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Restricting people’s liberty is justified when the costs of what is being asked are small, and the harms being prevented are significant, argues Dr Elizabeth Fenton
Vaccine mandates are ethically justified to reduce the risks of harm from infectious disease and ensure everyone who is able contributes their share to the achievement of a public good from which we all benefit.
Like all coercive policies, vaccine mandates restrict individual liberty by requiring a particular course of action. Seat belt laws and penalties for tax evasion are similarly coercive policies justified by appeal to reducing risks of harm, promoting social benefits, and fairly distributing burdens.
The fact that a policy is coercive does not alone make it ethically problematic. A coercive policy will be easier to justify when the cost to the individual of doing what is required is small, the harms prevented are significant, and the policy promotes important public good that can only be secured by a collective effort. Covid-19 vaccine mandates meet these conditions.
Three criticisms of these mandates have emerged in public debate. The first is that they are ineffective and counterproductive in terms of building public trust.
On-the-ground efforts to inform, educate, and invest in vulnerable or hesitant communities will be more effective in the long term without the costs of compulsion. These are not mutually exclusive, however.
When they are described and communicated correctly, mandates convey that vaccination is an individual and collective responsibility and are compatible with ongoing efforts to build trust and understanding around why that responsibility is being legally enforced.
The second criticism claims that vaccine mandates conflict with the principle that where public health interventions restrict individual liberty the ‘least restrictive alternative’ intervention should be used.
The Nuffield Council on Bioethics has argued that mandates are justified if, and only if, measures less intrusive on individual freedom, such as education and analysis of vaccine hesitancy, have been shown not to work.
The first problem with this claim is that the costs of a less restrictive strategy are potentially substantial in terms of higher levels of Covid-19 morbidity and mortality. We are not ethically required to tolerate those higher levels in the interests of protecting a small measure of individual freedom in the short term.
The urgency of preventing further spread of Covid-19, and reducing the social and economic costs of lockdowns, warrants the move to mandates before all less restrictive measures have been fully tested.
Second, advocates of a less restrictive alternative to mandates assume that we should only be concerned about restrictions of individual liberty. But for any application of this principle we must ask, less restrictive for whom?
A policy of voluntary vaccination imposes a greater risk of harm on those who cannot be vaccinated and those for whom the vaccination is less effective, and so restricts their freedom to live without fear of avoidable harms.
In the debate over vaccine mandates, this type of freedom is especially ethically salient. From the perspective of those who want to live free from the avoidable risks of infectious disease, vaccine mandates constitute the least restrictive alternative.
Finally, critics claim that vaccine mandates for Covid-19 violate important human rights, such as the right to refuse to undergo medical treatment.
This right means that others are under an obligation not to force a vaccine on you – they must not violate your bodily integrity. But it does not override an individual moral obligation to get vaccinated, nor does it obstruct the state’s right to coerce you to meet that obligation.
Critics argue that even if vaccine mandates do not violate bodily integrity, they violate a fundamental liberty right to make one’s own choices about whether or not to vaccinate, because they require a person to make a significant sacrifice (such as their job) in order to preserve that liberty.
However, this argument overlooks a key feature of mandates. They do not force an individual to make that sacrifice; rather they force the individual to decide how much they value this expression of their liberty relative to other goods, such as employment.
Those subject to the mandate remain free to choose which they value more – their freedom to reject a small burden that contributes significantly to the public good, or the good they are being asked to give up.
Objectors might respond that a vaccine mandate preserves this choice only in the sense that the thief who puts a gun to your head saying, “your money or your life,” offers you the freedom to choose which you value more. The freedom the thief gives you to choose does not make the threat morally justifiable.
In the current context, however, where the burden imposed by the vaccination mandate is significantly smaller than either “your money” or “your life”, the preservation of choice, coupled with the public health imperative to reduce the spread of disease, is sufficient to justify the mandate.
*Dr Elizabeth Fenton's research focuses on the ethical, political, and social dimensions of public health and health policy, particularly regarding fairness and equity in health resource allocation and policy making. She declares she has no conflict of interest.
