In the first decades of the twentieth century, a heterogeneous assortment of groups and individuals articulated scientific, political, and philosophical objections to vaccination. They engaged in an ongoing battle for public opinion with medical and scientific elites, who responded with their own counterpropaganda. These ideological struggles reflected fear that scientific advances were being put to coercive uses and that institutions of the state and civil society were increasingly expanding into previously private realms of decision making, especially child rearing. This essay (...) analyzes the motivations and tactics of antivaccination activists and situates their actions within the scientific and social climate of the Progressive Era and the 1920s. Their actions reveal how citizens of varied ideological persuasions, activists and nonactivists alike, viewed scientific knowledge during a period of swift and unsettling change, when the application of biologic products seemed to hold peril as well as promise. (shrink)

The three primary ethical challenges in preparing for public health emergencies - addressing questions of rationing, restrictions and responsibilities - all entail confronting uncertainty. But the third, considering whether people and institutions will live up to their responsibilities in a crisis, is perhaps the hardest to predict and therefore plan for. The quintessential example of a responsibility during a public health emergency is that of health care professionals' obligation to continue caring for patients during epidemics. Historically, this 'duty to treat' (...) has sometimes gone unrecognized or ignored, but it has also famously been adhered to, including during the recent SARS epidemic. And non-crisis examples of health professionals working in the face of personal risk are very common. The duty to treat should be circumscribed by several considerations, including the levels or risk and benefit at issue, the degree of public reliance on health professional action, and the nature of the individual health professional's acceptance of greater than usual risk. Examining the professional duty to treat and the legitimate questions it raises can provide insight into other actors' responsibilities. Public health ethics as well as professional ethics can help frame answers to some key questions: How strong are ethical responsibilities during crises? To whom do they apply? Should they be more explicit - and hence more circumscribed - or less explicit and hence largely aspirational? And how can public health policies encourage responsible actions? (shrink)

In the first decades of the twentieth century, a heterogeneous assortment of groups and individuals articulated scientific, political, and philosophical objections to vaccination. They engaged in an ongoing battle for public opinion with medical and scientific elites, who responded with their own counterpropaganda. These ideological struggles reflected fear that scientific advances were being put to coercive uses and that institutions of the state and civil society were increasingly expanding into previously private realms of decision making, especially child rearing. This essay (...) analyzes the motivations and tactics of antivaccination activists and situates their actions within the scientific and social climate of the Progressive Era and the 1920s. Their actions reveal how citizens of varied ideological persuasions, activists and nonactivists alike, viewed scientific knowledge during a period of swift and unsettling change, when the application of biologic products seemed to hold peril as well as promise. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that (...) they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested. (shrink)

Immunisation is offered to all age groups in the UK, but is mainly given to infants and school-age children. Such immunisation is not compulsory, in contrast to other countries, such as the United States. Levels of immunisation are generally very high in the UK, but the rates of immunisation vary with the public perception of the risk of side effects. This article discusses whether compulsory vaccination is acceptable by considering individual cases where parents have failed to give consent or have (...) explicitly refused consent for their children to be immunised. In particular, the rights of: a parent to rear his/her child according to his/her own standards; the child to receive health care, and the community to be protected from vaccine-preventable infectious disease are considered. The conclusion of the article is that compulsory vaccination cannot, with very few exceptions, be justified in the UK, in view of the high levels of population immunity which currently exist. (shrink)

Most countries promote mass immunisation programmes. The varying policy details raise a raft of philosophical issues. I have two broad aims in this paper. First, I hope to begin to remedy a rather curious philosophical neglect of immunisation. With this in mind, I take a broad approach to the topic hoping to introduce rather than settle a range of philosophical issues. My second aim has two aspects: I argue that the states should have pro‐immunisation policies, and I advance a view (...) on the subsequent and more specific question as to which sorts of pro‐immunisation policies they should prefer. I use the immunisation policies of the United States and New Zealand to frame my discussion of these substantive questions. Immunisation is effectively compulsory in the United States. New Zealand, by contrast, requires evidence not of immunisation but of immunisation status upon school enrolment: New Zealand's policy effectively makes immunisation choice compulsory. I argue that, as between the pro‐immunisation policies of the United States and New Zealand, the latter should be preferred. Though the threshold question as to whether states should have pro‐immunisation policies should be answered affirmatively, the move to compulsory immunisation cannot be justified. (shrink)

Most countries promote mass immunisation programmes. The varying policy details raise a raft of philosophical issues. I have two broad aims in this paper. First, I hope to begin to remedy a rather curious philosophical neglect of immunisation. With this in mind, I take a broad approach to the topic hoping to introduce rather than settle a range of philosophical issues. My second aim has two aspects: I argue that the states should have pro-immunisation policies, and I advance a view (...) of the subsequent and more specific question as to which sorts of pro-immunisation policies they should prefer. I use the immunisation policies of the United States and New Zealand to frame my discussion of these substantive questions. Immunisation is effectively compulsory in the United States. New Zealand, by contrast, requires evidence not of immunisation but of immunisation status upon school enrolment: New Zealand's policy effectively makes immunisation choice compulsory. I argue that, as between the pro-immunisation policies of the United States and New Zealand, the latter should be preferred. Though the threshold question as to whether states should have pro-immunisation policies should be answered affirmatively, the move to compulsory immunisation cannot be justified. (shrink)

The threat posed by avian influenza appears to be rising, yet global and national health programs are preparing only fitfully. A lethal form of avian flu has rooted itself deeply into the poultry flocks of poor Asian countries that will have a hard time eradicating it. Every so often a sick bird infects a human, who usually dies from the encounter, and on rare occasions the virus seems to have spread from one person to another before the chain of infection (...) dies out. All it would take to set off a raging global pandemic would be for the virus to mutate into a form that is readily transmissible among humans.Severe Acute Respiratory Syndrome garnered a great deal of public attention because it was novel and its potential for spread was unknown. However, the SARS corona virus is significantly less virulent than pandemic influenza viral infections. (shrink)