Jamrozik Euzebiusz, Handfield Toby, Selgelid Michael J
Centre for Human Bioethics, SOPHIS, Monash University, Clayton, Victoria, Australia.
Department of Philosophy, SOPHIS, Monash University, Clayton, Victoria, Australia.
J Med Ethics. 2016 Dec;42(12):762-768. doi: 10.1136/medethics-2015-103327. Epub 2016 Oct 3.
Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated-including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others' freedom to opt out of vaccination. It is often asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate.
大规模疫苗接种一直是针对许多传染病的一项成功的公共卫生策略。接种疫苗者的免疫力也能保护其他无法安全或有效接种疫苗的人，包括婴儿和免疫功能低下者。当疫苗接种率下降时，麻疹等疾病可能会在人群中迅速卷土重来。因医学原因无法接种疫苗的人面临着患重病和死亡的最高风险。因此，他们可能要承担他人选择不接种疫苗的自由所带来的负担。人们常常会问，国家采用并强制推行普遍强制接种疫苗是否合法。然而，这忽略了一个相关问题：在允许选择不接种疫苗的情况下，那些选择不接种的人，当其他人因他们的决定而受到伤害或死亡时，他们在道德上是否负有责任？在本文中，我们认为选择不接种疫苗的个人对由此给他人造成的伤害负有道德责任。以麻疹为例，我们展示了选择不接种疫苗会如何给他人，尤其是婴儿和免疫功能低下者带来重大的伤害和死亡风险。我们认为，毫无正当理由地施加这些风险是应受谴责的，并探讨了在疾病传播所需的集体行动背景下，如何达成对个人对伤害的道德责任的连贯理解。最后，我们考虑了对这一观点的几种反对意见，提供了反驳论据，并提出了在道德上可允许的替代普遍强制接种疫苗的方法，包括可控感染、自我实施的社会隔离以及对拒绝接种疫苗的经济处罚。
