Medical Autonomy, Vaccine Mandates, and A Theory of Justice
This is a research paper submitted in partial fulfillment of the requirements for the course DR38405, Worldview and Ethical Theory at Midwestern Baptist Theological Seminary (Kansas City, MO) on May 20, 2023.
Introduction
Medical autonomy has become a significant issue in the modern-day world particularly during the four years of the COVID-19 pandemic. In the four years of the pandemic, governments around the world enacted different measures with varying degrees of success in an attempt to minimize the overall damage of the virus. Almost every nation enacted vaccine mandates, restrictions for travel, and social distancing to limit transmission of the virus between people.[1] Some nations were more restrictive, whereas other nations were more flexible in COVID-19 restrictions, which caused public opinion to vary depending on the severity of the nation’s restrictiveness.[2] The varying degrees of restrictions and the public response to the different government regulations prompted important, philosophical questions to consider; such as, how restrictive is too restrictive? Does a pandemic allow governments to suppress personal rights? And in the case of this paper, how would someone who adheres to the political and ethical theory espoused by John Rawls in A Theory of Justice view medical autonomy in light of vaccine mandates?
In Rawls’ A Theory of Justice, he argues for a more abstract version of utilitarianism that removes some of the common objections to utilitarianism because of its abstract nature,[3] while providing an alternative to intuitionism. He essentially argues for a moral or ethical understanding that relies on social and cultural obligations,[4] which relies on the understanding of every citizen being free and equal;[5] and a moral and ethical system that can be determined in an objective manner in which everyone benefits.[6] Because each individual is free and equal, all political decisions must be made for “the greatest benefit of the least advantaged” and with those from every socio-economical background being able to take part in the decision.[7] If Rawls’ theory ended here, it would sound as if he would support the idea of vaccine mandates during a global pandemic, however, it is the assertion of this paper, that Rawls’ would reject the concept of mandated vaccines even if the alternative would be significant loss of life or even minor loss of life. Regardless of the consequences for not enforcing vaccine mandates—potential illness or loss of life, to force individuals to give up their own rights concerning medical autonomy or their own liberty would be seen by Rawls as unfair, and thus, unjust.
A Theory of Justice versus Vaccine Mandates
Despite the idea given by Rawls’ that every person is equal and that “social and economic inequalities are to be arranged . . . to the greatest benefit of the least advantage,”[8] Rawls continues in his theory with what he calls the “First Priority Rule” also known as “The Priority of Liberty.”[9] In this statement, he argues that any principle of justice is to be ranked and can be restricted for the sake of liberty. In particular, he argues that “a less extensive liberty must strengthen the total system of liberties share by all; [and] a less than equal liberty must be acceptable to those with the lesser liberty.”[10] According to these arguments and ideals concerning the first priority rule, it seems as if Rawls would absolutely argue against the concept of limiting someone’s individual rights even if limiting an individual’s rights could possibly save the lives of a significant amount of people. Or in other words, because vaccine mandates, regardless of their efficacy, can and do take away an individual’s rights of medical autonomy, the government ought not have the ability to require them—let alone the ability to enforce them. When considered in light of Rawls’ concept of a veil of ignorance, it could be assumed that if a society had the ability to determine ethical and moral concepts ahead of time, the individual’s medical autonomy would supersede pandemic concerns, especially when considering pandemic-related concerns do not happen frequently.[11] Though, arguably, government agencies would still have the ability to recommend or suggest the vaccines.
Concerning an Argument for Vaccine Mandates from A Theory of Justice
There could possibly be an argument for vaccine mandates based on Rawls’ Second Priority Rule, also known as “The Priority of Justice Over Efficiency and Welfare.”[12] If read without discernment, an individual might argue for vaccine mandates because the individual’s temporary inequality of opportunity would enhance the opportunities of all those with lesser opportunities. Opponents might also attempt to make an argument based on the concepts of duty and obligation, in which an individual ought to be vaccinated simply because they have an overall duty for the welfare of all mankind even if the law requiring vaccination seems to be unjust.[13] However, both arguments rely on a lack of context and a rejection of the very premise of Rawls’ theory—any principle of justice has to be ranked and can be restricted for the sake of liberty. Conversely, because a vaccine mandate restricts the individual rights of a person’s medical autonomy, no government ought to be able to force their citizens to partake in vaccine mandates—even if the vaccines were completely effective and the loss of life would be significant without a vaccine mandate.
Conclusion
Regardless of a person’s thoughts or opinions concerning vaccine mandates and medical autonomy, it seems clear from A Theory of Justice, that Rawls would not approve of vaccine mandates because of the removal of a person’s individual rights. Even if medical vaccines had a complete effective rate and it could be proven ahead of time that a particular vaccine could save the lives of a significant amount of people or prevent a pandemic; the individual would lose their own autonomy, thus there ought not be a law to mandate vaccines. If a government or governmental agency thought that a vaccine could be beneficial for the individual and ultimately the nation as a whole, then they could offer the vaccine and recommend the vaccine, but forcing people to take a vaccine is unfair and thus, unjust.
[1] Jia Liu, Yasir Shahab, and Hafiz Hoque, “Government Response Measures and Public Trust during the COVID-19 Pandemic: Evidence from Around the World,” British Journal of Management 33, no. 2 (2022): 571-572
[2] Ibid., 572.
[3] John Rawls, A Theory of Justice, rev. ed. (Cambridge, MA: Harvard University Press, 1999), xviii.
[4] Ibid., 95.
[5] Leif Wenar, “John Rawls,” Edited by Edward N. Zalta, The Stanford Encyclopedia of Philosophy, https://plato.stanford.edu/cgi-bin/encyclopedia/archinfo.cgi?entry=rawls
[6] John Rawls, A Theory of Justice, rev. ed. (Cambridge, MA: Harvard University Press, 1999), 453.
[7] Ibid., 266.
[8] Ibid.
[9] Ibid.
[10] Ibid., 266.
[11] Ben Davis, “John Rawls and the ‘Veil of Ignorance,’” Introduction to Ethics: An Open Educational Resource, (Huntingdon Beach, CA: NGE Far Press), 92-97.
[12] John Rawls, 266.
[13] Ibid., 309.
