Can mandatory vaccination be ethically justified? A deontological perspective.

Abstract

Covid-19 is one of the greatest health challenges the world has faced in recent times, and mass vaccination appears to offer the least harmful ‘way out’. At individual level vaccination reduces vulnerability to disease, but at population level vaccination suppresses disease circulation, so that those whom vaccination cannot protect are protected by the rest. The level of vaccination needed to prevent disease circulation varies with disease transmissibility and vaccine efficacy. For Covid-19, with current vaccines, it has been estimated as approaching one hundred per cent. In these circumstances, do we each have a moral duty to agree be vaccinated? If so, is it ethically permissible to coerce this decision through mandation?

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The case for mandating vaccination against Covid-19 has largely been made on broadly consequentialist principles, suggesting that vaccination is morally demanded by principles of fairness and the maximisation of utility, and that mandation is therefore justified. This analysis has some flaws from the deontological perspective; its understanding of what is easy (and fair) takes no account of differing individual perspectives. As a result vaccine hesitancy is treated as of no significance, and the case for preserving any autonomy at all, should enforced vaccination prove the most effective measure for the public good, is unclear. This paper relies instead on a broadly deontological analysis to suggest that, in the current context of the pandemic, the duty of rescue extends to choices we would otherwise much prefer not to make, supporting a moral obligation to choose vaccination even when we would much prefer not to. It suggests, however, that only selfish choice can be coerced, and that - even if the law were to permit compulsory vaccination - the permissible limit of coercion will be determined by the medical-ethical requirement that agreement to vaccination is sufficiently voluntary as to constitute consent.