Vaccination and other Altruistic Medical Treatments: Should Autonomy or Communitarianism Prevail?

Abstract

The publication of a report into a case where an organ donor's constraints on the race of potential recipients raises questions about whether respect for autonomy or communitarianism should prevail in altruistic medical procedures. This article briefly reviews how autonomy and communitarianism are balanced in cadaveric and live organ donation, bone marrow donation, gamete donation, blood donation and vaccination. It criticises vaccination policy for ostensibly respecting patient autonomy yet in practice compromising that autonomy in various ways. Vaccination is properly viewed as an altruistic medical procedure because some vaccines are of more good to society than to the vaccinee, who runs associated health risks. The conclusion is that there is a spectrum of attitudes to the value of autonomy, depending principally upon the invasiveness of the procedure. In most cases the autonomy-communitarianism balance is satisfactory, but this is not so in respect of cadaveric organ donation and vaccination. The article proposes that cadaveric organ donation should be governed by the communitarian law of well-publicised presumed consent. It proposes two alternatives for vaccination: that vaccination should be compulsory or, preferably, that procedures be modified so that parents have real autonomy in their decisions whether to vaccinate their children.

A hipótese vacinal: por uma abordagem crítica e antropológica de um fenômeno histórico

“…Avaliar a hipótese vacinal em seu conjunto constitui uma tarefa complexa para a qual nós não possuímos talvez as ferramentas metodológicas adequadas. Na maioria das vezes, para fundamentar a legitimidade da vacinação, os autores se limitaram, como salienta Myriam Bahia Lopes (1999), a estabelecer uma comparação entre países que adotam políticas diferentes. Olha-se, por cima da fronteira, para o país vizinho com vistas a comparar as estatísticas: o exemplo clássico é a comparação da mortalidade por varíola entre a França e a Alemanha, durante a guerra de 1870, quando somente esta última impunha a vacinação.…”

The influence of altruism on influenza vaccination decisions

“…Nevertheless, altruism is a psychological trait that can influence human behaviour and decision-making [14][15][16][17], thereby impacting the outcomes of vaccination strategies and other public health policies. Vaccination can be also regarded as a somewhat altruistic behaviour, because vaccines can be of greater good to society than to the recipient who bears the cost of vaccine [18]. As such, the decision to vaccinate has the potential to be influenced by altruism.…”

Philosophy, freedom and the public good: a review and analysis of ‘Public Health Ethics’ Holland, S. (2007)

“…Philosophy, freedom and the public good problem in the analyses of the ethics of immunization [110,[162][163][164]. Holland addresses these by posing four questions:…”