An Obligation to Immunize

It is just to limit the harms to our society’s public health, only insofar as we are members of a moral community—the group of people to whom duties and obligations are owed to and should be expected from—because public health is a public good and all members either benefit or are harmed by what we permit. Immunization requirements are an infringement upon an individual’s liberty to determine their own involvement or the involvement of their children. However, immunization is also a proven method of protecting the public health and of limiting the harm to a moral community. Therefore, notwithstanding its parentalistic nature, imposed inoculation is a justifiable and defensible means of providing for the public health and protecting our public good.

All morality, moral principles and moral precepts at some point reduce to intuitions; i.e., to feelings about what is right and wrong, good and bad, just and unjust. The most fundamental of all intuitions, and the most necessary condition for morality or for the moral community to exist is a right to life; i.e., a right to live. The right to life is a prima facie claim based upon an a priori reasoning: “I think…I am.”[1] Because I am, I must have a right to be, otherwise I would not be. Therefore, until proven otherwise it has been assumed that there is a right to life. It is from this basis that all other rights, duties, obligations, protections and theories of justice emerge to secure a particular quality of life. Furthermore, without life none of these other rights make any sense and are inconsistent because there can be no right to liberty, which is to live one’s life uninhibited, if there is no right to live. Thus, the right to life is the most fundamental and foundational principle of morality and about which there is little debate.

By corollary, if there is a right to life, then there must a right to all the things that are necessary for life. There is a right to life. Therefore there is a right to all the things that are necessary for life. So, each person has a right to water, air, food, education, security, safety, health, and whatever else is contained under the penumbra that is necessary for the life of a person.

Quality of life on the other hand is much more heavily debated and difficult to assert in terms of the positive duties of others. If there is a threshold to the quality of a person’s life, below which is unacceptable and is repugnant to the moral community, then the moral community has a positive duty to ensure that no member of their community falls or remains below that threshold. Disregarding or disavowing members is not an option because it does not absolve one’s responsibility them. Drawing a principled threshold however is not easy. For example, it must be delineated whether all members of the moral community should have the opportunity to live to at least twenty-five years of age, or to live one hundred and twenty-five years of age or to some point in between. Determining the level of pain a person must be in to trigger help from the moral community; whether the hint of pain is sufficient or if there needs to be more chronic or life-threatening pain. Identifying the types and severities of illnesses or diseases that are permissible in terms of quality of life; whether the flu is enough to trigger obligated assistance or is something like the Zika virus that has a higher rate of fatality required. Defining where upon the spectrum of wealth and poverty the threshold is breeched and a person’s quality of life is left wanting. Food is one of the rights entailed under the penumbra of the right to life and thus each person should be guaranteed a daily caloric intake that is sufficient to provide them the means to have a productive life, but that does not also guarantee that it must always be food that is to their liking.

It is clear that at some point requiring further positive duties from the moral community becomes over-demanding and the redistribution of time and resources to those who are less-well-off becomes harmful and even counterproductive, but exactly where that point lies is not entirely clear. A sufficient threshold could be established by resorting the “Original Position behind the Veil of Ignorance,” proposed by John Rawls.[2] If all the members of the moral community were to enter into a debate about what is a just distribution of health and resources in such a way that they were ignorant to their positions or roles in the society after they left the decision making table, it is supposed that they would agree on a threshold and correlating positive duties that would be the most fair to the members who will be least-well-off because no decision maker knows if that will be their position. Rawls argues that as a result of their ignorance in this hypothetical situation, the decision makers will make decisions in their own self-interest assuming their position as potentially the worst, and seek to achieve the greatest quality of life possible. This is the threshold of a sufficient quality of life that should be the standard for determining positive duties within the moral community and for triggering the actions to assist those who have fallen below the threshold.

It could be argued from a utilitarian standpoint that the best outcome or best consequence might not be to improve the conditions of the least-well-off, that it may cause more harm by leveling down some of the best-well-off in society and that redistributive justice is unjustified on these grounds. In response, it could be argued though not easily, that if the net happiness that would result either from leveling down while leveling up, or just increasing the happiness of the best-well-off is the same, then there is no justification for either on utilitarian grounds, and a principle of justice, like the original position, could be implemented to determine the best course of action. In addition, all things being equal, there is also something that feels wrong about not limiting the pain and suffering of members of our community, when there is a reasonable alternative and no good justification for not doing so.

In addition to the positive duty to mitigate the factors and conditions of those who fall below the quality of life threshold, there is entailed in this also a negative duty to not impose such harms upon any members of the moral community that would force them below the threshold. This particular negative duty does not supersede other duties to not harm per se, so long as the two do not conflict, and if they should then the duty that mitigates the most harm has authority, so long as the threshold is not breeched. Yet as with the positive duties, there must also be a limit to the negative duties because if there is no limit then there is a potential for every action to be shown to be harm too great to bear. The “Harm Principle” proposed by John Stuart Mill, which states that “the sole end for which mankind are warranted, individually or collectively in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will is to prevent harm”  is a good starting point.[3] First, there has to be some form of justification for when power can rightfully be exercised when there is a breach of duty, which the Harm Principle expresses. Second, as was expressed above in the section on quality of life, self-interest is one of the primary motivators for defining the just threshold of a sufficient quality of life within a moral community. When quality of life and self-protection are conceived of in these terms it reveals that both reach beyond the individual and actually depend upon the well-being, or the health aggregate of the community as a whole. This is what binds the moral community together to form the necessary interdependence to manage collective action problems.

A public good is something that all people within a society benefit from regardless of whether a person chooses to participate in the use thereof. It is not obligatory that any person participate in the use of a public good; any person at their liberty may opt-out of using it. A public good is not only something that is made by humans such as a park or road, but it may also be something like the air (oxygen) or water; things humans and other creatures need and share to survive, or that is sufficient for enjoyment or fulfillment of life. A public good however, only remains a public good so long as it continues to provide a benefit to the society. Water is necessary for the survival of humans and thus for the moral community. If a public good such as the water humans share becomes polluted or otherwise unusable, then it will cease to provide the necessary benefit to human life. If roads are not kept clear of debris or are otherwise unusable, then they will cease to provide their benefit to human mobility, which is essential in this society for human life. Thus, the public has a negative duty to not harm the public good, and a positive duty to protect and to ensure the sustainability of the public good both for his or herself and for the rest of the members of their society. As a result of who is responsible for the maintenance public goods, such as, maintaining clean and healthy potable water, clean air, nutritious food, and the general aggregate health of a society these are collective action problems.

The aggregate level of health of a society is a benefit to the public, regardless of whether any member of the public elects to participate in the use thereof. When the aggregate level of health of a society is threatened or harmed it ceases to be a benefit to the public. Thus, each individual has the duty to protect all public goods and to ensure that it remains beneficial regardless of whether they opt-in or opt-out of using it. Therefore, Public Health is a public good and as such the public has a positive duty to protect it and a negative duty to not harm it. This is further justified on the grounds that regardless of whether a person wants to benefit from or to contribute to the general health of their society, i.e., eating healthy, exercising, practicing safe sex, or participating in vaccination programs they do in fact benefit from its existence. Thus, if a person does not contribute to the general health of their society and yet benefits from it, then they are Free Riding on the contributions of others, which gives them an unfair advantage and also poses a harm to our moral community. If enough people opt-out of contributing to the general health of the public then the members of the society will be placed in jeopardy of breaching the just threshold established by the original position, thus breaching their duty to not cause harm to others. Furthermore, it will undermine the integrity of the interdependence of the moral community. To overcome the tendency to free ride and to meet the positive duty to protect the public good, the moral community is justified in creating an institution with authority to impose proven methods to maintain the just threshold upon the general public. This will also work to limit the over demandingness of positive duties upon individuals because it will remove from them the liberty to opt-out. This is all justified applying the interpretation of the Harm Principle stated earlier.

Any activity the general public is obligated by law to participate in the state has a duty to make that thing as safe as possible for the public to do without reasonable risk of harm. The Public School System is something that the general public is obligated by the law to participate in. Therefore, the state, which is the public, has a duty to make the Public Education System as safe as possible for the general public to participate in. Since, most children go to school, many of who attend public school, and start school at a very young age and usually prior to their being considered morally culpable and responsible or capable of responding to the positive and negative duties adults are bound by; the institution of school is perhaps the best institution to manage and track inoculations for infectious diseases of the general public. Making vaccinations obligatory for children as they enter into the public education system will provide the double benefit of creating a healthier environment for the students and increasing the level of health for the entire population.

There will of course be objections to this on both philosophical and religious grounds. However, it is difficult to see what argument a libertarian would make in opposition since this course of action is justified under the principle of liberty. One utilitarian argument has already been raised and rejected earlier in this paper and since this course of action is for the common good and is about good consequences, it does not seem plausible that a successful utilitarian objection can be made to oppose it. There may however be some ground to be made by a deontological argument, wherein the children in the public school system are argued to be being used as mere means to an end, i.e., that their humanity and their own personal goals are not being respected. There are two ways of overcoming this objection (1) the practice of inoculating the children is not only for the benefit of the public, but also the children themselves; (2) there are other options for the education of children such as private school and homeschooling. An argument could be made in regard to class discrimination because parents who are poor might not be able to afford one of the alternatives to public education, given that they desired the alternative because they had a sincere objection to their children being inoculated. This is perhaps one of the strongest objections because it is based on the theory of justice and there also does not seem to be an easy means to remedy the concern. Many of the other objections will most likely be made upon religious grounds and these also do not seem easy to overcome because of how connected religious ideals are to people’s identities. The remaining objections are most likely to be made on some form of scientific grounds, which question the reliability of the vaccinations that are currently available to the public.

It seems possible that since most of the objections have been overcome and that potentially a vast majority of the population will either be inoculated through the public school system or other means, that so long as a sufficient amount of the population is inoculated against the infectious diseases that cause the most problems and are the easiest to remedy given current technologies and costs, that so long as the just threshold can be maintained it is permissible to omit these sincerely conscientious objectors from inoculation. It is clear that inherent in the course of action recommended in this paper that there is a certain amount of parentalism (a gender neutral term for paternalism), which often arouses contempt. However, it is not clear that whether this level of parentalism, or this manner of parantalism is unjust or inherently bad or wrong. This seems to be especially the case if the Harm Principle as interpreted earlier is accepted wherein the only permissible reason to intervene in an individual’s liberty is to limit harm. Inoculation is a proven and effective method of limiting harm. Thus, by intervening in the liberty of individuals and imposing inoculation upon the population harms are being limited. Therefore, requiring that children be immunized as they enter into the Public Education System is justifiable and lacking a sufficient reasonable alternative can be viewed as obligatory.

[1] Rene Descartes, Meditations on First Philosophy (Second Meditation).

[2] Rawls, John, “A Theory of Justice” http://www.csus.edu/indiv/c/chalmersk/ECON184SP09/JohnRawls.pdf

[3] John Stuart Mill, “Introductory,” in On Liberty (1859), 18.

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