Is Compulsory Vaccination Compatible with Informed Consent?

By Ronald L. Scott
rscott@central.uh.edu

Recently the military has been criticized for requiring soldiers to take the Anthrax vaccine to protect against breathing weapons-dispersed anthrax spores. Vaccinations are a public health success story, protecting large numbers of the population from unnecessary disease. In 1900, more than 12,000 individuals contracted diphtheria. In 1996, no cases were reported. Similar reductions in incidence occurred for measles, mumps, polio, rubella and other diseases. However, immunizations undoubtedly cause harm to a small percentage of individuals taking a vaccine. Society uses some degree of coercion to require some individuals to be vaccinated in some circumstances, e.g., children who wish to attend public school. The law is well settled in such cases, and rests on sound principles of medical ethics and public policy. Although an individual receiving a vaccine bears some risk of adverse side effects, such individual also enjoys the public health benefits of the vaccination program. Even those not receiving a particular vaccination benefit from a healthy environment as a result of strong public polices favoring or requiring widespread vaccination. We still obtain "informed consent" from individuals (or their parents) taking a vaccine, but the element of coercion is strong enough to negate the real nature of informed consent. Some parents have objected to compulsory vaccination of their children on a variety of grounds. Some objections are medical in nature, i.e., the belief that the risk of possible adverse reactions outweighs the protection afforded by the vaccine. Some objections are more philosophical or religious in nature. Some advocates against compulsory vaccination propose limiting expansion of existing vaccination requirements for children, and allowing parents to "opt out" of existing mandates on religious or philosophical grounds. See web site for the advocacy group PROVE (Parents Requesting Open Vaccine Education) at http://home.swbell.net/prove/.

An adult taking a vaccination must be advised of the risks and benefits of the vaccine, together with the frequency and severity of any known side effects. An adult must consent to the vaccination and assuming he or she is adequately informed the legal and ethical elements of "informed consent" are present.

According to the Department of Defense (DOD), members of the military are not asked to sign a consent form before being given anthrax vaccine. The official anthrax web site maintained by the DOD states: "This vaccine, like other vaccines, is fully licensed by the FDA and does not require signed consent (emphasis added). Vaccine recipients will be provided with appropriate information on the anthrax vaccine at the time of immunization, or upon their request at any other period." See http://www.anthrax.osd.mil/.

Rep. Christopher Shays remarked at a March 24, 1999 hearing that " those being ordered to take the vaccine face a profoundly personal choice, whether or not to put something in their bodies they fear may do more harm than good. After military service, the uniform comes off, but the anthrax vaccine stays with you for life. Itís just not the commitment many dedicated men and women made to their country when they volunteered for military service." See at http://www.dallasnw.quik.com/cyberella/Anthrax/Shays.html. Military law allows the armed forces to severely discipline any member who refuses to take the vaccine. Pentagon officials recently rejected a call by the House Government Reform national security subcommittee to suspend the vaccination program on grounds that some military members do not trust the militaryís medical information. See Pentagon to Keep Anthrax Program at http://dailynews.yahoo.com/h/ap/20000218/pl/anthrax_vaccine_8.html.

The military has overstepped ethical if not legal bounds in administering the anthrax vaccine without obtaining the informed consent of members, and in issuing harsh punishment to members who refuse to take the vaccine.

02/25/00