COMMENTARY

Time to Deny 'Freedom to Kill' for Those Who Refuse Vaccines

Arthur L. Caplan, PhD

Disclosures

September 20, 2012

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Hi. I am Art Caplan, at the New York University (NYU) Langone Medical Center in the Division of Medical Ethics. Today I want to talk to you about a problem that a lot of primary care providers have to grapple with. You will have to grapple with it at a party or somewhere that you might be socially, no matter what type of physician or healthcare worker you are. It is the question of what to do about exemptions to having your child vaccinated. From an ethics point of view, are exemptions too easy to get?

The answer is pretty obvious: Yes. Why? Because we are in an explosion of diseases, including pertussis, whooping cough, measles, mumps, and many other diseases that, if you are over 35 years of age, you thought had disappeared completely. These diseases are at epidemic levels in many parts of the United States.

Let's talk about a concrete example. In Washington State, the rate of whooping cough is 9 times higher this year than it was last year. Why? It turns out that the state of Washington has the highest rate of vaccine refusers or exemptions. I believe that there is a connection. If you don't have your child vaccinated, then they are not only at risk themselves, but they can infect others. The outbreaks of whooping cough, for which the state of Washington has declared an epidemic, are due to vaccine exemptions.

We have a situation in which states, even when they require children who go to school to get their immunizations, allow exemptions. Two states, Mississippi and West Virginia, say that you can be exempt from vaccination for health reasons, so if your own child has an immune disease, he or she doesn't have to be vaccinated. That's reasonable. Another 15 states say you can be exempt on those grounds or for religious reasons. That is a little more dubious. Almost no organized religion is opposed to vaccination. The biggest opposition comes from Hollywood celebrities, not religious organizations.

The third category of exemption is to allow health, religion, and what is called "philosophical" or "conscientious objection," and that boils down to any reason you want. About 15 states have that, and guess what? Washington State is one of them. The philosophical and conscientious objection is way too generous. It's too easy: You basically sign a piece of paper. You don't have to give an explanation -- just say, "I don't want my child vaccinated," and that's it.

Again and again, all around the country, we are seeing outbreaks of mumps, measles, and whooping cough, because too many people are saying "no" to vaccination, and the ability to do so is too easy. A California physician has decided to try to do something about this: He has proposed a law that he is asking the legislature there to consider that simply says, "Make sure parents document that they had a discussion with their doctor about the risks and benefits of vaccines before they can decline."

That's not a very high bar, and not a great imposition, so I think that's a good law. There are many people and celebrities out of Hollywood who are fighting this tooth and nail. There are plenty of vaccine opponents -- "vaccine worriers" about such things as the unfounded claims about autism -- who are blogging and writing to one another saying, "You can't trample my personal freedom by having a law like the one proposed by the California doctor."

That is ridiculous. Of course you can make it harder to get an exemption. It is one thing to have personal freedom; it's another thing to have a personal freedom that can kill somebody else. In the United States, just up until the fall of this year, we have seen 9 infants die of whooping cough. The vaccine safety critics can't point to 9 confirmed cases of infants who have died from receiving vaccines. And you know that infants can't get these shots when they are under 6 months of age. They don't have enough of an immune system; they depend on the rest of us to get shots.

Freedom is a good thing. Freedom is a wonderful thing. Freedom to kill somebody else is not such a good thing. Physicians have to stand up in their communities and discourage exemptions. It is important to get legislation moving in other states, and doctors should be the ones trying to move these things forward, by saying, "Let's make it a little harder to get an exemption."

There is a duty here to protect the weakest, the most vulnerable of our citizens -- babies, people with immune problems, the frail elderly. They are the ones who are going to get ravaged if too many people say no. So, I think it's time for medicine to step in and say, "Enough."

This is Art Caplan, at the Langone NYU Medical Center, and thanks for listening.

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