Marckmann Georg
Institut für Ethik und Geschichte der Medizin, Universität Tübingen, Schleichstrasse 8, Tübingen, BRD.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Feb;51(2):175-83. doi: 10.1007/s00103-008-0448-2.
Vaccinations are among the most effective and cost-effective means to prevent serious infectious diseases. Actual vaccination rates, however, still fall short of their full potential to reduce morbidity and mortality both in industrialized and low-income countries. Therefore, strategies to increase immunization rates are ethically and economically mandated, raising the following ethical issue: To what extent is it ethically appropriate to restrict individual autonomy by compulsory immunization requirements in order to achieve a sufficient collective protection of the community? Restrictions of individual autonomy are ethically justified if the following five conditions are met: (1) proven benefit, (2) favourable benefit-risk-ratio, (3) acceptable cost-benefit ratio, (4) as little restrictions as possible and (5) fair and transparent decision procedures. Depending on how far these five criteria are met, different strengths of recommendation result for each specific immunization program. However, there are good ethical and pragmatic arguments against compulsory vaccination enforced by law. Rather, one should try to strengthen public support and trust in vaccination programs by a proactive and persuasive information policy.
疫苗接种是预防严重传染病最有效且最具成本效益的手段之一。然而，无论是在工业化国家还是低收入国家，实际疫苗接种率仍未充分发挥其降低发病率和死亡率的潜力。因此，提高免疫接种率的策略在伦理和经济上都是必要的，这就引发了以下伦理问题：为了实现对社区足够的集体保护，通过强制免疫要求来限制个人自主权在伦理上的适当程度如何？如果满足以下五个条件，对个人自主权的限制在伦理上就是合理的：（1）已证实的益处，（2）有利的效益风险比，（3）可接受的成本效益比，（4）尽可能少的限制，以及（5）公平且透明的决策程序。根据这些标准的满足程度，每个特定的免疫计划会产生不同强度的推荐。然而，存在有力的伦理和务实论据反对通过法律强制进行疫苗接种。相反，应该通过积极且有说服力的信息政策来努力增强公众对疫苗接种计划的支持和信任。
