Part I
THE CASE FOR
VACCINATION CHOICE
HUMAN, CIVIL, AND RELIGIOUS RIGHTS,
SCIENCE, HISTORY, ETHICS, AND PHILOSOPHY
Since Jacobson v. Massachusetts in 1905, the world has embraced human rights in many formsâwomenâs suffrage, the Nuremberg Code, free and informed consent, medical autonomy, the human rights revolution, and public health revolutions in sanitation, hygiene, and antibiotics. A thorough reconsideration of compulsory vaccination mandates is long overdue, based on the language of the Jacobson decision, which calls on courts to end vaccination mandates that are oppressive and unreasonable.
âMary Holland, JD
The U.S. governmentâs mandatory vaccination policies do not appear to comply with international human rights standards. The government has limited the exercise and enjoyment of specific rightsâincluding childrenâs right to obtain a free, public educationâbased on vaccination status.
âLouise Kuo Habakus, MA
A country that requires all children to receive a productâno matter how beneficialâknowing that some children will die and othersâ lives will be destroyed by the use of that product, risks losing all moral authority.
âJames Turner, JD
Science lies at the heart of the vaccination controversy, and there can be no substitute for it. The ethical practice of medicine requires full and informed consent. It is not possible to have the informed part of informed consent without the science. That vaccine safety science has been and remains inadequate is not in dispute.
âCarol Stott, PhD, MSc, CSci, CPsychol, and
Andrew Wakefield, MB, BS, FRCS, FRCPath
Chapter One
VACCINATION CHOICE IS
A FUNDAMENTAL
HUMAN RIGHT
Mary Holland, JD
Consider the meaning of the phrase âfundamental human right.â âFundamentalâ means essential, basic, and inalienable. âHumanâ means what we have simply by virtue of the fact that we are human beings. We are born human; we need not be of a particular age, nationality, gender, or class. A ârightâ is a claim that we may enforce against governments and other people. Thus we assert that we have inalienable claims we can make within society, simply because we are human beings. The decision of when and whether we vaccinate ourselves and our children is a fundamental human right.
Vaccination choice is a fundamental right because it implicates our most precious rightsâto life, liberty, and security of person. Basic lawsâsuch as religious laws, the Universal Declaration of Human Rights, the U.S. Constitution, and international laws that all countries must obeyâexist to protect inherent human dignity and the equal and inalienable rights of all members of the human race. Having witnessed the war crimes, genocide, and crimes against humanity committed during World War II, nations of the world explicitly embraced human rights in the United Nations Charter.1 They recognized that it would be impossible to secure a peaceful, just world without the Universal Declaration of Human Rights that proclaims a âcommon standard of achievement for all peoples and all nations.â2 In the aftermath of World War II, the world embraced the human rights principles of the Nuremberg Code, a set of ethical principles that forbids experimentation on human subjects without free and informed consent.3
Todayâs human rights laws reject many institutions of the pastâslavery, genocide, piracy, torture, inhuman treatment, and systematic discrimination based on race or gender. Some of these lawsâsuch as the prohibition against slaveryâhave become international norms that apply regardless of whether a particular country has signed a treaty or law to that effect. Today, nations also reject medical experimentation on human subjects without informed consent. Increasingly, nations are recognizing that all healthcare interventions must be based on free and informed consent.4
It is an undisputed, scientific fact that vaccines in their current state of development injure and cause death to certain vulnerable people. U.S. law considers vaccines to be âunavoidably unsafe.â5 Vaccination mandates today seek to protect the majority while sacrificing the unknowable, and unknowing, genetically vulnerable few. This utilitarian practice can only be justified if it is based on free and informed consent.
With a complete understanding of the risks and benefits of vaccines, individuals, parents, or guardians may elect to undergo the risks of vaccination to protect against possible disease. They are free to engage in a risk-benefit calculus with their healthcare practitioners and to accept the consequences of their choices. It is unjustifiable, however, for the state to deprive individuals of accurate information and then to coerce them to accept potentially life-threatening medical interventions. Compulsory state vaccination policies violate the rights to liberty and security of person, and when vaccinations result in death, such policies violate the right to life. Even in circumstances of epidemic disease, compulsory vaccination policies would be suspect without consideration of less invasive alternatives, such as self-quarantine and even coercive quarantine.
In the United States, several vulnerable groupsâsuch as children, military personnel, and immigrantsâdo not have a choice whether to receive vaccinations. Children cannot attend school and adults cannot keep some jobs without fulfilling vaccination mandates. The Vaccine Information Statements that healthcare workers are required by law to give with each federally recommended vaccination are grossly incomplete and often not given at all.6 Unlike manufacturers of almost all other products, vaccine manufacturers in the United States are legally free from ordinary tort liability for their âunavoidably unsafeâ products.7 The absence of free choice whether or not to use dangerous products, particularly when the manufacturers have exceedingly little liability for them, violates our fundamental rights.
Statesâ rights to compel vaccination in this country stem from a 1905 U.S. Supreme Court decision, Jacobson v. Massachusetts.8 In that case, the Supreme Court upheld Massachusettsâ right to require adults to be vaccinated during a smallpox epidemic. If the adults failed to comply, the state required them to pay a $5 fine. The Supreme Court found Massachusettsâ regulation reasonable for protecting the publicâs health, but it also pointed out that its decision would not justify âregulations so arbitrary and oppressiveâ that they would be âcruel and inhuman in the last degree.â Based on Jacobson, every state now offers at least the formal right to medical exemption from vaccination.
Overall, Jacobson has been interpreted expansively. Jacobson, justifying reasonable use of a stateâs police power, is now the basis for condoning mandates for up to forty-five doses of about one dozen vaccinations for childrenâin the absence of epidemics, at the cost of public school attendance, based on inadequate and incomplete science, and with significant evidence of undue corporate influence. One may argue today that state vaccination mandatesâincluding compulsory vaccinations for sexually transmitted diseases, such as hepatitis B, and noncontagious diseases, such as tetanusâare oppressive, unreasonable, and disproportionate to the publicâs health needs. Jacobson does not justify todayâs compulsory vaccination program.
Since Jacobson in 1905, the world has embraced human rights in many formsâwomenâs suffrage, the Nuremberg Code, free and informed consent, medical autonomy, the human rights revolution, and public health revolutions in sanitation, hygiene, and antibiotics. A thorough reconsideration of compulsory vaccination mandates is long overdueâbased on the language of the Jacobson decision, which calls on courts to end vaccination mandates that are oppressive and unreasonable. Even in the context of a military draft, which the Jacobson Supreme Court decision refers to by analogy, U.S. citizens have the right to conscientious objection. We must demand the right to philosophical exemption from vaccination mandates in every state as a first step towards truly free and informed vaccination choice.
On many occasions, Martin Luther King, Jr. quoted an abolitionist minister from the 1850s, Theodore Parker, saying, âThe arc of the moral universe is long, but it bends toward justice.â9 Ending compulsory vaccination is its own human rights struggle. It is time to bend the arc of the moral universe toward the justice of vaccination choice.10
Chapter Two
THE INTERNATIONAL
HUMAN RIGHTS STANDARD
Sookyung Song, JD
International law asserts the fundamental human rights to life, liberty, and security of person. National governments must protect and uphold these fundamental rights according to universal standards. International human rights law plays an increasingly important role in all countries, including the United States. Almost all countries have signed basic international human rights conventions, holding them to common goals and standards, and have strived to live up to them.
International law has long recognized that prohibitions against abusive human experimentation are necessary. On numerous occasions, from experiments by Nazi doctors to the U.S. Tuskegee Syphilis Study to the recent Pfizer trovafloxacin experiments in Nigeria,1 the modern world has observed the dangerous tendency to exact individual sacrifice in medical experiments for the alleged benefit of humankind. The interests of individual participants are not necessarily in line with those of the scientists and broader society, which may attach more value than the human subjects do to scientific progress and the so-called common good. Balancing these conflicting interests, international law has for decades incorporated the critical norm to protect human subjects from experimentation without free and informed consent.
The international community first set down fundamental human rights after World War II. Having witnessed unspeakable human rights violations and having suffered the worst war in human memory, world leaders codified fundamental human rights in the Universal Declaration of Human Rights under Eleanor Rooseveltâs leadership. Later, building on this declaration, countries adopted the
International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights. Together, the international community refers to these documents as the International Bill of Human Rights.
The modern international human right to bodily integrity affords the individual a right to make informed choices about vaccination and all medical interventions. The underlying idea is that those who undergo the risk of experimentation must make the final decision about their own participation after they are informed of the purpose, risks, and benefits of the experiment. While this right to choice in international law sprang from the Nuremberg Code, the international right to informed consent now encompasses the right to free and informed consent for all medical decision making.
This chapter provides a brief overview of the development of the human rights to bodily integrity and free and informed consent and shows why these rights apply to vaccination.
POST-WORLD WAR II HUMAN RIGHTS NORMS
Modern bioethics began in 1947 at the criminal trial of Nazi doctors. These practitioners had carried out medical experiments on human subjects in which they intentionally injured and killed individuals for the purpose of scientific discovery. The judges in these trials established ten principles, later called the Nuremberg Code, on ethical standards for medical research.2 The foremost principle in the Nuremberg Code is that âthe voluntary consent of the human subject is absolutely essential.â The Nuremberg Code elaborated that the subjectâs consent must be competent, informed, and free from coercion or inducement.
One year later, in 1948, the United Nations National Assembly adopted the Universal Declaration of Human Rights (UDHR)3 out of a global effort to represent the expression of rights to which all human beings are entitled. Although the after effects of the Nuremberg trials were still felt, the UDHR did not expressly address human experimentation but simply prohibited any âcruel, inhuman or degrading treatment,â4 with the belief that this language was broad enough to cover experimentation on human subjects.
The International Covenant on Civil and Political Rights (ICCPR)5 subsequently laid out specifics on the rights proclaimed in the UDHR and directly picked up the issue of human experimentation. In Article 7, the ICCPR clearly dictates that âno one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his free consent to medical or scientific experimentation.â Article 7 articulates that medical experimentation without free consent may at times amount to torture or inhumane treatment. Unlike the UDHR, however, the ICCPR drafters did not stop there. In addition to the prohibition against certain kinds of treatment, Article 7 affirmatively creates an individual right to informed consent for medical research. The structure of this provision, with the second sentence complementing the first, reflects an effort to address medical conduct that may not rise to the level of torture but nonetheless infringes on the right to bodily integrity. The drafting history of Article 7 illuminates how seriously the drafters considered the consent principle: