Vaccines and the Ethics of Parental Choice

Ubaka Ogbogu argues that vaccinating a child against illness is in the child’s best interest and should be the default norm.

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There has been much discussion lately regarding the resurgence of vaccine-preventable childhood infectious diseases and the problems of anti-vaccination and vaccine hesitancy. These discussions were triggered, in part, by a number of recent events: (1) an outbreak of measles at Disneyland; (2) Roald Dahl’s heartrending essay recalling the loss of his seven-year old daughter Olivia to measles, and in which he urged parents to get their children immunized; and (3) the comments of US politicians like Rand Paul, who think that vaccines should be resisted based largely on conspiracy theories and the idea that individuals have the right to choose not to be vaccinated.

Vaccine proponents (like myself) have argued that vaccinations are essential to promote community welfare. We have appealed to scientific evidence, which indisputably shows that recommended childhood vaccines are generally safe and effective. Scientific evidence also shows that a sufficient number of children need to be vaccinated in order to achieve herd immunity. We have advocated for a robust and routine program of mandatory vaccinations sans religious or personal exemptions.

Vaccine opponents have countered by questioning the science behind childhood vaccines or by referencing a right to be exempted from forced medical intervention that interferes with personal beliefs and preferences. Among those who oppose vaccines lies the assumption that parents have an automatic and unassailable right to make decisions regarding vaccination on behalf of their children. From this it follows that taking away that right is a violation of the parent’s liberty or participatory interests. This assumption is ethically and legally unfounded.

Nurse_administers_a_vaccine

The law requires that medical decisions be left to the choice of capable individuals. Since most young children lack the capacity to make such decisions, especially during the crucial early years when most childhood vaccines are administered, the decision to vaccinate becomes a substituted or supported decision that must be rendered by a legal appointee. This decision-making authority will typically, though not necessarily, be appointed to the child’s parents. The decision made should be one that advances the best interests of the child.

While Canadian courts and statutory instruments have awarded parents a privileged position in making substituted decisions on behalf of their children, it is also the case that parental decisions must be made to promote or advance what is objectively deemed to be the child’s best interests in the specific context of the decision in question. The question therefore is not whether parental rights in this context can be suppressed for the sake of community welfare but rather, whether parental decision-making that denies a child an opportunity to receive potentially life-saving vaccines can ever be considered a best interest decision. I think not, and here’s why.

Ensuring that vulnerable children get immunized against vaccine-preventable childhood diseases is as much in their best interest as making sure they receive necessaries of life such as food and shelter, or that a child wears a seat belt while travelling in a motor vehicle. In Canada and most other jurisdictions, vaccines that protect against childhood diseases are available, at no cost, starting from infancy. A few doses – in many cases not exceeding a couple – provide effective life-long immunity to dangerous and sometimes deadly infectious diseases. Side effects are generally rare and mostly minor. Much like not wearing seat belts, failing to immunize a child exposes him or her to a preventable danger that could have devastating effects, including disability and death.

Putting aside arguments about social good, herd immunity, discouraging free loading and preventing harm to others, vaccinating a child for the child’s sake is not just the right thing to do, but also the only thing to do. There are no other measures that would objectively better protect a child from infectious disease – not sanitation, not prayer, not eating natural and healthy foods, not cutting ties with the outside world, not homeopathic remedies, and certainly not parental objection, however honestly held. Because we cannot rely on parents who are resistant to or hesitant of vaccines to reach this conclusion, society ought to step in and do what promotes the child’s best interests. At a minimum, society must insist that childhood vaccinations against vaccine-preventable illness should be the default norm. Once that is done, we can then focus on helping parents understand the norm and on encouraging their participation in operationalizing it.

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Ubaka Ogbogu is Assistant Professor cross-appointed to the Faculties of Law and Pharmacy & Pharmaceutical Sciences at the University of Alberta @UbakaOgbogu

One comment

  1. Vaccination is a medical treatment, therefore prescription must comply with patient’s rights: proper diagnosis, prognosis and informed consent. Forced treatment can only occur in the presence of an immediate and identified threat to public health. Measles is not a threat.

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