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 | Wednesday, November 11, 2009 at 6:44:21 mst
Comment ID: #1
Name: Robert Nasir
E-mail: RobtNasir(at)yahoo.com
URL: http://GreatLakesObjectivists.com
The government has no proper role to play in providing health care ... including preventive care ... to the citizenry.
Vaccination is one area in which a pragmatic case can, and is, made for the benefit we'd all see, having the government handle (or at minimum compel) compliance.
But this is only a benefit out-of-context. The price we pay in the full context for abandoning the principle of individual autonomy is immeasurable.
In the long run, pragmatism is a killer.
I'd trade a greater risk of infection for the benefits of freedom any day. With the unleasing of doctors, of technology, of tax dollars, with the free flow of ideas and capital, the new cures and ready availability of treatment (and vaccinations), I'd happily shrug off the risk of catching a bug from the neighbors.
(Of course, in a freer society, that risk would ultimately be lower anyway.) |
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| Wednesday, November 11, 2009 at 6:57:56 mst
Comment ID: #2
Name: Robert Nasir
E-mail: RobtNasir(at)yahoo.com
URL: http://Vintage309.com
The case for Forced Quarantine is more interesting. I certainly agree that, in cases where the evidence is conclusive that a person's infection represents an imminent danger to others, compulsion to remove that person from the threatening situation can be proper.
Personally, I find the interesting question is of how expert testimony is used, not in a judicial, but in an executive context. I would suppose the means of determining when a proper standard of evidence has been reached would be similar, and in complex cases, I know recourse to a judge's sanction can be sought (as in the case of search warrants), but I'd be interested to hear additonal perspectives on this. |
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| Wednesday, November 11, 2009 at 9:04:09 mst
Comment ID: #3
Name: Guy
This issue would be covered under private property rights in a truly free society. Private schools and day care could decide if they would require vaccinations for admittance, and if so which ones. Airlines, hospitals, employers and other private service providers could decide to what extent they offer services or jobs to people who may be more likely to spread disease or cannot prove vaccination. If one doesn't wish to receive certain vaccinations, one chooses accordingly. |
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| Wednesday, November 11, 2009 at 10:51:01 mst
Comment ID: #4
Name: Charlie
Aren't we talking about government employees here? As in, those who voluntarily accept the terms of employment in exchange for the benefits having a particular job brings? I realize that because the employer happens to be a government that it's our right and responsibility to micromanage their policies, but whether or not one of them "violates" some person's right(s) isn't the issue. People willingly forego their rights all of the time in order to benefit financially, and should be free to do so. The only rights-related issue here is: is this policy the most efficient and cost-effective way for the government of the state of New York to perform it's tasks - and thereby avoid unnecessarily wasting it's citizen's resources? |
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| Wednesday, November 11, 2009 at 13:29:31 mst
Comment ID: #5
Name: Dana H.
Diana's response is true as far as it goes, but it doesn't address the issue of the New York health workers. No force is involved here. As the article stated, "Workers are being told to either get the swine flu vaccine or lose their jobs."
It is perfectly valid for an employer to stipulate conditions of employment. In this particular case, the conditions are even reasonable. Doctors and nurses come in close proximity to people more vulnerable to infection than the general population. So even if a bout of H1N1 is mild for them, it could be devastating if transmitted to one of their patients. |
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| Wednesday, November 11, 2009 at 13:33:45 mst
Comment ID: #6
Name: Dana H.
P.S. On re-reading the article, I'm now not sure that the mandate applies only to employees of the state. The article refers to New York mandating vaccinations for "its" health workers. But I can't tell if this means all health workers practicing in the state, or only those employed by the state. If the former, then of course the mandate is wrong. |
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| Wednesday, November 11, 2009 at 13:43:22 mst
Comment ID: #7
Name: Haon
E-mail: noahkgreen(at)gmail.com
"So... when a person contracts a dangerous communicable disease and then exposes other people to it by ordinary social interactions, he violates their rights. It's akin to driving a car while drunk. That person is exposing other people to major threats to their life and limb without their consent. That's what justifies government action to protect the healthy -- but only in the form of forced isolation of the sick."
The analogy is a good one, but it seems to make Diana's case weaker rather then stronger. If someone is a drunk driver, we have ways to prove that they broke the law. We can do a breathalyzer test, show their erratic driving patterns from a security/traffic camera, etc. If they violate someone's rights in the process (smash another person's car, drive on the sidewalk, whatever) we have ways to prove they did this.
But if someone I run into on the train who decided not to get vaccinated, is a carrier, and passed the potentially deadly disease onto me, even though they violated my rights, I doubt anyone will be able to prove that this happened, and certainly no one would be brought to court for not getting vaccinated and spreading the disease on a crowded subway car.
Diana says: "It's not a violation of the rights of others to fail to be vaccinated. You have every right to get sick and die! The tort lies in knowingly or willingly spreading the disease to others." And yet it is my understanding that mandatory vaccination is advocated primarily to deal with people who either knowingly or unknowingly are spreading the disease to others. I don't ask to be exposed to another person's germs. |
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| Thursday, November 12, 2009 at 11:01:09 mst
Comment ID: #8
Name: Emma B
E-mail: fertilityproject(at)gmail.com
One unique quirk of communicable diseases is that you generally are contagious for days before you are actually ill, or before you (or some other entity) realize you have the illness in question.
I had what was probably the H1N1 flu earlier this fall. I got it from someone who probably had a very mild case of it -- her daughter had it, but she herself felt under the weather for a day or so. I was in contact with her after her kid was sick, but before she realized her child had the flu rather than a random fever, and before she felt sick herself. My children and I didn't get sick until about 24 hours after we'd been exposed, and on that one day where nobody seemed to be sick, I took my kids to the McDonald's playground, where they probably merrily spread it all over the place. None of us had any conscious intent to disseminate it to others, but that's what we did, regardless of intentions.
A lot of diseases, such as measles, start off looking like a cold, the kind of thing nobody bothers self-quarantining from work or school or public spaces for. By the time you realize there's a problem, you've already done your part to infect others. That's why quarantine measures have been notably ineffective throughout history in halting the spread of contagious disease, and continue to be ineffective in unvaccinated populations. If you choose not to vaccinate yourself, it's logically equivalent to making the choice to spread it to other people. |
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| Thursday, November 12, 2009 at 18:44:56 mst
Comment ID: #9
Name: Wes
Another thing to consider: A lot of people can't get vaccinate and depend on herd immunity for protection. First, many people can get the vaccine but have no immune response, so they are not immune. It's rare, but it happens, and there is no way to know if this is the case until someone gets sick. So anyone, whether vaccinated or not, could get sick and pass on a disease. Second, when herd immunity falls, more people can get sick and die, or receive permanent damage. For humans, herd immunity should be around 90%.
http://www.slate.com/id/2232977/
http://www.timesonline.co.uk/tol/news/uk/article1055533.ece
I believe it is in everyone's best interest to get vaccinated, but I don't think the government should mandate vaccines; the private sector would handle that. Even if my kids were vaccinated, there is no way I would take them on an airplane or take them to daycare unless there was some sort of vaccine policy. Businesses would eventually deny services to people who choose not to get vaccinated.
On a side note, there is almost no rational reason to avoid getting vaccinated. The anti-vaccination crowd is going to do damage to people with there anti-reason and anti-life position. Check out Generation Rescue, Age of Autism, or anything Jenny McCarthy says to see this for yourselves. Don't even get me started on Andrew Wakefield. |
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| Friday, November 13, 2009 at 15:36:13 mst
Comment ID: #10
Name: Diana Hsieh
E-mail: diana(at)dianahsieh.com
URL: http://www.dianahsieh.com/blog
Emma -- You are assigning all moral and legal responsibility for avoiding some contagion to the person who might transmit it. Yet that's wrong -- for two reasons.
First and most obviously, it's wrong because the people who might catch it are responsible for taking measures if they wish to avoid it. If a person really really doesn't want to catch the flu (swine or not) during flu season, then he ought to refuse to shake hands, keep away from sick co-workers, and for goodness sake, not play at the McDonald's playground. To engage in those activities is to tacitly consent to the risks involved, including catching the flu. Heck, a person can get vaccinated himself! Notably, if a person is in serious danger from the flu -- perhaps he's immunocompromised -- then he needs to quarantine himself. That's particularly true when the contagion is not of serious risk to most people, as with the flu. Similarly, if I'm a person with delicate bones, it's my job to protect myself from injury while driving car; to demand that everyone else drive 30 MPH would be absurd.
Secondly, people are not justly held morally or legally responsible for merely causing some harm. The harm must be unreasonable, outside the ordinary risks of life. The flu simply doesn't qualify. Moreover, the responsible person must *know* that he is imposing that unreasonable risk of harm on others. A person satisfies that epistemic condition when he's showing signs of illness, but not before. To ignore that epistemic condition for moral responsibility is to demand omniscience. It would require that people take all kind of preventative measures based on the arbitrary speculation that *perhaps* they're a greater danger to others than they have reason to believe. That's wrong. (Notably, that epistemic condition goes back to Aristotle, and it formed a huge part of my dissertation.)
As for the question of herd immunity that Wes raises, I think to claim any obligation to vaccinate on that basis is nothing but altruism. Why I am obliged to vaccinate myself (or my children) because the vaccine might not be effective for someone else (or their children)? Even if vaccines presented no health risks whatsoever -- and that's clearly not the case -- why should anyone be morally obliged to spend their time and money for the sake of the immunity of the herd?!? |
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| Saturday, November 14, 2009 at 20:30:40 mst
Comment ID: #11
Name: Emma B
E-mail: fertilityproject(at)gmail.com
Re herd immunity, the obvious response is because you and/or your children benefit from it, whether or not you choose to vaccinate them. You may be healthy and low-risk, but it's still quite possible for you to catch the flu and have serious complications from it. The fewer people who are infected with the flu and can transmit it to you, the lower your chances of doing so. Once approximately 90% of the population is immunized against a disease (either through vaccine or through illness and recovery), there aren't enough vulnerable hosts for the disease to circulate freely, and even unvaccinated people are therefore unlikely to be exposed. If you choose not to vaccinate, you're still receiving the benefit of other people's choices to assume the (small) risks of vaccination in the name of public health -- you can't opt out of the biological reality. I'm not an Objectivist myself, so I'm murky on the finer points of philosophy, but wouldn't that be considered freeloading?
Vaccines aren't a foolproof solution for individuals, though, because they are not 100% effective. With the flu, for example, about 25% of the immunized population don't display enough of an immune response to the shot to prevent them from getting or spreading flu. I can vaccinate myself and my family, but there's still a 5% chance I can catch flu from one of them (25% their vaccine fails, 25% chance that mine does too), which is pretty high if you happen to have something like asthma. Ironically enough, the people with weaker immune systems often are the ones who don't develop full protection. In addition, many vulnerable people (very young babies, immunosuppressed people, pregnant women) cannot be vaccinated for some diseases like measles at all, and are entirely reliant on herd immunity.
As for quarantine/self-protection, effective self-quarantine of vulnerable people is practically impossible, and the sort of personal hygiene measures you propose are of limited effectiveness against airborne illnesses. If I work outside the home, I can be infected by the sick co-worker in the next cubicle, or by the contagious one who'll be actively ill tomorrow. If I choose not to work outside the home, my kids can still be expected to bring home all manner of crud from school. I can homeschool them and deny them friends and social activities, but that won't help when my husband brings it home from work. If I make him work from home too, someone's still got to do the grocery shopping, and take the kids to the doctor and the dentist... you see the problem.
My father had a heart transplant, so I actually have some personal experience with immunosuppression and quarantine. Despite all of our best efforts, and even serious protective measures like face masks and obsessive handwashing for all of us (and he was a surgeon, so I don't use the term idly), he suffered from several serious illnesses every year, usually picked up from one of us kids. I'd say a better analogy than 30-MPH driving, one I know you're familiar with, is gun safety. If I don't want to get shot, I should stay away from bad parts of town, wear hunter orange in the woods, and avoid walking downrange, but I also shouldn't have to wear body armor so that you can wave your barrel around indiscriminately, either. Quarantine is not, and has never been, able to make a significant dent in the transmission of illness, or protect individuals. The only thing that's been able to stop the diseases like measles and polio which were once endemic is herd immunity, either through widespread vaccination or effective and prompt antibiotic treatment. |
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| Saturday, November 14, 2009 at 21:39:44 mst
Comment ID: #12
Name: Emma B
E-mail: fertilityproject(at)gmail.com
(Wanted to address the epistemiology separately, because that last comment was getting long...)
"A person satisfies that epistemic condition when he's showing signs of illness, but not before."
This, I think, is our major disagreement.
Does the person also satisfy that epistemic condition if he knows he's been exposed to a disease, but is still in the incubation period? He cannot yet know whether he is ill, but if he is to become ill, it's certain that he is already contagious. For example, let's say I have twin babies who are too young to have gotten their MMR vaccines. One baby develops the symptoms of measles and is formally diagnosed with it by a doctor, while the other baby still appears well. Do I send the well baby to day care the next morning, knowing that there is a significant chance she'll come down with it in the next day or two, by which time she will have spread it to all the other babies in day care?
I would say that no, I'd be horribly negligent to do so, and would bear moral responsibility for the illnesses of the other children. But what about their older brother, who has gotten his MMR vaccine? There's a 1-in-20 chance that his vaccine didn't take, and that he's a measles carrier. It's virtually certain that some of the other children in the school are likewise vulnerable, and measles is incredibly contagious. Should I pull him out of school preemptively, and if I don't, what level of responsibility would I bear? What if he goes to a Waldorf school, and I know many of his classmates are unvaccinated? Should I avoid going out to lunch with my pregnant friend, on the 0.25% chance that neither of us is immune and that I'm a carrier? Should my husband stay home from work, to prevent potentially infecting his colleagues with young children? Should I skip the grocery store and stay away from public transportation for the same reason? Or what if it's not my baby with the measles, but I know that another baby in day care got sick yesterday? In that case, we're only a day or two back in the illness chain, and we know there's a non-zero likelihood that we're already contagious. Where do you draw the line for what constitutes "unreasonable risk of harm"?
I suppose you could say that we're all culpable, because everyone in that scenario knows that there's been a case of measles. However,if we deliberately choose not to give our eligible children MMR vaccines, we similarly have some degree of advance knowledge, above and beyond the background risks of life. The background risk is the 5% chance of a vaccine failure, but our children have a 90% chance of becoming contagious without warning if they are ever exposed to measles. We know that we could mostly prevent other people from being unwittingly infected by giving our children MMR vaccine, but we choose not do. Have we committed a sin of omission? Does it make a difference if we hypothesize that the MMR has absolutely no risk whatsoever? (And yes, I know there are some risks, but I believe the rational scientific evidence shows them to be quite small.) If it does, where is the inflection point at which the personal risks of the MMR outweigh the potential negligence of spreading the disease to others?
Or would you still say that none of us bear any moral responsibility for any of the above actions, including sending the currently-well twin to day care, because we do not know with certainty that any of us other than the sick twin are ill? If so, I suppose it's nice to be philosophically consistent, but the disease doesn't care so much about that. |
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| Saturday, November 14, 2009 at 22:24:18 mst
Comment ID: #13
Name: William H Stoddard
E-mail: whswhs(at)mindspring.com
URL: http://whswhs.livejournal.com/
Emma: I'm not going to attempt to address the issue of mandatory vaccination. But I want to comment on the practical issue you raise.
One member of my circle of friends is a professional voice actor who cannot afford to lose work time to respiratory infections; even a mild infection would lower the quality of his voice unacceptably. Half a dozen of us get together on the first Saturday of every month. But if one of us is at risk of being contagious, we will warn him and each other, so that he can choose not to attend, or so that, knowing our presence would stop his attending, we can choose ourselves not to attend. In other words, we deal with it through informed consent: We don't presume to decide for him whether the risk of exposure to us is one he can put up with, but let him know the facts and decide for himself.
I did likewise, a few weeks ago, when I was getting over an upper respiratory infection at a time when I had to drop off a work assignment at a location where I have two friends who normally join me for lunch afterward. Rather than just make the decision, I told both of them the state of my health, and they chose to join me.
I think that in any situation of voluntary association, giving the people you are dealing with notice of the risk and letting them choose whether to accept it shows the greatest respect for their rights. This would apply, for example, to a school: If your child had been exposed, the proper course would be for you to let them know and ask if your child should attend or not. Or the school could set policies in advance, and ask you to agree to them before enrolling your child. This is hard to do at a public school, where attendance is legally mandated; but private schools would have every right to set such conditions. |
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| Sunday, November 15, 2009 at 9:44:22 mst
Comment ID: #14
Name: Emma B
E-mail: fertilityproject(at)gmail.com
William: as a parent, I try to do the same thing with myself and my own children in the context of playgroups and public outings, and expect the other mothers of our social circle to do the same. However, in the above case where I took my H1N1-contagious kids to McDonald's, I simply didn't know. My friend's kid wasn't yet sick enough for her to think it worth mentioning or self-quarantining. By the time her child had progressed from "under the weather" to "has the flu", the disease transmission was already in its fifth generation (friend's kid -> friend -> me -> my kids -> other kids at McDonald's).
Again, not a big deal in the context of H1N1, which isn't that threatening for most people. I had some trouble with it (presuming that's what we had) because of my asthma, but my kids were not terribly sick. I worried about it no more and no less than I do any other flu, cold, RSV, etc. But what if we'd been infected with measles or whooping cough instead of the flu?
I'm not actually arguing for truly mandatory vaccination either. As a requirement of school/daycare entry, certainly, and I also think it reasonable to require vaccination as a condition of employment -- if you're that concerned about the risks of vaccines, you can opt out of either. From a purely scientific viewpoint, I think it's pretty clear that widespread vaccination is the best way to eliminate the disease, and people who don't vaccinate increase the risk to everyone else. However, science isn't the sole consideration, and I think the moral dimension is interesting here. |
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| Sunday, November 15, 2009 at 21:23:16 mst
Comment ID: #15
Name: Diana Hsieh
E-mail: diana(at)dianahsieh.com
URL: http://www.dianahsieh.com/blog
EmmaB -- Thanks for your replies. I do disagree with you on a number of points, but I just don't have time to reply at present. So you get the last word! |
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