Ludwig Maximilian University of Munich, Department of Philosophy, Munich, Bavaria, Germany.
Bioethics. 2021 Mar;35(3):237-245. doi: 10.1111/bioe.12835. Epub 2021 Jan 4.
In response to the COVID-19 pandemic, some authors have advocated a program of controlled voluntary infection (CVI) with SARS-CoV-2. Under CVI, during periods where the medical system is under capacity, volunteers from low-risk groups would be intentionally infected after giving informed consent, and then quarantined until they have developed immunity. Proponents claim that this could have benefits for society, such as building herd immunity and ensuring that critical workers won't be incapacitated during the peak of the infection. They also claim that this could have benefits for individuals, such as being safely exempted from lockdown measures and (for individuals who are likely to be infected anyway) ensuring that the infection happens under relatively less dangerous conditions. Some respond that CVI would unethical. Here, I argue that, while CVI may or may not be ill-advised for empirical reasons, there are no in-principle ethical objections to it (i.e., if CVI would work as well as its proponents think, it would be ethical to implement it). I present three arguments for this conclusion. The first is an argument from informed consent: informed consent to relevantly similar medical procedures renders performing these procedures permissible, so informed consent to CVI would render it permissible. The second is an argument from reasonable beneficence: it draws on recent work by Caspar Hare on relevantly similar choices to argue that CVI is permissible. The third is an argument from precedent: smallpox variolation was permissible, and CVI is relevantly similar to that, so CVI is permissible.
针对 COVID-19 大流行,一些作者主张实施有控制的自愿感染(CVI)计划以感染 SARS-CoV-2。在 CVI 下,在医疗系统能力不足的时期,低风险人群的志愿者在知情同意后会故意感染,然后进行隔离,直到他们产生免疫力。支持者声称,这对社会可能有好处,例如建立群体免疫并确保关键工作者在感染高峰期不会丧失工作能力。他们还声称,这对个人也有好处,例如可以安全地免受封锁措施的限制,并且(对于那些很可能被感染的人来说)可以确保感染在相对不那么危险的情况下发生。有人回应称 CVI 不道德。在这里,我认为,尽管出于经验原因,CVI 可能是不明智的,但从原则上讲,它没有道德上的反对意见(即,如果 CVI 像其支持者认为的那样有效,那么实施它就是合乎道德的)。我提出了三个支持这一结论的论据。第一个论据是知情同意的论据:对相关类似医疗程序的知情同意使执行这些程序变得合法,因此对 CVI 的知情同意使其合法化。第二个论据是合理善行的论据:它借鉴了 Caspar Hare 最近关于相关类似选择的工作,认为 CVI 是可以接受的。第三个论据是先例的论据:接种天花疫苗是合法的,CVI 与之相关,因此 CVI 是合法的。