This assumption is questioned by Tim Dare in his paper ‘‘Disagreement over Vaccination Programmes: Deep or Merely Complex and Why Does it Matter?’’ Dare argues that significant aspects of the debates over mass vaccination programs are ‘‘deep’’, in the sense that the parties in dispute ‘‘lack a background context of shared standards and beliefs from which rational argument might proceed’’. However, the deepness of the disputes over the moral permissibility of mass vaccination programs should not lead, argues Dare, only to passivity or to a resort to force. Instead, recognizing the depth of these disputes could lead to the adoption of strategies other than rational argument to make progress, such as accommodation, which might still avoid the use of coercive force. Yet, while Dare’s paper treats disputes over mass vaccination programs as being deep in the technical sense that he outlines, this does not undercut the usefulness of the type of rational debate over these issues that Flanigan and Luyten engage in. This is so for at least three reasons. First, it might be that some aspects of the disputes over vaccination programs are not deep in the sense described by Dare, and
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so could be amenable to rational resolution. Second, the disputes between some subset of the participants in these debates might not be deep in Dare’s sense, and so while the debate between this sub-set of participants and others might be a deep one, this does not preclude the disagreements among the members of the sub-set in question from being amenable to rational resolution. Finally, even if the disputes that Flanigan and Lutyen address do transpire to be deep in Dare’s sense, this could only be discovered by pressing rational argument to its end—and then determining if the disputes are still in place. Given these reasons, it is to be hoped that all of the papers in this Special Issue of HEC Forum will make notable contributions to the current discussions over some of the ethical issues that are raised by programs of childhood vaccination—even if aspects of the vaccination debates are indeed deep in Dare’s sense.
Reference Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., et al. (1998, February 28). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103), 637–641.
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