The ethical issue of vaccination in the United States has become a controversial one of late, despite its status as a long-standing medical practice borne of practical results and rigorous scientific study. However, recent years have seen a rise in the anti-vaccination movement, cultivated chiefly through the Internet and popular cultural figures advocating for vaccine refusal. When viewing and examining this issue from a utilitarian perspective, it becomes clear that compulsory vaccination remains a moral and ethical imperative, regardless of the controversy that has surrounded it.
The ethical issue of vaccination in the United States has become a controversial one of late, despite its status as a long-standing medical practice borne of practical results and rigorous scientific study (Galvani, Reluga and Chapman, 2007). Compulsory vaccination has been part of the United Nations’ charter and standards of best practice in international law for over 70 years; most citizens are required to immunize their children under threat of numerous penalties, depending on the nation (Ciolli, 2008). However, recent years have seen a rise in the anti-vaccination movement, cultivated chiefly through information circulated through the Internet and popular cultural figures advocating for vaccine refusal. As a result, a tension occurs between the utilitarian notion of serving the greatest good (i.e. facilitating herd immunity through universal vaccination) and the libertarian notion of individual autonomy (i.e. vaccination through personal choice). When viewing and examining this issue from a utilitarian perspective, it becomes clear that compulsory vaccination remains a moral and ethical imperative, regardless of the controversy that has surrounded it.
The Ethical Dilemma of Vaccination
Central to the dissemination of anti-vaccination sentiments is the widespread and pervasive nature of the Internet and social media. Through the advocacy of anti-vaccination arguments as connected through anecdotal evidence and news of potential vaccine risks, social networking sites function as an echo chamber wherein a “rhetoric of doubt” can lead to local cultures becoming vocal minorities online (Kata, 2010). The lack of authentication and peer review on Internet-based information is said to heavily contribute to the anti-vaccination movement of the past few years, regardless of the veracity of this information (Kata, 2010). Furthermore, research indicates that it is extremely difficult to educate anti-vaccination advocates, as these sentiments lie more in social discourses and postmodern societal tensions than in genuine misinformation.
Utilitarianism as a Theory of Justice
Utilitarianism is a theory of justice popularized by John Stuart Mill in 1863, in which his book Utilitarianism outlined the primary arguments of this philosophical framework. One of the most important facets of Mill’s work in utilitarianism is the Greatest Happiness Principle, which postulates that “actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. By happiness is intended pleasure, and the absence of pain; by unhappiness, pain, and the privation of pleasure” (Mill, 1998). In essence, utilitarianism most values actions that provide the greatest possible number of positive consequences, and discourages those actions that offer the most negative consequences. Utilitarians uphold the virtues of both communal-based social goals and individual goals alike, though the former are typically favored over the latter (Mill, 1998).
Mill’s theory of justice, based in utilitarianism, postulated that justice and morality were largely identical, with justice being a major component of morality (Mill, 1998). The major goal of utilitarianism is to promote valuable things that offer utility to the greatest number of people – whether they be practical or physical pursuits. Mill states that happiness comes in varying degrees, and there are some forms of pleasure that are more just (and have more ‘utility’) than others (Burns, 2005). Among these attributes is well-being, which is of the highest moral interest; utilitarianism demands that societal priorities must favor performing actions that would enhance the well-being of as many people as possible (Veenhoven, 2009). Utilitarianism, as a practice, is intended to cause the maximum possible good in a society, valuing all life as equally important in the abstract.
Mill’s defense of utilitarian principles is predicated on several basic concepts. Chiefly, Mill states that the typical standards of utility and happiness are not determined merely by individual needs, but of broader societal needs that, if met, can bring greater happiness to a larger number of people (Bronfenbrenner, 1977). Rather than focus happiness and utility of action on what pleases the individual in the moment, Mill prioritizes the needs of the many over the long-term as more virtuous goals to meet (Mill, 1998). In essence, Mill’s theory of justice works to ensure happiness and well-being for all by ensuring that all members of a society work toward the greater good, rather than focusing solely on the self.
Vaccination from a Utilitarian Perspective
Given the major elements of utilitarianism, in which actions are most valued when they provide the greatest good, universal vaccination is philosophically ethical. The primary goal of vaccinations are to eliminate and prevent infectious diseases that are contagious and can cause death or great harm to human beings of all ages and states of being. Vaccines work most effectively in aggregate; as they prevent diseases from being contracted, rather than curing disease that have already been contracted, they are most useful when applied to the whole of a community. Communities wherein all members have been vaccinated are virtually immune to disease, which provides physical well-being according to utilitarianism (Galvani, Reluga and Chapman, 2007).
Other utilitarian benefits to vaccination exist as well: the quality of life and productivity of both children and adults is higher when they are healthy and not made infirm due to an easily-preventable disease (Galvani, Reluga and Chapman, 2007). Not only do vaccines maximize the level of good in a society (by improving health and reducing the rate of deaths), they help to maintain this standard of goodness in a universal way regardless of gender, racial or socioeconomic circumstances (as every person in a community is made continually safe from the threat of disease). From a utilitarian perspective, vaccination provides the “best ultimate outcome for the society,” due to its universal coverage and substantial preventative benefits for entire communities (Varghese, Kutty and Ramanathan, 2013).
Major Objections to Vaccination
While utilitarianism as an ethical principle is grounded firmly in the well-being of the community, opposition to both utilitarianism as a practice and in the context of vaccination exist. Some of those who oppose universal vaccination take an openly anti-utilitarian perspective on the matter, specifically noting that vaccination “sacrifices a few to benefit many” (Kata 2009, p. 1710). While this perspective is rarely found, some expressions of anti-vaccination rhetoric involve alleged ethical problems with the justification of vaccinating to protect society – linking vaccines with the process of abortion, animal torture, and more (Kata, 2010). Utilitarianism may also lead to exclusion of individuals who are unable or unwilling to vaccinate from the whole of society, which is often the case with immigrants dealing with closed borders to nations who refuse to let unvaccinated individuals through (Navin, 2015).
Another significant opposition to the utilitarian approach to vaccination comes from parents who actively resist larger organizations (e.g. governments, health organizations) making the choice to vaccinate children without their consent or consultation (Varghese, Kutty, and Ramanathan, 2013). In many cases, the urge to provide maximum coverage by these institutions requires “coercive means” to reach their goals, which many feel infringe on personal liberties (Varghese, Kutty, and Ramanathan, 2013). This can lead to obstruction on the part of parents who are effectively mandated to vaccinate their children without their consent, which can create interpersonal conflict and resistance to the principle of universal vaccination.
Central to this specific opposition to vaccination is the aforementioned fear of negative reactions to vaccines – for example, allergic reactions or the development of autism through vaccines are beliefs widely circulated and developed in both local communities and via the Internet (Kata, 2009). From the perspective of game theory, even those who do not believe vaccines will actively harm them still intermittently oppose vaccination due to the belief that “diseases are less risky than their respective vaccines” (Galvani, Reluga and Chapman 2007, p. 5693). From this perspective, the utilitarian vaccination strategy already allows these individuals to maintain an acceptable level of herd immunity, and therefore allow themselves to exercise their individual self-interest. In self-interest based models, the elderly (who have a higher likelihood of suffering from vaccine-preventable diseases) would prioritize themselves as recipients of the vaccine, unlike utilitarian approaches to vaccination that would favor children (given their longer life span and greater susceptibility to disease) (Galvani, Reluga and Chapman, 2007).
In short, utilitarianism strictly opposes a more libertarian approach to vaccination, where it is more important for individuals to be given the choice to vaccinate, rather than be mandated to do so by a larger body (Navin, 2013). While these cases may not strictly oppose vaccination as a concept, they oppose the specifically coercive nature of utilitarian approaches to vaccination – these cases in which a community is broadly organized to undergo compulsory, universal vaccination without what is perceived to be their individual consent. This violates the ethical principle of beneficience from a healthcare delivery perspective, which some take to mean respecting their individual liberty rather than improving well-being on the whole (Varghese, Kutty and Ramanathan, 2013). As perhaps the most visible and highly-publicized resistance to the utilitarian approach to vaccination, modern culture appears to have issues with the tension between prioritizing personal autonomy and a broader sense of public health (Navin, 2013).
Utilitarian Defenses to Anti-Vaccination Criticisms
When weighing the present and potential criticisms of utilitarian vaccination approaches against the benefits of the practice itself, it becomes clear that these objections are not sufficient to warrant an abandoning of said practice. What must first be recognized is the overwhelming evidence that many of the anti-vaccination arguments commonly used to resist vaccination (e.g. links to autism and to other adverse vaccine effects) are patently false and completely unsubstantiated. Instead, these are a symptom of the misinformation and echo-chamber identity politics of Internet message boards and overprotective parents valuing sensationalism over scientific rigor (Kata, 2010). Independent of any utilitarian concerns, many of the premises upon which this controversy is founded are simply scientifically untrue, barring an abstract postmodernist sense of “truth” facilitated by abstract narratives valued by individuals within the anti-vaccination movement (Kata, 2010).
Moving on to more direct concerns from a utilitarian perspective, the libertarian concerns over utilitarian coercion to vaccinate children without their parents’ consent are minor compared to the greater harm to both their children and to the community at large that would be prevented through the herd immunity provided by vaccination (Navin, 2013). Furthermore, the effectiveness of vaccines is not the primary tension for a libertarian; instead, it is the aforementioned mandated distribution of vaccines through a government body rather than as a result of personal choice. If this focus on personal autonomy were disregarded, and the simple question of personal health were the sole deciding factor, it can be reasonably inferred that a libertarian would choose to vaccinate either way. The outcomes of both situations would be identical (the individual becoming vaccinated), but utilitarianism ensures the herd immunity of vaccines by vaccinating everyone, which constitutes their most effective form.
Utilitarians carry a tremendous need to care for the vulnerable, both through the abstract nature of beneficience and the more specific need to prevent those unable to protect themselves (e.g. children too small to be vaccinated, people with weaker immune systems) from contracting diseases (Navin, 2013). As such, this greater societal need accommodates both the utilitarian desire to see to the greater good and the libertarian yearning for autonomy, as the strict physical benefits of vaccination would keep these individuals alive and healthy in order to assert said autonomy.
When viewing the anti-vaccination controversy through the lens of utilitarianism, the overwhelming need to maintain a universal vaccination system becomes increasingly evident. Utilitarianism, on the whole, is an ethical theory of justice that seeks to facilitate the greatest good for the highest number of people – vaccinations, given their deeply important role in public health and the requirement of herd immunity to facilitate their effects, qualify as a deeply utilitarian act. However, obstacles to this utilitarian approach to vaccinations stem largely from misinformed, anecdotal fears of vaccine side effects, obstructionist government agencies restricting individual liberty, and more. Despite these complaints, utilitarianism remains the most effective, fundamental way to ensure the public health of those seeking their individual liberty in any other way. Weighing the immense public utility of vaccinations as a practice against the abstract desire for individuals to maintain their own sense of autonomy, it becomes clear that utilitarianism offers a sensible and comprehensive defense for the practice of universal vaccination.
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