Should coercion be used for vaccination programs?

[hyperdeath]

The danger posed to public health by anti-vaccination idiocy doesn't need reiterating. A trickier subject, however, is whether or not people should be coerced into being vaccinated, or having their children vaccinated. Is it a human right to refuse any kind of medical intervention, even if you put other people at risk by breaking herd immunity? Conversely, is it a human right to have your health protected from the bad decisions of others?

What are people's thoughts on this?

[ischemgeek]

My thoughts:

Coerce people to vaccinate their children? Yes. No hesitation there on my part. Best interest and all that.

Adults: By all means, restrict them from working certain jobs and going to certain areas (don't let someone who's unvaccinated onto a cancer ward unless they're a patient, for example), but otherwise no. Bodily autonomy unless it causes grave risk to others.

[Flewellyn]

It's a tricky question. Obviously, bodily autonomy is a fundamental of any view of human rights, and compelling vaccination would certainly be a violation of autonomy. The question becomes whether or not the collective right of other people to be free from illness as a result of good herd immunity, overrides the individual right of a person to refuse medical treatment.

This is where I reach for my constitutional law (US) education, and pull out the concept of "strict scrutiny". In US jurisprudence, "strict scrutiny" is applied to a law when that law could breach a fundamental right, and/or discriminates by a "suspect classification" (such as race or religion). "Strict scrutiny" means that the law in question is subject to three tests: it must be justified by a compelling governmental interest, it must be narrowly tailored to meeting that goal alone, and it must use the least restrictive means of meeting the goal. Exactly what those terms mean is defined more by precedent than by dictionaries, but I think the basic meaning is clear enough.

So, would compulsory vaccination for everyone (except those who cannot be vaccinated for medical reasons) meet the "strict scrutiny" tests? I'm not sure. I think it would depend on whether the government confined the law to children, or also compelled adults. Adults have the legal right to refuse medical treatment in any case*, even when it would endanger their life, and this principle should be upheld as matter of bodily autonomy. Children are a different matter.

There's a lot of precedent in common law, and in other legal systems, for the government having an interest in safeguarding the welfare of children over and above their own wishes, and the wishes of their parents if need be. This is why we have child protective services, for instance. The reasoning, obviously, is that children are more vulnerable, lacking the experience, intellectual development, and emotional maturity to make decisions about their own welfare. Leaving this up to the parents works most of the time, but the government has an interest in seeing to the welfare of children when the parents fail.

Any law which compelled parents to vaccinate their children would be one with the potential to violate the children's bodily autonomy, as well as the rights of the parents to religious freedom, if they had religious objections. So, it would definitely come under strict scrutiny.

So, first, what's the compelling government interest? I think the public health benefit of preventing deadly infectious diseases is a major one, especially given the facts about herd immunity. If unvaccinated children were at risk, without risking the health of vaccinated children, I would still say that protecting those children from potentially deadly illness is compelling enough, but the fact that they also put vaccinated children and adults at risk makes the case much more compelling. (Also, it helps that many vaccines are one-shot, lifelong protection types. As such, vaccinating children means they are still protected as adults.)

Is it narrowly tailored? Well, if we compelled all children to be vaccinated with the goal of preventing the spread of communicable diseases among children, I would say so. There isn't a better way to immunize than via vaccines, not that anyone has discovered. And herd immunity being what it is, only total or near-total coverage will work effectively. Also, doing so would not compel any other medical procedures.

Finally, is this the least restrictive means of doing so? Again, I would say yes. Compulsory vaccination does not put a great deal of onus on the child, or the parents, especially if the law that compelled it also provided funding for the vaccinations, so that they were free of charge for the parents. The law would have to exempt children who, in the judgement of their doctors, could not safely be vaccinated, of course; it's them that herd immunity is so crucial to protect.

So, I'd say that this would pass strict scrutiny, if it was aimed only at children. Requiring adults to vaccinate would probably not.



* Unless you're a pregnant woman, it seems.

[emptyell]

Considering that government has the authority to impose quarantine to contain outbreaks I would say yes of course, within the constraints outlined by Flewellyn. I also agree with Ischemgeek that they should be a requirement for some forms of employment. I assume that part of the herd immunity function is the public contact variable. But yeah, if an adult is so opposed that they're willing to forgo all the social advantages entailed by their choice then they should be free to do so. Freedom of choice does not mean freedom from consequences.

[GodSlayer]

The danger posed to public health by anti-vaccination idiocy doesn't need reiterating. A trickier subject, however, is whether or not people should be coerced into being vaccinated, or having their children vaccinated. Is it a human right to refuse any kind of medical intervention, even if you put other people at risk by breaking herd immunity?
What are people's thoughts on this?

well, if it's a human rights issue, then, since there's no human right to be free to roam your birth nation, you can coerce them to either be immunized or be imprisoned/exiled*. that way they have the choice to exercise their human right if they think it being respected above all is what matters most, or to forgo it if they'd prefer the compromise to stay in a nation they like the benefits of, just as they are willing to pay taxes in return for staying where they want to live rather than finding somewhere with a more enticing tax policy.

*it doesn't violate anyone's human rights to be locked up for smoking marijuana, so locking them up for egalitarian reasons shouldn't be a problem.

Conversely, is it a human right to have your health protected from the bad decisions of others?

if so, who is it that goes before a human rights tribunal for failing to protect the homeless, the malnourished, etc. at home and abroad? (Australia has what they call a "boat people" problem -- refugees try to illegally enter the country, and law enforcement tries to intercept them and keep them out of the country so that the country has no obligation to give them any sort of assistance in surviving ... are you and I not disregarding such human rights just as much as the Australians? it seems a little unfair to blame them for failing to protect these people, just as it's a little unfair to try the government where they come from who don't have the resources to help them because the whole country is in a bad way. so, even if it's a human rights issue, rather than mere civil rights and such, what's the practical implication?)

[GodSlayer]

Considering that government has the authority to impose quarantine to contain outbreaks I would say yes of course, within the constraints...

we can all think of horrible things governments have had the authority to do which are considered violations of human rights, so it doesn't answer the question of their moral authority to do it to say that we currently let them do it (no more than meat being legal settles the question of animal rights/veganism/etc.)

[The_Laughing_Coyote]

well, if it's a human rights issue, then, since there's no human right to be free to roam your birth nation, you can coerce them to either be immunized or be imprisoned/exiled*

*it doesn't violate anyone's human rights to be locked up for smoking marijuana, so locking them up for egalitarian reasons shouldn't be a problem.

The hell? Who is saying this here?

Is this some sort of strawman thing or do you have a point?

[Flewellyn]

well, if it's a human rights issue, then, since there's no human right to be free to roam your birth nation, you can coerce them to either be immunized or be imprisoned/exiled*. that way they have the choice to exercise their human right if they think it being respected above all is what matters most, or to forgo it if they'd prefer the compromise to stay in a nation they like the benefits of, just as they are willing to pay taxes in return for staying where they want to live rather than finding somewhere with a more enticing tax policy.

*it doesn't violate anyone's human rights to be locked up for smoking marijuana, so locking them up for egalitarian reasons shouldn't be a problem.

Insert narrowed-eye Frye from Futurama macro of your choice here.

I mean, seriously, what the hell ass?

[GodSlayer]

I mean, seriously, what the hell ass?

I can't offer you a constructive reply unless you have some substantive criticism to offer.

all I can say is that I answered the question.

[GodSlayer]

*it doesn't violate anyone's human rights to be locked up for smoking marijuana, so locking them up for egalitarian reasons shouldn't be a problem.

The hell? Who is saying this here?

me
http://en.wikipedia.org/wiki/Universal_ ... s#Adoption
which of these nations who assent to this declaration considers it a violation of those rights to impose on someone's private drug habits (in fact, how many of them even distinguish medical use from recreational...not my country, and they're on the list).

[The_Laughing_Coyote]

So fucking what, Godslayer?

To me this falls under the heading of 'Bodily Autonomy', which to my knowledge is something A+ is for.

So what in the name of fuck are you trying to argue, you derailing fuckhead?

[emptyell]

Godslayer,

Are you incapable of posting on topic?

This is a thread about vaccination, not drug policy.

[Hedonismbot]

GodSlayer, the policies of any given country are utterly irrelevant to what is actually right and wrong. What other actions a state takes are utterly irrelevant to the question at hand. The question is whether or not it is moral/ethical/generally desirable for a state to coerce people into becoming vaccinated, not whether or not it comports with actions the state has already taken.

As for the actual topic:

In the case of children, I honestly don't even think it's a question. Children should be given all vaccinations that are deemed safe to give them, no matter how their idiot parents feel about it and preferably on the government's dime. We don't let parents force their children to play Russian Roulette, and failing to vaccinate them is essentially the same thing just with polio instead of bullets.

When we're talking adults, it's a lot less clear and I'm not sure how I feel about it. I would like some form of disincentive to avoiding adult vaccination, but I don't know what it should be. Probably something less lenient than jail time but still strict enough to be onerous. Perhaps some form of "Stop Being An Idiot And Get Vaccinated" tax? Sounds cool to me.

[Catherine]

I personally think that not vaccinating a child, that can have the vaccination, some genuinely have other underlying conditions which make them dangerous, is child abuse or at best wilful negligence. It is similar to clueless parents feeding kids on some fad diet so they don't get the nutrients they need. And I believe there should be legislation for this.

Again due to herd immunities, not getting yourself vaccinated is very selfish, not sure I'd advocate legislation to force people to get vaccinated though, extensive education campaigns sure. I'd probably make an exception in extreme cases such as epidemics though.

[GodSlayer]

GodSlayer, the policies of any given country are utterly irrelevant to what is actually right and wrong. What other actions a state takes are utterly irrelevant to the question at hand. The question is whether or not it is moral/ethical/generally desirable for a state to coerce people into becoming vaccinated, not whether or not it comports with actions the state has already taken.

my post was in the same vein as the prior one:

Considering that government has the authority to impose quarantine to contain outbreaks I would say yes of course...

'given the current situation, without question', to paraphrase these notions.

[Hedonismbot]

Emptyell was also making a bad argument, and if I'd been paying more attention or they were being obnoxious I probably would have called them out on it.

That doesn't really change that your argument was also bad, though.

[Wicknight]

-- All my personal opinion --

It should be required that parents vaccinate their children. This is a breach of bodily autonomy since the parent is responsible the protection of the child's bodily privacy, but it is a justified one since the child cannot consent to the outcomes of not being vaccinated. The alternative would be to say it is solely up to the parent but then restrict the child from things like schools. That is unacceptable since I don't believe a parent has the right to deny their child basic rights such as education (I don't believe in home schooling)

Adults should be allowed refuse to be vaccinated but equally society should be allowed be aware that they are unvaccinated and take measure to protect others against that. I wouldn't be as near as extreme as other posters about imprisoning or exiling people, but it should be a requirement of particular jobs, particularly those that involve working with children such as teaching or child care, to demonstrate that yo have been vaccinated.

This is not a perfect solution, unvaccinated people will still exist in society but hopefully it would be enough to stop the tipping point effect.

[fullofthoughts]

I think the system we have now is appropriate, where it is difficult for a parent to avoid vaccinating their child, but not impossible. My main reason is that while the aggregate risk for all parents who choose not to vaccinate can be large (IE if herd immunity is lost) the individual risk to the child itself is still small. I don't think the increased risk to the individual child is great enough that imposing such a risk constitutes abuse by the parent. I would be willing to change my opinion on this if someone gave evidence showing that not getting vaccinated increases the risk of getting said illness and suffereing long term damage to some realistic number (say 1% for the sake of argument). This would be a different situation.

I am a huge supporter of vaccines and I am ok with all kinds of encouragement for children to get vaccinated. I just think that making it a legal requirement crosses a line.

[emptyell]

Emptyell was also making a bad argument, and if I'd been paying more attention or they were being obnoxious I probably would have called them out on it.

Do you mean the quarantine analogy? I know it may be a stretch on some level but it seems to me a similar situation just with differences spatially and temporally. An outbreak is localized in space and time whereas the effects of vaccination are not, but both address protecting the public from communicable diseases.

Or was it something else?

[SubMor]

I just think that making it a legal requirement crosses a line.

Would you mind explaining how you've come to this conclusion? It seems to me that the very real, tangible health benefits from getting stuck with a needle outweigh the costs of having to go to a doctor. Catching a communicable disease isn't just a danger to the person who has it; it's also a danger to everyone they're around. How do you reason that a society-wide health benefit is outweighed? Where's the line?

[fullofthoughts]

I just think that making it a legal requirement crosses a line.

Would you mind explaining how you've come to this conclusion? It seems to me that the very real, tangible health benefits from getting stuck with a needle outweigh the costs of having to go to a doctor. Catching a communicable disease isn't just a danger to the person who has it; it's also a danger to everyone they're around. How do you reason that a society-wide health benefit is outweighed? Where's the line?

My point that there is a risk benefit analysis to make here and as far as I understand, the invidiual risk to any one child is relatively small, small enough that it does not outweigh a parents right to decide medical care for their child. I am open to data that proves my assumption wrong but the mere presence of such a risk without any actual quantification is not enough to sway me.

[SubMor]

My point that there is a risk benefit analysis to make here and as far as I understand, the invidiual risk to any one child is relatively small, small enough that it does not outweigh a parents right to decide medical care for their child. I am open to data that proves my assumption wrong but the mere presence of such a risk without any actual quantification is not enough to sway me.

(Emphasis mine.) I think you've got your words mixed up here a bit. That seems to be backwards. "The risk is too small to outweigh the parent's right to decide?" Seems like a small risk would totally justify disregarding the parent's right to decide.

That said, what are rights but social constructions in the first place? Parents have no inherent right to determine their children's medical care; we, as societies, tend to grant these rights as a matter of habit, but it's not like they're immutable.

But how sure are you about that risk? How dangerous is it to receive a vaccine versus to leave your house? On a daily basis, we don't avoid actions simply because they have a non-zero chance of causing harm; instead, we recognize that there must be a certain threshold—some formulation of likelihood and severity of harm—below which concerns are not merited. It turns out that trying to google for solid information on this is not a terribly pleasant task, so I'd love it if someone knew of some actual data here, but it seems to me that the risks of allowing parents not to vaccinate their children is very real while the harms of mandating it are vague at best.

[Wicknight]

I just think that making it a legal requirement crosses a line.

Would you mind explaining how you've come to this conclusion? It seems to me that the very real, tangible health benefits from getting stuck with a needle outweigh the costs of having to go to a doctor. Catching a communicable disease isn't just a danger to the person who has it; it's also a danger to everyone they're around. How do you reason that a society-wide health benefit is outweighed? Where's the line?

My point that there is a risk benefit analysis to make here and as far as I understand, the invidiual risk to any one child is relatively small, small enough that it does not outweigh a parents right to decide medical care for their child. I am open to data that proves my assumption wrong but the mere presence of such a risk without any actual quantification is not enough to sway me.

The risk to any one child is only small when every other child has the vaccination. That is the whole point. Once you reach a tipping point of children without vaccination the risk to any one child sky rocket.

You mentioned herd immunity but you don't seem to quite follow what produces that immunity in the first place.

[fullofthoughts]

It is possible to reach or maintain herd immunity without mandating vaccines. Except in recent years, we have done an excellent job of achieving high vaccination rates. It is likely that the current trend is a fluke brought on by the autism/vaccine controversy, a controversy that is waning. Why make new laws if they are not needed?

But to address the other point. Yes, not vaccinating your kid presents them with risk. But the factor for deciding legality should be the amount of risk, not the mere presence of risk.

[emptyell]

It seems to me that the consensus here is that government has the authority but it should be used as sparingly as possible to achieve the desired objective. This can and has been done through limited legal mandates combined with education and publicity. Voluntary action is always preferable to enforced compliance.