The Shotgun Blog
Wednesday, November 18, 2009
This G&M article carries the provocative title: "Refusing to get vaccinated is selfish." Now, I know what you're thinking. Old Publius is about to get on his high horse and start quoting Rand for several pages. I'll keep it to one of Rand's key observations today, that individuals legitimate interests do not conflict. The author walks right past this insight, and keeps walking:
The public nature of Canadian health care creates both individual rights and individual responsibilities. But people can assert rights to a public resource without recognizing a responsibility toward its limited nature. This problem was brilliantly described in 1968 by ecologist Garrett Hardin in the journal Science as “the tragedy of the commons.” In this hypothetical case, individual actors operate on self-interest and ultimately destroy a shared limited resource – even when such destruction is clearly not to anyone's long-term benefit. Canadians are familiar with this tragedy because it describes the collapse of the Atlantic cod fishery.
Mass H1N1 vaccination refusal similarly might destroy (at least temporarily) our health-care system, with the threatened 100,000 people in hospital. We have a limited number of hospital beds and respirators and a finite number of people who know how best to use them. Every vaccinated person increases the likelihood that health-care professionals will be free to treat other people. What's more, inoculation reduces transmission. If unvaccinated people make health-care workers sick, they cannot look after other patients.
Health resources are finite because they are "publicly," i.e. state, controlled. The tragedy of the commons is that it is public. Everyone owns the commons and so no one does. The commons ceases to be a tragedy once it is divided up among private owners, each with a benefit in protecting their property, and a corollary responsibility toward it.
Assuming for a moment that the vaccine is both safe and effective, refusing to get it would be profoundly unselfish. Even the most determined altruist has to concede that taking steps to keep healthy is selfish. A corpse cannot have any self interests, and a diseased body is a poor vehicle with which to pursue one's goals. Unless the author means selfish in the sense of simply being reckless toward others, then his argument is blatantly illogical. I suspect he does mean "selfishness" in that sense, in being callous or reckless toward other people. Being "selfish" is a sort of ethical mark of cain to many people in modern Canada. In effect, the author is trying to guilt people into doing the "right thing."
This does not mean that the author has not raised a valid public health issue. People refusing to get vaccinated, assuming again that it is safe and effective, is a major public health issue that could overwhelm our tottering health care system. Misinformation is always a constant uphill battle in educating people about their health. The statist would shrug and say that ordinary people often don't know what's good for them, so massive forced inoculations might be necessary. No one has suggested this yet, but if the death count enters into the high thousands, which it might, expect the idea to be floated. Yet the origin of the problem, as the author correctly states, is the tragedy of the commons.
Being a public system Medicare encourages moral hazard. A person pays into the system based on their income, not their health. There is then little incentive to make wise and healthy choices. Not wanting to get sick would seem incentive enough. Not everyone, however, has the same assessment of risk. Knowing that there is little financial consequence to their action, that for most already healthy people they will simply miss a few days of work, many will skip taking the vaccine. If, however, they would have to bear the full financial cost of their recklessness, many would reconsider their decision.
A health care system in which the majority of the population was covered by private insurance, the second scenario could take hold. Refusing to take the vaccine? Fine. But the insurance company has the right to refuse your claim, on the same grounds that life insurance is not paid out in cases of suicide. German auto insurance contains a provision that an accident claim can be refused, if the driver was travelling faster that 130 km / hr, oddly enough the average speed on the Autobahn. Insurance companies are in the business of assessing risk, something they are better at than governments and private individuals. It's their job after all and they have a vested interest in being good at it.
Politicians and bureaucrats, beyond whatever consciences they might have, are interested only in not being blamed and losing votes. Private individuals can make their own assessment. If they are right they save the bother of getting the shot, if they are wrong they bear the full consequence of their action, rather than having those costs socialized under the current system. A free market would encourage people to be selfish, i.e. to take responsibility for their actions rather than expect everyone else to take up the slack. Something crude guilt trips will never accomplish.
Posted by Richard Anderson on November 18, 2009 | Permalink
I have heard similar guilt trip arguments about seat belts. And again the problem is not one of people having too much freedom to do as they wish, the problem is socialized medicare.
The other thing to remember about the H1N1 hysteria is that it is government and media created. By all accounts the virus is far less a threat than the run of the mill seasonal flu. Seasonal flu kills 4000-8000 Canadians a year, so far H1N1 has yet to break 100.
Government creates the hobgoblin then tries to make it look like it's saving you from it so it can pat itself on the back and rationalize bigger more expensive bureaucracy's and more limits on your freedoms. It's all just a big con.
Posted by: Farmer Joe | 2009-11-18 9:32:31 AM
4,000 - 8,000? Interesting. I thought the state was more along the lines of 1,000 to 2,500. Guess it depends on the source doesn't it? ;)
But I would agree that so far H1N1 is not a pandemic.
The other interesting nugget is apparently the stats for the regular flu have plummeted to almost 0 cases. Does H1N1 have the regular flu for breakfast?
Posted by: Charles | 2009-11-18 11:00:42 AM
"The other interesting nugget is apparently the stats for the regular flu have plummeted to almost 0 cases. Does H1N1 have the regular flu for breakfast?"
I noticed that too. I figure it's because anybody who goes into the doctor with flu-like symptoms is treated as an h1n1 patient (this even happened to my nephew; he was fine 2 days later). The doctor also said that only about 2 in every 1000 cases are severe enough to warrant hospitalization.
Also the increased awareness of proper sanitization is a large contributor to the fall in seasonal flu rates.
I suppose it is good that doctors are treating all flu symptoms this way, since it's better to be safe than sorry. At the same time, it's convenient for fear-mongers since they now have an opportunity to exploit the statistics. If someone dug out the cases of h1n1 that were confirmed by bloodwork, I would bet that those stats would be much different.
Posted by: EndtheFed | 2009-11-18 2:43:29 PM
Whatever happened to "It's my body, my CHOICE"?
Posted by: h2o273kk9 | 2009-11-18 4:08:55 PM
I don't know how to respond to this, but I think the ethical issues here are more complicated than you might want to reduce them to.
H1N1 is an airborne illness, and spreads easily and rapidly in enclosed spaces. One might raise the question about the responsibility of individuals not to knowingly spread illnesses to the public.
It's easy to say that nobody has any positive obligation to anyone else, but when you couple that with the fact that it's possible to do real physical harm to other people by virtue of pure negligence--as in the case of spreading infectious disease--it's worth considering whether or not there are rights that may be in conflict.
Most libertarians seem to come down on the side that: colds, flus and other common viruses are just "part of life" and we all simply assume the risk of catching them, and it's up to us to take preventative measures. Which is really an incomplete thought, and suffers from problems when the issue is thoroughly explored. Such as, in the case where someone knows they are a carrier of a specific illness and knowingly exposes other people to the infection.
These cases are your classic: "I feel like I'm coming down with something, but I really have a lot of things to do at the office today." So they go get on the subway, or a taxi, and in the office, and potentially spread the illness to tens if not hundreds of people. And if you consider the fact that those people in turn will spread it to thousands more, you should start to see the problem.
Is it reasonable, particularly in situations where the general public health is an extreme risk by virtue of a highly infectious illness, push a degree of a preventative measures on the public? I don't know. But the question is worth flushing out.
Posted by: Mike Brock | 2009-11-18 4:51:44 PM
Worth thinking about. However, we live in an age and a society that delights in pushing the boundaries ever more into CONTROLLING our thoughts, actions, and BODIES.
And since the gov't can't seem to run a pandemic well (think SARS and now H1N1) and politicization of science is rampant (think H1N1 and Anthropogenic Global Warming), and hypocrisy is a social disease (think abortion and the social benefit of NOT ridding ourselves of future taxpayers)...count me as skeptical that a rational debate will ensue along the lines that you propose.
Posted by: h2o273kk9 | 2009-11-18 5:10:22 PM
Last paragraph of this article for the 4000-8000 number.
Posted by: Farmer Joe | 2009-11-18 5:14:39 PM
That argument is really just an appeal to consequences and doesn't really speak to the validity of my argument, though.
It's sort of like how some creationists try to dismiss evolution on the basis that they think it leads to bad things like eugenics. Except of course, whether it does or not has no impact on the truth value of evolution.
Same thing here. Whether or not someone knowingly exposing me to a contagion is a violation of my liberty (to be free from physical harm, in this case) is not contingent on whether or not the consequences to trying to stop it are worse. That's a completely tactical argument.
Posted by: Mike Brock | 2009-11-18 5:43:28 PM
'Emergencies' have always been the pretext on which the safeguards of individual liberty have been eroded.
Friedrich August von Hayek
Posted by: Farmer Joe | 2009-11-18 6:32:06 PM
1st. Just in case you were wondering...I'm no creationist.
2nd. Appeals to consequences are valid...given the law of unintended consequences and all.
3rd. You may have a point about "knowingly" exposing you to a contagion but then you have just diverged from the thrust of your own argument...if I choose to NOT get the shot, that doesn't mean I have the contagion in the first place nor that I will ever get it...so forcing me to get it in that scenario falls on you forcing me to be exposed to a contagion in the first place (yes, dead I know). So what if my body responds negatively to this vaccine for no reason at your insistence?
Now who is guilty?
Posted by: h2o273kk9 | 2009-11-18 7:24:34 PM
FYI, I'm not against the getting the shot myself...just being FORCED to do it.
Having said that, I neglected the most salient critique of your analysis.
4th. Why should my exposing you to the contagion I carry matter in the slightest when you already have the shot?
So much for violating your civil liberties.
Posted by: h2o273kk9 | 2009-11-18 8:10:27 PM
H1N1: A lesson on how to control a large population. Is the flu shot voluntary? Does this article suggest flu shot conscription? Would all Canadian Provinces concur with forcing the flu shot on all citizens? I hope not!
Posted by: Agha Ali Arkhan | 2009-11-18 8:37:58 PM
"Appeals to consequences are valid...given the law of unintended consequences and all."
Actually, they're never valid when they're made as an argument against the underlying truth behind what the consequences are being predicted for.
If I was talking about whether or not it was a good idea to give the government more specific power, than talking about potential consequences would be informative. But the moral and ethical justifications for the why the government ought to have the specific power are not subject to potential negative consequences.
"so forcing me to get it in that scenario falls on you forcing me to be exposed to a contagion in the first place (yes, dead I know). So what if my body responds negatively to this vaccine for no reason at your insistence?"
I think the point of a mass vaccination is as much about denying an infection vector to the contagion as it is about preventing specific individuals from getting sick. That is to say, it's about not giving the virus a path to follow through the population.
If as little as 20% of the population goes unvaccinated, the virus can spread readily, and even potentially infect vaccinated people who's immunoresponse to the vaccine was not as effective as in others.
This is why when as little as 17% of British parents stopped vaccinating their children for Measles, Mumps and Rubella, there were outbreaks of Measles throughout entire schools in the UK, including among some children who had been vaccinated.
Vaccination is about reducing infection vectors in the public, thus protecting people with say, weaker immune systems, who cannot solely rely on vaccination themselves. Instead, they rely on the fact that the rest of the population is vaccinated--reducing their exposure.
Any expert in epidemiology will explain all this to you. :)
Posted by: Mike Brock | 2009-11-18 8:51:59 PM
You have merely repeated the rationale for providing shots to the population. Stuff I already understand well. What you didn't answer was my question.
If I get the shot but never would have gotten sick nor been infected but the shot itself got me sick...then it is you who have violated my civil liberties.
You are the one who spoke of this being your rationale.
You win the argument on the numbers game, I fully agree...but that's not the argument you were making.
Posted by: h2o273kk9 | 2009-11-19 5:19:08 AM
I'm very influenced by Ayn Rand. However most people who quote her do not know she was an atheist and about her life. Unless you have actually read Atlas Shrugged, Anthem, We the Living you should not be quoting her. So many people open their mouth when they don't know what they are talking about.
I admit I'm selfish, but I can admit it. Ultimately someone will cover their own ass to prevent trouble. There is no such thing as altruism, everyone does something for a reason.
Posted by: Doug Gilchrist | 2009-11-20 9:54:15 AM
Mike, are you still doing the Hot Room?
Posted by: Doug Gilchrist | 2009-11-20 9:54:59 AM
"Vaccination is about reducing infection vectors in the public, thus protecting people with say, weaker immune systems, who cannot solely rely on vaccination themselves. Instead, they rely on the fact that the rest of the population is vaccinated--reducing their exposure".
Mike, this is the "safety" argument totalitarians and misguided folks make to justify coercion (i'm not saying that you don't get it). i simply don't owe a person with lowered immunity my liberty. i know i sound like a Randoid, but i owe nothing to the collective but respect and good will. i'm not forcing anyone to do anything in any way. its up to others to be careful.
liberty/risk or coercion/safety. take your pick; but remember, there's really no such thing as safety. that will happen when we all reach Lollipopland.
Posted by: shel | 2009-11-22 12:28:58 PM
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