My repose to article “Compulsory vaccination protects autonomy”

(Journal of Medical Ethics)

I thank the authors for critically engaging with my paper “Ethics of vaccine refusal”.

I agree that personal autonomy does not of itself invalidate medical mandates.

I note that I do not conclude that vaccine mandates are wrong just because they violate body autonomy of vaccine refusers. Rather, ‘mandatory vaccination, immunity passports, or any other form of discrimination on the basis of the vaccination status are defeasible not because they limit basic freedoms and rights but because they discriminate against (and thus devalue) the innate constitution of all human beings.’ Moreover, the premise that vaccine mandates are justified by the value of human autonomy is logically inconsistent: ‘We must, first of all, value our kind ‘as it is’ in order to bestow worth on what we ‘ought to become’, and to pursue any ontological transformation by devaluing the innate constitution of other members of the kind would, paradoxically, negate the value of our own judgement.’ https://blogs.bmj.com/medical-ethics/2021/03/01/discrimination-on-the-basis-of-vaccination-status-is-inherently-wrong/

It seems the authors interpret the healthy, innate human constitution that includes our immune system - an act of nature that determines our objective identity - as an act of social coercion, which I contend is a category mistake.

For the sake of clarity, I summarise the three strongest arguments against the ethical permissibility of vaccine mandates:

1. Vaccine mandates imply that all humans are born in a defective, inherently harmful state that must be biotechnologically augmented to allow our unrestricted participation in society, which amounts to discrimination on the basis of healthy, innate characteristics of the human race. This devaluation of the innate human constitution is not only universally dehumanising, but it perverts the very concept of human rights; discrimination against the unvaccinated implies that being born human is no longer a guarantee of full human rights.

2. The right to free, uncoerced medical consent is not negotiable, under any circumstances, because without it we have no guaranteed rights at all; every other right can be subverted by medical coercion. Crucially, by accepting any medical treatment imposed by coercion we would be acquiescing to the taking away of the right to free medical consent not only from ourselves but from our children and from future generations, and we do not have the moral right to do this. Acquiescence to medical coercion is therefore always unethical, even if the mandated intervention were a placebo.

3. Vaccines are known to occasionally cause deaths of healthy people. When an employee is required to receive vaccination as a condition of employment, that employee is economically coerced to participate in an activity where a percentage of employees are expected to die ‘in the course of employment’ as a direct result of the mandated activity. It may be objected that infectious pathogens also kill people, but these two categories of deaths are not ethically equivalent. Infection with a pathogen is not mandated, whereas deaths resulting from mandatory vaccination are mandated deaths, a legalised killing of some people for the prospective benefit of the majority. Critically, any discrimination against the unvaccinated amounts to a violation of the right to life, because a small percentage of the targeted population are expected to die as a result of this coercive treatment. By refusing to acquiesce to mandated vaccines we take an ethical stance in defence of the right to life.

This letter is also available on the journal website: https://jme.bmj.com/content/early/2023/07/28/jme-2023-109426.responses