Category Archives: Ethics 101

Vaccine refuseniks are free-riders.

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In a post a couple weeks ago, I commented on the ethical dimension of opting out of vaccination against serious contagious diseases:

Of course, parents are accountable to the kids they are raising. They have a duty to do what is best for them, as well as they can determine what that is. They probably also have a duty to put some effort into making a sensible determination of what’s best for their kids (which may involve seeking out expert advice, and evaluating who has the expertise to be offering trustworthy advice).
But parents and kids are also part of a community, and arguably they are accountable to other members of that community. I’d argue that members of a community may have an obligation to share relevant information with each other — and, to avoid spreading misinformation, not to represent themselves as experts when they are not. Moreover, when parents make choices with the potential to impact not only themselves and their kids but also other members of the community, they have a duty to do what is necessary to minimize bad impacts on others. Among other things, this might mean keeping your unvaccinated-by-choice kids isolated from kids who haven’t been vaccinated because of their age, because of compromised immune function, or because they are allergic to a vaccine ingredient. If you’re not willing to do your part for herd immunity, you need to take responsibility for staying out of the herd.
Otherwise, you are a free-rider on the sacrifices of the other members of the community, and you are breaking trust with them.

(Bold emphasis added.)
In the comments on that post, Jennifer takes issue with the free-rider characterization:

My kids are not vaccinated, and I am not a free-rider. So far my kids have had chickenpox, pertussis, and measles. I expect my kids to get many of the diseases for which there are vaccines. By the way, the measles was from a child who had recently gotten the MMR, and was shedding the live virus.
Please stop the scaremongering. My kids got through those illnesses just fine, and are extremely healthy. I’ve chosen the possibility of occasional acute disease over the very real possibility of chronic disease. For example, 1 in 10 kids now has asthma! 1 in 67 now has autism.

I thought, therefore, that it would be worthwhile to examine at more length my claim that vaccination refuseniks are free-riders.

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Silence is the enemy: addressing the causes.

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Yesterday, in my first post about the Silence is the Enemy campaign, I wrote:

Addressing rape directly. From the point of view of ethics, you’d think this would be a very short discussion. It is wrong to commit sexual violence. It is wrong to act out your frustration or your sense of entitlement or your need to feel that there is something in your life that is within your control on the body of another human being. It is wrong to treat a woman or a child (or another man) as less than fully human.
Anyone who would argue otherwise could only be a moral monster. Or thoroughly steeped in a culture that regards women and children as less than fully human, and the desire, anger, and frustration of men as something that can be acted out on women and children.

The ethics of sexual violence seem pretty black and white. And yet sexual violence is a reality — as a constant threat, if not as something that has been committed — for more women than you can imagine.
As usual, Zuska say it better than anyone else:

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Ethics and the ‘Oprah effect’.

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There’s an interesting piece in the Chicago Tribune on the “Oprah effect”. The upshot is that products or people who Oprah deigns to grace with airtime tend to find enormous public acceptance.
While this is well and good if the product is a novel or the person is a television chef, it’s less clear that the Oprah effect is benign in the case of people without medical expertise offering medical advice.
From the article:

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Trust and accountability in the vaccine-autism wars.

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There’s a new feature article by Liza Gross [1] up at PLoS Biology. Titled “A Broken Trust: Lessons from the Vaccine-Autism Wars,” the article does a nice job illuminating how the themes of trust and accountability play out in interactions between researchers, physicians, patients, parents, journalists, and others in the public discourse about autism and vaccines. Ultimately, the events Gross examines — and the ways the various participants react to those events — underline the questions: Who can we trust for good information? and To whom are we accountable for our actions and our decisions? In many ways, it strikes me that the latter question needs more consideration than people typically give it.
The question of trust, on the other hand, is one with which people seem more ready to grapple. The challenge, however, is that such grappling seems more often than not to result in mistrust.

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‘Chronic’ Lyme disease article in Journal of Medical Ethics called unethical.

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You may recall my examination earlier this month of a paper by Johnson and Stricker published in the Journal of Medical Ethics. In my view, it was not a terribly well-argued or coherent example of a paper on medical ethics. Now, judging from an eLetter to the journal from Anne Gershon, the president of the Infectious Diseases Society of America (IDSA), there is reason to question the factual accuracy of that paper, too. The Johnson and Stricker paper promised an exploration of ethical issues around an antitrust investigation launched by the Connecticut Attorney General examining the IDSA’s process for developing guidelines for Lyme disease. In particular, Johnson and Stricker suggested that conflicts of interest led the IDSA panel to improperly exclude “chronic” Lyme disease from their disease definition and treatment guidelines.
It’s true that IDSA has a horse in this race. However, as I noted in my earlier post, so do Johnson and Stricker. And unlike Johnson and Stricker, IDSA president Gershon seems to have a good handle on how to frame coherent and persuasive arguments.
From Gershon’s eLetter:

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With celebrity comes duties: Jenny McCarthy, Oprah Winfrey, and the ethical burden of a soapbox.

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At White Coat Underground, PalMD explores the question of what kind of responsibilities might fall on celebrities, especially those who use their soapboxes in a way that exceeds the tether of their expertise. The particular celebrities under examination are Jenny McCarthy, who has used her celebrity to spread her views on the proper treatment and prevention of autism, and Oprah Winfrey, who has used her media empire to give McCarthy a soapbox with more reach.
Pal writes:

Jenny claims an expertise based on her personal experience. Whether one views themselves as an expert is largely irrelevant, unless others so christen them. In Jenny’s case, various fake experts have helped promote her status as an expert (making her a 2nd generation fake expert?) and she has embraced this status.
Being a public figure confers a certain status in our society, whether or not it should. It gives one great reach and influence. While Jenny’s putative lack of intelligence certainly makes her susceptible to having her status used by others, it does not absolve her of her responsibilities. She has made a conscious choice to use her status to spread a message, and has chosen to listen to some experts over others. The moral culpability is hers. …
When it comes to medical issues, the only thing consistent about Oprah is her own inconsistency. It appears that she christens experts based on her personal preference rather than any objective criteria. This is a problem. Oprah’s influence is inversely proportional to her ability to choose good experts, which is a troubling trend. One thing she is good at is picking a winner; Dr. Phil may or may not be a good therapist, but he’s great TV. Time will tell whether Jenny is equally lucrative, but Oprah doesn’t pick losers, so we’re likely to be seeing Jenny under Oprah’s banner for a long time to come.

Rather than hewing to close to the specifics of Jenny McCarthy or Oprah Winfrey, I’d like to raise the questions more generally:

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Using analogies in ethical reasoning.

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One of the things we’d like to be able to do with our powers of ethical reasoning is tackle situations where we’re not immediately certain of the right thing to do (or, for that matter, of the reason why the plan someone else is advocating strikes us as wrong).
A common strategy (at least in an ethics class) is to whip out an ethical principle or rule, try to apply it to the situation you’re pondering, and see what it tells you to do: What can I do here that respects the humanity of others and of myself? or, Which of the available courses of action maximizes benefits and minimizes harms (taking into account, of course, that benefits and harms to others matter just as much as benefits and harms to me)? The disadvantages of this strategy is that most of the ethical principles that yield clear judgments in decision scenarios also encounter decisions where they seem to break and give absurd judgments.
An alternative strategy is to take the situation we’re puzzling over and consider how similar or dissimilar it is from one or more cases for which our ethical judgments are clear. This strategy of using paradigm cases to guide our ethical responses to situations that deviate somewhat (but not too much) from the paradigm cases is called casuistry.

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