Autonomy and moral obligation to be vaccinated
By Sam Ben Meir
NEW YORK – To date, nearly two hundred million Americans – just over 60% of the population – have been fully vaccinated against Covid-19. Recent reports indicate that unvaccinated adults are more than three times more likely to tip Republicans. In other words, for every unvaccinated Democrat, there are about three unvaccinated Republicans. An important question not only for bioethicists but for all of us is therefore whether there is a moral obligation to vaccinate.
Some have argued, such as independent researcher Michael Kowalik, that “there is neither a moral obligation to vaccinate nor a solid ethical basis for mandating vaccination under any circumstance” – in which case a mandate for vaccination would by definition be unfair. and morally illegitimate. For Kowalik, “the autonomy of agents with regard to self-constitution has absolute normative priority over the reduction or elimination of risks associated with life.”
The utilitarian case of the moral obligation to be vaccinated is quite simple. Utilitarianism tells us to act in such a way as to produce the most good for the greatest number. However, collective immunity produces the greatest good for the greatest number, and it is therefore a morally laudable objective: individuals then have a moral obligation to contribute to the achievement of collective immunity by being vaccinated. As bioethicist Karey Harwood points out: “Utilitarianism would even tolerate a certain risk of prejudice to a few individuals for the benefit of many” – but “No one asks for a heroic sacrifice.” Those for whom vaccination is medically contraindicated, and therefore require medical dispensation, should of course receive one.
The classic problem with utilitarianism is that it poorly protects the rights of the individual – and the advocate of personal autonomy may remain skeptical and argue, as Kowalik does, that “compulsory vaccination amounts to discrimination against healthy and innate biological characteristics ”. I would say that compulsory vaccination does not amount to discrimination – that discrimination aims to degrade, humiliate and ultimately deny the inherent dignity of the other. Mandatory vaccination does not discriminate against healthy people, nor do speed limits discriminate against superior drivers who are able to drive safely at speeds in excess of the limits. The road is a shared resource, which is why we must obey the rules of the road while driving. Likewise, our immunity to disease is a shared resource that we are collectively responsible for protecting.
Nonetheless, we can strengthen the arguments in favor of the moral obligation to get vaccinated by showing that not only getting vaccinated is not necessarily an infringement of ‘agent autonomy’, but can even be seen as an infringement. an expression of autonomy. The greatest modern thinker of autonomy was Immanuel Kant, and for Kant autonomy had little or nothing to do with the freedom to do what one wants. (Indeed, they were rather opposites.) Kant understood autonomy in terms of what the very word implies – namely, auto (self), nomos (law). Thus, autonomy is self-legislation; not the ability to do what we want, but to act according to a law that we legislate for ourselves. In fact, Kant explicitly maintains that whenever I act out of self-interest or out of simple inclination (even inclination to help others), then my action is not really gratuitous and has no moral value. These actions may be in accordance with duty, but they are not done for duty – and this is a decisive criterion of moral worth.
This would seem to suggest that if we are to know if there is a moral obligation to get vaccinated, we have to ask ourselves if getting vaccinated is at least in accordance with our duty, that is, what the moral law requires. . How then to evaluate an action according to the moral law? One of the classic formulations of Kant’s moral law is known as the principle of universalization: it tells us to act only on maxims that we can rationally universalize. Ask yourself: can I rationally want everyone to act by the same maxim that I am about to apply? So, to take a classic example: suppose I am considering making a promise that I don’t intend to keep – can I rationally want everyone to make a similar false promise when it suits them? The answer is no, because then the whole institution of making deals (promises, contracts) would collapse. So when I make a false promise, I’m actually making an exception for myself – I’m saying everyone should stick to their agreements but I’m exempt.
Let us now consider the moral obligation to vaccinate: can I rationally want – that is to say, can I want without contradicting myself – that no one is allowed to be vaccinated? The answer is obviously no, because then it would be too dangerous for anyone not to be vaccinated and millions of people would probably die. Likewise, there is a moral obligation to wear a mask to reduce the transmission of disease. During a major pandemic, I am safe without a mask only as they are typically worn. When I refuse to wear a mask, knowing that it will reduce the spread of contagion, what I say whether I know it or not is that it is okay for everyone to wear a mask, but I am an exception. Everyone else is responsible on their own small scale for the welfare of the community to which I belong, but I am not responsible.
Kant proposed another formulation of moral law, sometimes referred to as the principle of dignity – it says never to treat another person just as a means but always also as an end in itself. That is, treating any other person (or rational being) as possessing infinite intrinsic worth. Notice, that doesn’t say that we can’t treat each other as a means: it says you can’t just treat yourself as a means, that we always have to also recognize the other person as a being with intrinsic worth. Now, what does this have to do with the issue of vaccinations? Since those around me are vaccinated, I am less likely to contract the virus: so, in a sense, I use their willingness to vaccinate as a means for my own well-being. Its good. However, if I refuse to vaccinate, then I am not reciprocating or contributing, I am not treating those around me, and their well-being, as an end in itself. Again, I am effectively making an exception of myself – which is, from a Kantian (and even utilitarian) point of view, capital moral sin. This can be seen as a sort of Kantian version of the stowaway argument, which is typically used against those who refuse vaccination because they passively receive herd immunity without contributing to it. In short, by refusing vaccines, we are acting as free riders, which is morally inadmissible in a civilized society.
We must remember, however, a basic principle of ethics – that “should” implies “power”. If I have a moral obligation to get vaccinated, that assumes I have access to the vaccine, but not everyone has access. If the insatiable greed of companies like Moderna prevents them from making the vaccine available to developing countries, then it is a far greater and more harmful moral outrage than the refusal to be vaccinated.
I have not attempted to argue that we should just follow Kant’s moral theory. Without a doubt, he got some things wrong. Yet it can be argued that we have lost sight of autonomy in its most robust and critical sense. Our sense of solidarity suffered as a result. We have forgotten the words of John Donne: “No man is an entire island; every man is a piece of the continent, a part of the main one. What Kant understood correctly is that we are universal beings – that when we choose, we are choosing for all of humanity. And finally, it is because the reason is universal, the same for all across time and space. We are increasingly fractured as a society in large part because we have lost our common confidence in the universality of reason and truth. If and when it does, we will rediscover that our freedom is not achieved by being tough individualists, but by acting on behalf of our neighbor.
Sam Ben-Meir is professor of philosophy and world religions at Mercy College in New York.