Vaccination, ethics and freedom of choice

Earlier this month, News24 asked me to contribute to a piece on whether vaccine mandates were ethically defensible. Here are some more fleshed-out answers to their questions. David Benatar’s (a colleague at the University of Cape Town) Business Day column on the same topic is worth reading, if the paywall isn’t an impediment for you.

Is it an individual’s ethical duty to get vaccinated?

Yes, because the small inconvenience to individuals of time spent in queues — and then the minimal risk of (typically, trivial) adverse effects is a small cost to pay for the benefits of vaccination. These include not only protecting yourself from serious illness, but also playing your part in protecting all the other humans you come into contact with.

What factors play a role in making the decision ethical or not?

The main criterion in this case would be harms incurred versus harms avoided, where the most serious relevant harm here is the potential loss of life. If there is any low-cost action we can take to avoid harms, it would be an ethical failure to choose any other option.

In France, the state has forced medical professionals to get vaccinated — is that ethical or not?

One reason it might not be ethical is if such actions are a violation of their conditions of employment, but what most people would be concerned about in such cases is the possible violation of personal liberty.

And yes, it would be a violation of personal liberty, but that does not always mean it is an unjustified violation of that liberty. State employees, for example, can more reasonably be expected to have their freedom curtailed than private clinicians would, in such cases, because the state has a compelling interest in promoting population-level immunity and setting a precedent of moral responsibility, as well as in taking precautions to minimize future burdens on the healthcare system.

Should the state therefore force medical professionals, or any other South African to get vaccinated?

Just as public schools require certain vaccinations in various jurisdictions (most of the USA, for example), it would seem in general reasonable to insist on vaccinations for those who are benefiting from or providing public services. Having said that, achieving a net positive outcome for public health can certainly accommodate exemptions to mandatory vaccination.

A key consideration here, as is often the case, is to encourage reflection on the difference between our ethical responsibilities and our legal obligations. While we might want to allow certain individuals or groups of individuals to decline being vaccinated, that would have no bearing on the argument for it being your ethical duty to be vaccinated unless there is some compelling reason not to do so.

The main complicating factor here is that, as with many emotive debates involving liberties, it’s difficult to make the case that personal liberty does not need to be regarded as an absolute good in itself, rather than a principle that is intended to — on the whole — promote individual and societal flourishing.

It can be compatible with a liberal position to infringe on personal liberties in order to secure societal goods that promote liberty on the whole. Vaccinations are such a case, in that people who cannot be vaccinated — such as the immune-compromised — suffer a curtailment of their liberties when the rest of us refuse to be vaccinated.

And if we do so not because of a fear of harm, but simply because we insist on being free to say no just because we abhor being told what to do, we are failing in our ethical duties.