COVID Vaccination, Part Three: The Ethics
It is sometimes said that the study of ethics is “philosophy’s illegitimate child.” I think the gist of that saying is to question whether the subject belongs properly to the discipline of philosophy or whether, ultimately, it is the true province of theology, i.e. religion. My own position is that although ethics is often associated with religion, it does not always NEED to be. Ethical reasoning, however, always does require a set of principles that inform and guide it. Those principles often come from religion but may also reflect secular values as well. For example, the utilitarian philosophy of John Stewart Mill (i.e., “the greatest good for the greatest number”) has no direct connection to any religion, per se, but clearly reflects ethical philosophy, none-the-less. So, for the purposes of this essay, let’s keep ethical reasoning within the realm of philosophy, be it an “illegitimate child” or not.
Now, it’s indisputable that the COVID pandemic has stirred up a hornet’s nest of ethical dilemmas. One of the most vexing, at the moment, revolves around vaccine mandates. Should people be REQUIRED to get vaccinated? Although this question is bandied about fiercely at present, historically, society has answered this question again and again and again: YES. And I would venture to say that nearly 100% of the American born people reading this HAVE been vaccinated. Not once, but many, many times: for polio, measles, mumps, tetanus, diphtheria, and others. We don’t think of these vaccinations as having posed ethical dilemmas, however, because they were mostly administered in childhood, and the decisions involved had all been made by the public health officials of the time and then were essentially acquiesced to by parents and guardians. COVID vaccination mandates, on the other hand, are especially contentious because they largely apply to adults who are generally accustomed to more in the way of decision making prerogatives than the young are. So, if we respect the principle that adults deserve to have those prerogatives, the answer to whether vaccines should be mandatory becomes: NO. Free societies have long held the position that body boundaries are sacrosanct. Accordingly, no rational adult should be forced to have ANYTHING injected into his or her body that he does not consent to, whether or not it’s for their own good or the good of society at large.
But, supporting the right of adults to decide this matter for themselves
does not automatically give the “vaccine hesitant” carte blanche and allow them to avoid the consequences of their decision. The “anti vaxers” seem to want it both ways: the freedom to refuse vaccination, but then they also demand that they be protected from any of the consequences of that decision, a position which is untenable in any reasonable ethical discussion.
And that’s where mandates and vaccination “passports” come in. Member’s of a free society have the right, in so far as it’s feasible, to limit their exposure to contagious pathogens in the public square. Even though I have long been a champion of individual rights over governmental rights, when I go in to a crowded department store, I want to know if it’s safe to do so. When seated in a theater, I want to know that the individuals seated around me are free from communicable disease. When going into to a grocery store I want to know that I won’t be stricken with a terrible illness as a result. So, in so far as mandates and vaccination passports work to shield us from disease exposure, they are ethically justified, and SHOULD be accepted by citizens of every political stripe.
It is with no pleasure, however, that I advocate what amounts to a reduction in personal freedoms. However, because the disease at hand is SO transmissible and SO horrible, such constraints, I believe, are necessary and clearly justifiable.
When dealing with what is unquestionably a severe public health hazard, society MUST take measures to protect the populace from harm. While much of the authority we vest in government is for the express purpose of securing a citizen’s right to life, liberty and the pursuit of happiness, the PRIMARY responsibility of ANY government is the protection of its populace. And, with COVID, the need for such protection could not be more dire: we must never loose sight of the fact that COVID is a killer. And it kills not just the old and infirm, it sometimes kills the young and healthy. And, worse than that, it kills horribly, basically suffocating it’s victims to death. Not a pleasant way to die, I think you’d agree.
So, in my view, American adults do have, and should always have, the right to refuse vaccination, or, indeed, medications of any sort. However, people that do refuse vaccine protection, are not, and must not, be shielded from the consequences of their decision manifested in the restrictions that constitute society’s rightful response.
When considering society’s proper response to vaccine refusal we can classify that response as mild, moderate or severe. Mild response would be involve preventing unvaccinated individuals from attending theater, dining in restaurants, etc. More stringent response would include unpaid leave, loss of employment, being unable to gain employment or being unable to access public transportation. Severe responses, however, would take restriction one step further..
Severe responses could involve restricted access to certain medical treatments that, for a variety of reasons, are in short supply. Such treatments, in developed counties would include convalescent plasma, gene therapies and treatment with various recombinant drugs. In “under developed” countries, such treatments might even include supplemental oxygen, ventilator support, and even intravenous fluids. In cases of this nature, rationing access to rare cutting edge treatments, could result in poor outcomes or even death. In such a circumstance, we can ask whether vaccination refusal should be included among the multiple considerations that determine who gets these limited resources? The answer, perhaps surprisingly, is: YES. And, such a therapeutic triage would be ethically justified. I must emphasize, however, that this would apply ONLY to treatments that have severe availability limitations such that not everyone that needs the therapies can get them. And the ethical principle that justifies such a position is simple: rational adults must be held accountable for their actions and face consequences for their decisions, especially when the consequences of their actions cause or may cause HARM to others.
Now it has been suggested (thanks L.O.) that the individual refusing vaccination harms him or her self primarily. From this point of view, the “vaccine refuser” is akin to cigarette smokers or alcohol abusers whose bad life style choices harm basically themselves. Sadly, vaccine refusal isn’t exactly like that, and “refusers” harm not just themselves but untold numbers of innocent victims. How so? In at least three ways.
The first is easy to understand; the unvaccinated are more likely to contract COVID and are thereby more likely to spread it through both asymptomatic and symptomatic carrier states. Although there have been sporadic reported transmissions from vaccinated individuals, the likelihood of such is very low.
The second type of harm that refusers cause is to siphon off limited medical resources from others that need them. Already, in New York State, they have started cancelling “elective surgery” to save limited bed availability for the rapidly increasing numbers of delta variant cases primarily. As reported on September 14, 2021, an astonishing 97% of COVID deaths were among the unvaccinated. (Source: www.media.pa.gov). The current percentage is likely to be HIGHER! If the number of people with COVID continues to increase and resources get even more limited, the definition of “elective” is certain to expand, and those needing non COVID treatments will have their treatments unavoidably postponed, or even cancelled, and will suffer accordingly.
The third type of harm is more complicated; the unvaccinated group of people allows for a bigger pool of replicating virus. This results in increasing opportunities in which the virus can freely mutate, thereby potentially developing more transmissible and/or more virulent strains. This phenomena has already been widely observed with the delta strain. It is also possible that enhanced mutagenesis can produce strains that are resistant to vaccine induced antibodies. This latter possibility is at the heart of the present high level of concern regarding the new South African omicron variant. Although, at this early stage, it’s not clear if that variant is more contagious or more virulent, the reason for heightened concern is that the new strain has mutations at THIRTY loci in the S-protein, resulting in a substantially different shape of that protein such that current antibodies might not recognize it.
With these stark realities in mind, one can understand why it would be ethically justifiable to withhold limited availability treatments from those individuals afflicted with the disease by virtue of their own voluntary and irresponsible decision to refuse vaccination. By restricting limited availability treatments, we would thereby vouchsafe those treatments for those with “breakthrough” cases, thereby increasing the chance of those patients surviving. While NO ONE would be happy with such a state of affairs, treatment rationing would be justifiable on both practical and ethical grounds, and might, at some point, become a necessity.