What can ethics tell us about compulsory vaccination? Its role is to inform political decision-makers on avenues for combining ethical issues with other health, economic and legal issues. However, like other researchers who have contributed to the development of such ethical analyzes in public health over the past 25 years, I can only wonder about certain risks of slippage. However, a consensus exists around a conception of ethics as an exercise of nuanced arbitration in the influence that certain fundamental values will have on the acceptability of such or such intervention. However, this search for balance can be jeopardized by the disproportionate importance given from the outset to one of these values, namely the almost sacred respect for individual rights and freedoms.
Ethics are based on an open and democratic deliberation as to the best balance to be found in the respect of values likely to come into conflict in a given situation. The concern for respect for individual freedoms and decision-making autonomy must be balanced by an equal concern for solidarity with the community, respect for the common health good, the responsibility of everyone to limit the negative effects on the population or sharing. equitable burden associated with the pandemic.
Most of the time, public health interventions involve inevitable encroachments on certain values. For example, defending the right to refuse to be vaccinated requires placing respect for autonomy and individual freedoms at the top of the hierarchy of values, but to consider values such as the defense of the common good as of secondary importance. , the protection of the population against contamination, civic responsibility, the solidarity of each one towards the community, the protection of vulnerable people or benevolence towards the other.
Ethics is not the right
Given our society’s attachment to individual rights and freedoms, encroachments on respect for these values should only be justified as a last resort. But freedom cannot be reduced to the freedom not to take responsibility for others. If we can understand that certain jurists unconditionally defend individual freedoms, constrained by the charters of rights and freedoms, ethics is not law. The evaluation of ethical acceptability cannot be followed by any value promoted to the rank of absolute and dogma if not at the cost of a perversion of its function.
The ethical acceptability of an intervention or a health policy will of course depend on the social, economic and epidemiological context and on scientific knowledge, which by nature is constantly evolving. However, vaccines are objectively safe, convincingly effective, free, easily accessible, and they cause (in the vast majority of cases) only minor inconvenience to the vaccinee. Conversely, the vaccinated must live daily in contact with unvaccinated carriers of a highly contagious virus, at work as well as in shops and other public places. They are exposed to an easily avoidable risk of contamination. The concrete difficulties raised by the application of the vaccination obligation cannot be minimized. But, another element of context, the seriousness of the repercussions of the present wave of cases of COVID-19 on the offloading of care and surgical operations, on the school environment, on the economy constitute circumstances which call for a reconsideration of the weight given. to individual freedoms in ethical analyzes. The effects of vaccination on the freedom of a minority of the unvaccinated must be weighed against the effects of non-intervention. Focusing on the ethical impacts of compulsory vaccination skews the analysis in favor of the unvaccinated, therefore designated as victims. In its search for balanced opinions, ethical wisdom should equally raise the issues arising from non-intervention in society.
Among the three stages of prevention that are informing, convincing and coercing, coercion should be a measure of last resort. But in the current emergency context, it would be irresponsible, even unethical, to argue that additional information and conviction work could have a considerable impact on the prevention of irreparable harm done to patients deprived of care, to the system. health and society. Extending the mirage of a massive and immediate conversion of the unvaccinated to the values of the common good and social responsibility will only be a pseudoethical justification for inaction.