Page 42 - Preventing pertussis in early infancy - Visser
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Chapter 3
condition towards being able to participate in a part of society.
Several arguments are brought forward to defend mandatory vaccination. These
arguments usually start from a societal concern for the health of the general public and are often utilitarian in nature. The classic utilitarian John Stuart Mill, for example, justified exercise of state authority over the liberty of individual citizens if this protects the public at large against serious harms (Pope 2000, Childress et al. 2002). Reducing harm and thereby protecting public health and societal life is still considered to be the classic and core function of the government by some authors (Pope 2000, Verweij et al. 2014). In line with Mill, it is therefore argued that state authorities are allowed to mandate vaccination on grounds that the value of protection against harm and injury caused by infectious diseases outweighs the value of individual autonomy (van den Hoven et al. 2003, van Delden et al. 2008, Stewart 2009, Galanakis et al. 2013, Flanigan 2014, Galanakis et al. 2014, Wicker et al. 2014).
This same argument is used in a different way in support of mandatory vaccination for health care workers (HCWs), who are thought to have a special responsibility to attend to the needs of the –frail and sometimes elderly – patients entrusted to their care. Authors defending mandatory vaccination for HCWs state that ‘vaccination is consistent with a collective professional obligation, and being immune is a part of the responsibility of being a healer’ (Galanakis et al. 2013). Apart from the special responsibility to care for the health of patients which comes with being a HCW, authors such as Van den Hoven et al. argue that HCWs also have the responsibility not to undermine the goal of the institution for which they work, which often seeks to realize herd immunity to protect patients or residents from infectious diseases such as influenza (van den Hoven et al. 2003). It would be inconsistent, they argue, if HCWs offer the vaccination to, for example, residents and do not take it themselves (van Delden et al. 2008, Galanakis et al. 2013).
Furthermore, some authors reason that mandatory vaccination is defendable because it is merely an exercise of ‘weak paternalism’. Soft or weak paternalism refers to an interference in the choices of individuals who do not base their choices on information, or who make their choices unreflectively (Pope 2000). This contrasts with ‘strong’ paternalism, which refers to interference in an informed and voluntary individual choice. As many authors have described that most vaccination decisions are either badly deliberated or based on wrongful reasoning, the conditions for weak paternalism seem to be present (Jacobson et al. 2007, Gust et al. 2008, Omer et al. 2009, Brown et al. 2010, Larson et al. 2011). Weak paternalism is considered unproblematic on utilitarian grounds, as it protects the public as well as individuals against the effects of their own poor decision making on their own health and the health of others (Pope 2000, Buchanan 2008, Nys 2008). It is also unproblematic on Kantian grounds, such as Thomas Nys shows when he argues that interfering in someone’s choice to preserve health is not disrespectful of autonomy as health is a prerequisite to exercising autonomy. Therefore, interfering in a choice that compromises health can be considered respectful of autonomy (Nys 2008).
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