Unreasonable Dissent

When policemen broke down the door of an Arizona couple’s home last month intent on taking their unvaccinated and sick child to the hospital, it wasn’t a case of the state overstepping its bounds. Nor was it at the command of a paternalistic physician usurping a parent’s right to make healthcare decisions for their child.

It was a justified intervention and one that demonstrates how we approach conflict at the precarious boundary between personal liberty and social responsibility.

There are multiple reasons a person may end up not vaccinating their child (though no motivation should come from concern that long-tested vaccines are unsafe). For instance, poverty has a direct effect on access to treatments, ultra-orthodox religion drives whole communities to abstain, and those with compromised immune systems might be put at risk if treated with “live” vaccines like those used to prevent measles, mumps, and rubella.

Because our civil liberties are held in such high regard, there is little government interference in one’s choice whether or not to vaccinate. Many states, including Arizona, allow for exemptions despite the fact that the World Health Organization has listed vaccine hesitancy as one of the top ten threats to global health in 2019.

The fundamental right to govern ourselves is encoded in our bill of rights and permeates the moral underpinnings of the practice of medicine. Our autonomy is highly guarded and rightly so. Nonetheless, our right to self-determination is finite and can be superseded by the state.

For instance, statutes against loitering and reckless endangerment limit our actions regardless if there is intent to cause harm. Our ever-evolving laws ensure public safety and security by restricting what is socially permissible. The negative effects of the anti-vax movement have created increased need for careful moral and legal definition in public health law.

Minors are not typically extended complete autonomy and are instead governed by a parent or legal guardian until they come of age or by the state, if a guardian is lacking. When parents disagree with each other or in this case with the state and their values threaten the welfare of a child, various methods of mediation become necessary.

In a medical setting this begins with a physician or healthcare team who navigate disagreements using several moral decision-making frameworks. They may consider arguments based on the child’s best interest or whether intervention is deemed necessary to prevent significant risk of serious harm. They may even consult internal ethics boards or external social workers in order to come to a tenable decision before taking any drastic measures.

On the rare occasion when physicians do deem it absolutely necessary to intervene, any action to go against a parent’s will then typically involves the courts. Arizona lawmakers recently stiffened this process by requiring the Department of Child Safety to obtain a warrant from a judge before any non-emergency intervention can be made.

These checks and balances exist precisely to protect our autonomy and those who are not able to protect themselves.

Concern for this particular child involved not one but two doctors’ opinions from two different clinics. Both were concerned that the child’s symptoms and lack of vaccinations presented threat of meningitis. While concern for the child’s well-being may not have justified such forceful intervention on its own, seeking to prevent a potentially deadly meningitis outbreak in their community likely compelled them to escalate the issue to authorities.

The greater the potential harm, the less risk tolerant we become. Had the child been vaccinated and the life-threatening contagion ruled out, the situation may not have warranted such drastic intervention. Instead, the parent’s autonomy was suspended because the decision to forego routine, preventative medicine had potential deadly social consequences.

The imagery of a SWAT team knocking down the door of a family home may be horrifying and such force seemingly overkill at first glance, but let’s not conflate two different issues: the purpose of reasonable public health policy and the overly-cautious use of force by our police.

Checks on autonomy are necessary when a personal decision puts neighbors at risk. So, before you take up arms in the name of freedom or let go another exasperated sigh of incredulity, understand that this is our system working as intended. The anti-vax movement will likely be heavily curtailed because of numerous examples like this. When it does, it will not be an erosion of our rights or a giving in to tyrannical government, but a recognition that our individual liberties occasionally come with responsibilities to one-another.