Maya Goldenberg and Chris Kaposy draw out a possible relationship between the recent Baby W case in New Zealand involving a request for “unvaccinated” blood and COVID-19 vaccine mandates in force during the pandemic.

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In New Zealand, a recent controversial case involving parental decision-making mixes concerns of pediatric ethics with vaccine hesitancy. An infant designated “Baby W”, a four-month-old born two months premature, required surgery to fix a heart valve disorder. The baby’s parents requested that only blood from unvaccinated donors be used for blood transfusion related to heart surgery. Starship Children’s Hospital in Auckland along with the New Zealand Blood Service told the parents that they could not comply with the request, for various logistical and ethical reasons. The delay in providing the heart surgery was already causing damage to the baby’s heart, according to specialists. Accordingly, the hospital made an application to the High Court in Auckland to remove Baby W from the care of his parents and perform the surgery. The application was granted, and the surgery was performed successfully around December 9.

As of December 13, a second couple has come forward requesting “unvaccinated” blood for use in the surgical care of their toddler, who has hypoplastic left heart syndrome, another life-threatening illness. Because of the position established by Starship Hospital in the Baby W case, the parents are considering taking their toddler overseas for treatment at a hospital that will honour their request.

Photo Credit: Chris/flickr. Image Description: Blood in a transfusion bag.

Cases of parents refusing lifesaving treatment for their children have legal and moral precedent that make the Baby W situation somewhat straightforward. From a bioethics perspective, the case is similar to many others that have gone before and is not exceptional. While patients have a right to refuse treatment for themselves in most situations, they do not have the converse right to demand treatment that does not meet medical standards. Furthermore, when deciding on behalf of someone who is incapable, such as parents deciding on treatment for a baby, there are often rules related to how the person ought to decide. Asking for unvaccinated blood would count as a demand for treatment unsupported by medical standards, and so there is no moral obligation for providers to put in the additional effort to meet the parents’ request. The precarity of blood supplies in many countries, including New Zealand, also gives reason not to set precedent whereby patients or their proxy decision-makers can tailor their blood requests. Imagine, for example, asking for blood donors from the same religion, or refusing donations based on the donor’s religion. In this case, the parents’ refusal to accept vaccinated blood infringed on child protection laws, thereby warranting putting the child’s health care decision making into the state’s hands. This decision seems justified.

The interesting feature of this case is the strangeness of the request for unvaccinated blood. This request is surely an outgrowth of vaccine hesitancy and misinformation, for example about virus shedding by vaccinated people. But added to the influence of misinformation is the likelihood that the request for “unvaccinated blood” is an unintended consequence of how vaccine mandates and passports have been used during the COVID-19 pandemic. While vaccine mandates were once a measure of last resort, they were exercised widely during the pandemic, arguably because the emergency situation demanded it. But with this intrusive and coercive government intervention, there has been public pushback in many countries, along with pushback against the uncomfortable consequence of segregated public spaces, differential access to education, work, and recreation, and different treatment of vaccinated and unvaccinated people as a whole. An odd consequence of this situation in which different treatment has been normalized, is that it shouldn’t be too surprising that unvaccinated people are asking for different treatment for themselves and their children.

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Maya J. Goldenberg is Professor in the Department of Philosophy at the University of Guelph. @goldenbergmaya1

Chris Kaposy is an Associate Professor at the Memorial University Centre for Bioethics, and an editor of the Impact Ethics blog.