IMMANUEL KANT has been on my mind as I’ve followed the national response to recent measles outbreaks. Kant, a German philosopher, emphasized the danger of a temptation we are all vulnerable to—the temptation to make special exceptions for ourselves. The person who acts against principles that she thinks others ought to follow becomes a kind of moral “free-rider,” attempting to benefit from public moral order without contributing to it.
The spread of disease among the intentionally unvaccinated highlights the free-rider problem faced by parents who seek exemption from vaccination.
Some people believe that leaving their children unvaccinated (or under-vaccinated) minimizes their children’s health risks. If everyone around them has been vaccinated, their risk of infection is indeed low. But when too many people decide to forego vaccination, “herd immunity” is lost and disease outbreaks occur.
In a public without herd immunity, the risks posed by disease far exceed the small risks associated with vaccination. In other words, free-riding does not work when everyone is doing it. Herd immunity does not require universal vaccination, but it does require vaccination of a sufficient majority.
Who should get to be in the minority that remains unvaccinated and yet retains protection from disease? This is who: Babies who are too young to be vaccinated, our elders who cannot mount a robust immune response to some types of vaccines, and cancer patients and people with compromised immune systems all clearly have a claim to be shielded by their neighbors’ immunity. The decision to ask for an exemption for one’s own healthy child is a morally risky decision, one that requires an honest examination of conscience.
Kant thought of conscience as an inner judge, a “scrutinizer of hearts.” I have come to think of my conscience not as a private sense of right and wrong but as an inner voice that keeps my actions in line with publicly defendable moral standards. Do I think that my own child deserves exemption from the very small risks associated with vaccination more than other generally healthy children? I remind myself that the majority of parents must accept these small risks in order to guard against the much greater risks that infectious disease epidemics would pose to everyone’s children. Could I, in good conscience, justify my choice if another child were to suffer permanent health problems or even die from a disease contracted from my unvaccinated child?
Parents with financial means can move to a different neighborhood to save their children from dangerous, failing, or underfunded schools. You can buy your child a better public or private education. But you can’t move to a district where your child’s health will not impact and be impacted by the health of others (such a place would be one void of neighbors to fear orlove). You can’t buy into a public with herd immunity either, yet you may choose to share the responsibility for sustaining this resource. The health of our bodies always depends on choices other people make.
I assume that when people say “I would do anything for my child,” they do not mean to suggest that they would act against their most deeply held moral commitments. Many people of faith strive to fulfill a moral commitment that takes the form of an aspiration: to love one’s neighbor.
In Søren Kierkegaard’s Works of Love, he remind us, “If there are only two people, the other person is the neighbor; if there are millions, every one of these is a neighbor, who in turn is closer than the friend and the beloved.” What better way to extend love to our million neighbors than to choose to vaccinate ourselves and our very nearest neighbors, our children?
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