How Ought We to Protect Society from Itself? Regarding: The Vaccination Fear (Part 2)

As I noted in my last post, disputes regarding vaccinations often find their focus in an alleged causal link between vaccinations and the development of autism. The questions that drive the debate are:

(1) Is it reasonable to conclude that vaccinations are causally connected with the emergence of autism?

(2) If we respond in the negative to the first question, what society ought to do (if anything) in response to the relevant facts about vaccinations?

In this follow-up post, I restrict discussion to the second question, which is tougher to sort than the first. The reason it’s trickier is that it’s a normative matter and not merely factual (though, strictly speaking, there are normative commitments involved with factual judgments, and in this context I set aside this issue). Again – one of my general theses is that, while any standard of evidence but the most minimal requires that one commit to a negative response to the first question, a negative commitment alone does not generate a particular conclusion with regard to the second question. With that in mind, I assume in this post that we’ve determined that vaccinations are not causally connected to the emergence of autism in the course of human development.

Three of the normative questions involved with the “what society ought to do” question are:

(1) Ought government to mandate vaccinations?

(2) If the government does not mandate vaccinations, ought there be some other incentive to encourage vaccination of the citizenry?

(3) Ought there to be no effort on behalf of the government or society at large to intervene on the freedoms of individuals in making their own healthcare decisions?

Before I address each of these questions, I consider a few issues with regard to people’s freedoms to do as they wish. I aim to prove what may seem to be a trivial point – though, while the point I make is trivial when considered alone, its application to social and political policy is non-trivial. The point is this: people are not and should not be free to do whatever they believe is right.

Also, as I hinted in the last post, I have one more comment about the justification of beliefs and behaviors. This point is complementary to the complete-freedom thesis I just identified. Namely, that a belief that X is right does not make X right, whether we consider X as applied the person himself or herself – or X as applied to other members of society.

First, with regard to the complementary point: Many people in the United States defend their beliefs by appeal to the refrain that “everyone is entitled to their opinion,” as if opinions were appropriate justifications for belief. They are not, of course – the fact that I believe X does not make X true, nor ought it to count for just anyone as reason to believe X.

In Crimes Against Logic, Jamie Whyte describes this mistake in some detail. Here is an excerpt:

“Jack has offered some opinion… with which his friend Jill disagrees. Jill offers some reasons why Jack’s opinion is wrong and after a few unsuccessful attempts at answering them, Jack petulantly retorts that he is entitled to his opinion.

The fallacy lies in Jack’s assumption that this retort is somehow a satisfactory reply to Jill’s objections, while, in fact, it is completely irrelevant… Jill gave reasons to believe that Jack was mistaken. She did not claim that he had no right to this mistaken view. By pointing out that he is entitled to his view, Jack has simply changed the subject from the original topic… to a discussion of his rights.

… As with most of our fallacies, once seen, [the mistake] is obvious… If the opinions to which we are entitled might nevertheless be false, the entitlement cannot properly be invoked to settle a dispute… it does nothing to show that the opinion in question is true.” (p3)

Harry Clarke, a blogging and academic economist out of Australia, discusses this same issue (and refers us to Whyte’s book) in a blog post from a few years ago.

The upshot of this mistake in reasoning is that, often, people who hold irrational beliefs maintain that they are justified in behaving according to those beliefs. However, the fact that they hold an opinion to be true is not a satisfactory justificatory reason for their actions, thought it may explain their reasoning. An explanation is not a justification – see the SEP article on this distinction.

If people have the right to act according to their beliefs, there are limits to how far this right extends in practice.

This may seem at first to be obvious, so it’s a good idea to specify the sort of limits I mean when I claim that there are limits to the effectiveness of the “It’s what I believe is right” reason-for-action. Because I’m considering social policy in this post, the limiting principle is practically valuable because tells us to what extent the enforcer of the limits is justified in interfering. The enforcer of the limit on people’s freedoms to do as they please, given the scope here, is society at large. This is often the role of government.  There are enforcers other than the government, and I’ll note at least one of these at the end of this post.

So just what is the limit on government or society interfering with a person’s acting-according-to-belief? The principle I adopt is similar to J.S. Mill’s harm principle: So long as a person’s behavior is sufficiently isolated from its effects on other members of a society, that person can behave however s/he likes – and government ought not to interfere. If a person’s actions injure, or are likely to injure, another person, then different levels of interference – either by the government or by other social actors – are justified.

The fine details of the sufficiency element of this principle are going to be somewhat arbitrary, and I don’t think it’s useful here to solve Sorites-like problems to pin them down. What we can tell, without that detailed work, is what the obvious cases look like. By moving from more obvious to less obvious – but still compelling – cases, we can see if the vaccination issue is analogous to any of these clear-enough cases to draw a similar conclusion for the vaccination case.

In the following cases, Y is an actor, and Z is representative of one or more other actors. For instance, Z could be Y’s friend, a specific unknown member of society, or it could be a group of people. Z also could be a social institution – a church, a post office, or even a grocery store.

Also of note is that I’m talking about pre-emptive interference and not retroactive involvement (punishment).

Case 1: If Y acts-on-belief with intent to injure Z, this is a clear case in which the effects of Y’s actions are not isolated enough from Z to grant Y a claim to completely free action. Thus, the government would be justified in interfering in this case. Direct interference is appropriate. So, if Y decides that he’d like to go target shooting, and that his target for the day will be Z, an agent of the government ought to restrain Y from shooting Z.

Case 2: If Y acts-on-belief without intent to injure Z, but where an injury is assured, the effects of Y’s actions again are not sufficiently isolated from Z to grant Y a claim to completely free action. Again, the government would be justified in interfering in this case. Again, direct interference is appropriate. If Y decides that he’d like to go target shooting, and decides also that he’ll be setting up his paper targets in front of a local shopping mall entrance, and somehow the patrons won’t notice his behavior and so won’t know to get out of the way. (The idea here is that Z is certain to hit someone in his attempt to hit his targets.) The government ought to restrain Y from shooting at those targets.

Case 3: If Y acts-on-belief without intent to injure Z, but where an injury is likely, the effects of Y’s actions are not sufficiently isolated from Z to grant Y a claim to completely free action. Some kind of interference is warranted – direct or indirect – and the sort of interference warranted depends on the degree of likelihood and the severity of Z’s injury. Certainly, the kind of interference that’s justified likely will look different from case 1. For instance, if Z wants to drive his car at a medium speed through Grant Park during the “Taste of Chicago” festival, he ought to be stopped.

Case 4: If Y acts-on-belief that Y is helping Z, but where an injury is likely, the effects of Y’s actions are not sufficiently isolated from Z to grant Y a claim to completely free action. Indirect interference is warranted. As in the other cases, the government would be justified in interfering here as well. However, the kind of interference that’s justified likely will look different from the first two cases. For instance, if Y gives Z – a strung-out heroin addict – $20 at Z’s request, out of an interest in helping Z, some kind of interference designed to prevent Y from enabling Z to continue harming herself is appropriate.

Notice that in none of these cases is Y acting in such a way such that the effects of his behavior are sufficiently isolated from Z to grant Y a claim to complete freedom of action. This is a non-controversial assumption, I think.

The particular brand of interference justified in each case differs in degree, as we get from the more severe (case 1) to the less severe (case 4). In case 1, the government ought to restrain Y actively. In case 4, the government has reason to encourage Y to behave otherwise, but active restraint would not be justified. Cases like the last one are difficult to solve, because it will be difficult to find a principle designating an appropriate type and level of interference to which most people can agree.

The vaccination case is similar either to case 3 or 4, as parents who do not vaccinate their children either do not vaccinate because they don’t know or don’t care – they’re ignorant of fact or apathetical toward fact. In either case, a limited kind of interference is likely appropriate.

Therefore, the principle follows: the government ought to interfere to encourage parents to vaccinate their children. It ought not to actively restrain but ought to employ methods like disincentives to encourage the appropriate behavior.

If you think that driving one’s Subaru through the “Taste of Chicago” festival is relevantly different from refraining from vaccinating one’s child, consider the following:

No one is assured to be hurt by one’s driving through Grant Park – it’s probable that most everyone will leap out of the way before they are Subie-mashed. Likewise, if one takes the appropriate precautions – keeps the child away from other children, etc., it’s likely that the non-vaccinated child will not contract a devastating disease. That said, it’s possible – or probable, even – that people in the park will be harmed by the meandering motorist. Likewise, it’s likely that the child will not be protected sufficiently from disease-causing germs, so harm is likely in the case that he or she is not vaccinated against preventable illnesses. Encouraging people to vaccinate is a little like encouraging people to drive on Michigan Avenue instead of wherever they please – safety on Michigan Avenue is not assured, but injuries are a lot less likely with that kind of order in place.

Additionally, if enough people act-on-belief not to vaccinate their children, whatever their reasons, the protection rate will drop below the rate at which outbreaks can be prevented. (See my first post on this topic for links to articles about vaccination rates necessary to achieve satisfactory levels of protection.) This is what makes the vaccination case more like case 3 than case 4 – because not vaccinating one’s own child affects others in society – not just one’s own child. By not vaccinating Little Timothy, the parent may be acting-on-belief with an intention (however misinformed) to help Little Timothy (case 4). However, the parent inadvertently acts-on-belief in a way that’s likely to harm society and its members (case 3).

The sort of interference-through-encouragement appropriate in this case will be like that appropriate in the motorist taking the scenic route through Grant Park. That is, we ought to employ a strong disincentive against the behavior we want to discourage. The driver who’s caught driving through Grant Park will be cited – perhaps even have her license suspended for recklessly endangering the welfare of others… a similar disincentive ought to be offered for parents who refuse to vaccinate their children, whatever their explanatory reasons for their choices.

As I noted above, there are at least three normative questions involved with the “what society ought to do” question are:

(1) Ought government to mandate vaccinations?

(2) If the government does not mandate vaccinations, ought there be some other incentive to encourage vaccination of the citizenry?

(3) Ought there to be no effort on behalf of the government or society at large to intervene on the freedoms of individuals in making their own healthcare decisions?

It seems fair at this point to suggest that the answer to the first question is that the government ought not to mandate it – it ought not to jail or restrain in any fashion the people who choose not to vaccinate their children. Nor ought the government to take a “hands-off” approach here – doing so would be to abandon its duty to protect the welfare of children who cannot protect themselves. Also – if we answer in the affirmative to the third normative question, the government would neglect its duty to prevent massive harms to society at large.

The second question turns out to be the right one for this issue. The answer here is that the government ought to incentivize vaccinations of children, and ought to take seriously its duty to protect those children (and society at large). It ought to take seriously its duty to protect these members of society from parents, whether they are well-intending people without justification for their beliefs, or apathetic people who do not care about the risk they pose to their children and their communities.

Another avenue for interfering in a reasonable way with parents’ choices not to vaccinate would be for societal institutions to take up the reins.

One approach is for medical professionals to incentivize the choice to vaccinate by refusing to accept as patients the people who do not vaccinate, and thus present a health risk to themselves and to other potential clients. Here’s one healthcare professional who’s done just that: http://www.kevinmd.com/blog/2012/05/pediatrician-mmr-vaccine-mandatory-practice.html

What I think will create a stir in the coming months is the discussion about whether or not to test the Anthrax vaccine on children: http://www.msnbc.msn.com/id/47466101/ns/health-health_care/t/panel-debates-should-we-test-anthrax-vaccine-kids/#.T7Vpc3lYveF