Mandating vaccines requires nuance | Guest column

Submitted by Burk Gossom, M.D.

A medical practitioner faces ethical dilemmas on a regular basis, whether it is the end of life, assisted suicide, tube feeding, handling child abuse, etc. Over decades there have been intense national discussions with university ethicists, religious leaders and physicians. The result of these decades of thought has resulted in an ethical framework within which we make decisions. Medical ethics are based on four important principles: respect for patient autonomy, beneficence, nonmaleficence, and justice. When these principles conflict, resolving them depends on the details of the case.

Autonomy refers to the belief that all persons have intrinsic and unconditional worth, and therefore, should have the power to make rational decisions and moral choices, and each should be allowed to exercise his or her capacity for self-determination. For example, you cannot do surgery without consent. Patients are allowed to refuse life-saving treatments. If we as a society decide to override this ethical guideline we should have a very good reason as it opens very scary doors.

The case of a minor or an incapacitated person is different. Society has an obligation to protect children and those not capable to make their own decisions. They should not be conflated with a grown adult making their own decisions.

Do we have a rational or moral imperative to override the guiding principle of autonomy with mandated COVID vaccines? Delta is so infectious that you are going to get exposed. Vaccinations may delay this exposure but will not stop it. It is just a question of time. It is a very dangerous path when you force medical treatment on an adult when their choice only hurts themselves and they are not a public health threat. I am a strong advocate for vaccines but in the grand perspective, the unvaccinated represent no serious threat to the vaccinated.

Are those who are choosing to not get vaccinated being unreasonable? Some are, but not all. The risk of COVID for those under age 19 remains extremely low with less than 500 deaths in the USA since the beginning of the pandemic. The government database has recorded a record number of adverse vaccine reactions so the risk-benefit analysis in this age group needs to be examined closely. In young adults who have had COVID, the second vaccination causes more heart inflammation than COVID itself. Our best data says it is harmful to fully vaccinate this subgroup. Natural immunity provides better and more durable immunity than the vaccine so mandating an immunization in this group also seems particularly foolish.

I want to stress my strong support for vaccination, but global vaccine mandates violate basic medical ethical principles, provide no benefit to the vaccinated and in some cases may cause more harm than good. In other situations, the risk vs benefits ratio is extremely small further negating the rationale for universal mandates. The choice for vaccination should be nuanced looking at the total picture rather than a one size fits all.