A Vaccination Antinomy

Background:  Mary and her daughter Violet live on an island with a vigorous voluntary vaccination program.  There is nearly 100% compliance, so the population has herd immunity against serious disease X.  There are periodically a few immigrants who may carry X, enough to necessitate continuation of the vaccination program.  But not enough to destroy herd immunity. The rare refusers don't vaccinate because their children have special medical problems, but Mary isn't in that category. Vaccination records are confidential.  The public at large won't know what Mary decides to do.

Here's an argument that Mary should vaccinate Violet. To do otherwise is to unfairly freeride on the other citizens.  After all, Mary does believe in the vaccination program and does desire its benefits.  She is only contemplating not vaccinating Violet because the others have vaccinated their children.  If she goes through with it, she will be taking advantage of everyone else.  She will be making an exception of herself, acting as she would not want others to act.

Here's an argument that Mary shouldn't vaccinate Violet.  The vaccination is painful, and also poses slight risks.  So Mary has to be able to justify the harm she would do to Violet. But she can't.  We may harm our children a little or even a lot, to prevent a more serious harm to them.  We may harm them a little, to prevent a very serious harm to others.   But this case fits neither description.  Having her vaccinated would not benefit Violet, since she's already immune to X.  It wouldn't benefit anyone else either, since the whole population is immune.  It wouldn't even benefit others by encouraging them to keep vaccinating their children, since records are confidential--no one will know if she doesn't vaccinate. 

Note: in the real world, people aren't caught in this bind.  We don't know there's herd immunity against any particular disease.  We can always justifiably think vaccinating a child has some chance of benefitting both the child and others.  (And by the way, my own children did receive all the routine vaccinations plus others.)

The scenario isn't real, but it also isn't far-fetched.  People could be sure their community has herd immunity against X, and it seems to me these two arguments would genuinely compete for our attention in such a situation. Though I initially lean toward argument #1, it does strike me as strange for a parent to have a child jabbed, in the full knowledge that this is "for fairness" and without benefit to the child or anyone else.  Thus:  puzzlement.


Stuart W. Mirsky said...

This is a very good example of the kind of moral conundrum attempting to base our moral choices on reasoning alone must get us into. Perhaps this is why reasoning cannot, itself, provide a basis for moral choices?

Even granting that reasoning is an integral part of moral decision-making, why we finally choose one thing instead of another doesn't seem to be susceptible to settlement simply by reasoning,especially in a case like this where there are perfectly sound reasons for choosing either side. Perhaps this isn't really a moral dilemma at all? Or perhaps something else is wanted.

It's rather like the Trolley argument where a person is confronted by two terrible choices without any opportunity of choosing some other obviously better one. In that case, where whatever the chooser does will have morally abhorrent consequences, perhaps we should just conclude that the chooser is not really facing a moral dilemma because he isn't in a position to make a morally better choice? The same, albeit in an opposite sense, goes in this case where the choice to vaccinate is as morally laudable as the choice not to do so, depending on how one views the reasons which can be adduced for either choice.

Perhaps the only moral question is one of having the right sentiment and then what kind of sentiment would suffice? Perhaps just to do no harm or to do some positive good, even if the harms and the goods are susceptible to different rational considerations themselves? So whether or not to vaccinate isn't really a moral question, on this view. It's just a practical one.

Aragorn said...

The problem with the dilemma is that herd immunity doesn't confer individuals 100% immunity even if everyone else is immunized. It just means that the pathogen will not have the opportunity to spread through the population which will make it highly unlikely (but not impossible) for your kid to get in contact with it. There is still a marginal chance that your kid will get the disease if she remains unvaccinated. You can then base your calculus on that likelihood.

I still say that the benefit will still outweigh the cost even in the ideal world you've hypothesized.