Friday, October 5, 2012

Freedom and Mandatory Vaccinations

I had a long and somewhat heated discussion with my wife over the very old topic of Mandatory Vaccinations. As a resident physician at a major university medical program, my wife has a unique view on the topic of communicable diseases. I, of course, am an insane Libertarian. That's Libertarian with a capital "L."

My wife deals with a reality that not many Americans know exists in this country. This reality is that the health system is overrun by illegal, and consequently uninsured, immigrants. These people only see a physician when they are in dire need of help. So, they come to the Emergency Room full of sickness, disease, and injury. Because they are the poorest of the poor from an assortment of third world nations, they carry all of the diseases that the third world has in abundance, but that we don't see very often in the "regular" United States. Diseases that we have virtually wiped out, Polio, TB, Yellow Fever, Pertussis (Whooping Cough)and other crawling nasties, all make the scene in these people. My wife has often commented that the only difference between her an a doctor working with Doctors With Out Borders is that she can go home at night.

So, armed with her perspective and experience, and I armed with my insanity that people should actually be allowed to decide what kind of health care and treatments they should receive, we began our discussion.

Of course, my wife was all for mandatory vaccination. Her position was that the benefit of vaccination doesn't come in to play unless ALL people are vaccinated. My position was that an individual should be allowed to choose what they put in their body. Our arguments are old ones. Medial professionals have been making this argument since vaccinations have been available. And... They are right.
Without mandatory vaccination, Polio would still be rampant in the US. Without mandatory vaccination, Small Pox would still be a world wide killer. I choose these two diseases because they are virtually unheard of in the modern world. Small Pox has been eradicated. Polio is only seen in the extreme rural ares of the third world where modern medical facilities are simply not available.

My stance is that vaccinations should be strongly encouraged by medical staff, but the government, with its monopoly on force, should not compel people, at the point of a gun, to be vaccinated.

With much back and forth, my wife used my own liberty smell test on me... My smell test with any law or policy was put forth by Thomas Jefferson in talking about religion. Jefferson said "...But it does me no injury for my neighbor to say there are twenty gods or no God. It neither picks my pocket nor breaks my leg." I use the last part as my smell test. Does it break my leg, i.e. injure me or violate my rights? Does it pick my pocket, will it require the government to confiscate my property to accomplish?

My wife after hearing my smell test, I thought it failed because the government would "pick my pocket" to pay for vaccinations. My lovely and brilliant wife immediately came back with the Government can't pick my pocket if I am dead. That stopped me in my tracks.

Becoming deathly ill certainly falls in to the "break my leg" category. I needed to go back and read up on the issue to find out if I could come up with any better arguments. Why? I don't like to loose arguments. And my wife had just used my own stuff to kick my ass. This is what happens when you marry somebody MUCH smarter than you are. You end up getting your intellectual ass handed to you.
Anyway... To the interwebs I went.

It turns out... there are no better arguments. The founders typically allowed the police power of the government to be used to set up quarantines, many against the wills of the people trapped within. Of course it didn't become a federal issue until 1905. Jacobson v. Massachusetts came to SCOTUS. Jacobson brought the very same argument that I had to the Court. The Court said, with a vote of 7 to 2, that the state did indeed have the right to use police power to force vaccination on citizens.

I looked to Libertarians to give a cogent personal liberty angle against mandatory vaccination. I found that there really isn't a good angle. Why? Because getting someone else sick does indeed violate their rights. After reading many of the arguments presented by hard core Libertarians supporting mandatory vaccination. The only ones really advocating against vaccination were trying to make a religious argument. I reject this argument entirely, because it flys in the face of these institution's own teachings. If life is scared, you must do all you can to preserve it. Rejecting lifesaving medical treatment because you put things in God's hands is NOT preserving life. It is throwing it away. No dice on that argument.
The other arguments either say that vaccines don't work, or that they give kids autism. Complete bullshit Vaccine effectiveness is well documented, and the connection with autism has no scientific basis.

So... Where do I come down? I STILL think that it is vital that the individual have the right to determine the course of their medical treatment, whatever their beliefs. HOWEVER, after reading the Court's ruling in Jacobson v Massachusetts, I also think that the government does have the right to use its police power to enforce vaccinations. The safety of the general population, especially from contagions that are easily spread, is an inherent part of the social contract that governments have with their citizens.

I then re-read the Bill of Rights. When I am in doubt about something, I go back to the Bill of Rights, and Madison's Federalist Papers. Madison points the way. In those documents, the words that stuck out, are the ones with the force of law. The Fifth Amendment:
No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.
...nor be deprived of life, liberty, or property, without due process of law. The Constitution guarantees that we can not be deprived of life, liberty, or property without DUE PROCESS OF LAW. What that means is that the government does have the ability to deprive people of all of the above, but it must be through due process. So, the government can force us to take a vaccine, as long as due process is followed.

So where do we draw the line? Small Pox is deadly, but the Measles is not. Pertussis is spread through the air, but HPV is not. If we can prevent Polio with a vaccine, and we can prevent Rubella, do we not have an obligation to eradicate both? I think that these are the questions that need to be vigorously debated. Are they? Unfortunately not. Congress has all but totally gave its power in this debate over to the CDC and the Department of Health and Human Services.

I can square my wife's argument with the Constitution. I am fine with some mandatory vaccination. As long as there is significant risk from a very communicable disease. I am not happy with it, and it feels wrong, but there are very specific times were the common good must be put before the individual. Now the only hard part is trying to come up with a way that I can tell the wife I have come over to her way of thinking, without having to admit that I was wrong...

Jacobson v Massachusetts

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