Medical ethics and broadening the context of debate

Vaccine Refusal and What to Do About It: a Systematic Review of the Ethical Literature

“…Fifteen papers from this sample present arguments that vaccine refusal is justi ed based on respect for parental autonomy, rights, or liberties (21,23,25,31,32,35,36,39,68,71,75,80,94,100,121). Some argue that vaccine refusal is justi ed on the basis of preserving legal rights (31,80) or expression of religious freedom (23).…”

“…that in a low-incidence (and therefore low-risk) setting mandates cannot be justi ed (45, 87,104)-most make their arguments from autonomy, informed consent, and personal liberty and do not weigh these against the potential for harm (12,16,61,82,89,107,114). One author argues that even if mandates improve vaccination rates, they damage trust with parents and make refusers more steadfast in their decision (121), so are not sustainable. Finally, some authors present middle-ground positions that-in their vieware more autonomy-or liberty-preserving, including persuasion (121) or weakly enforced mandates (71), or argue that policy responses should take the least coercive approach that is feasible and effective to balance the needs of the individual with public health (117).…”

“…One author argues that even if mandates improve vaccination rates, they damage trust with parents and make refusers more steadfast in their decision (121), so are not sustainable. Finally, some authors present middle-ground positions that-in their vieware more autonomy-or liberty-preserving, including persuasion (121) or weakly enforced mandates (71), or argue that policy responses should take the least coercive approach that is feasible and effective to balance the needs of the individual with public health (117).…”

“…For example, authors disagree on the effect of both nudges and conscientious objection policies on parental autonomy or liberty. With respect to nudges, some argue they are autonomy-preserving because they steer parents in a certain direction while allowing choice (106), do not override or challenge the strong views of deeply opposed opponents (42,44) and uphold informed consent (121). Some supporters of nudging weigh multiple normative considerations, arguing that nudges that appeal to social responsibilities in a medical practice setting are justi ed because they appropriately balance parental autonomy against the practitioner's responsibility to promote trust and collective bene ts (3,80).…”