Bioethicist says parents who don't vaccinate should face liability | Hacker News Reader

Bioethicist says parents who don't vaccinate should face liability

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33 pointssoundsop68 comments

It feels like a reasonable idea. You're not going to get much money. Perhaps you should go after the people promoting the anti-vaccine stance instead?

Measles outbreaks are happening in a few places: (http://www.bbc.co.uk/news/uk-wales-south-west-wales-22221704) (http://www.nyc.gov/html/doh/html/diseases/immmea.shtml)

Some nurseries in some countries prohibit children that don't have vaccination certificates. That seems reasonable - you can chose which nursery to send your child to.

Andrew Wakefield is a crook. In my opinion he should have paid a huge fine. (http://tallguywrites.livejournal.com/148012.html)

Typhoid Mary got quarantined against her will for spreading the disease, so this idea is quite similar (but not as extreme). Basically if you're harming others you're liable. There's an interesting text on old cases of healthy carriers at http://cythereabast.wordpress.com/2007/02/20/the-board-of-he...

Typhoid Mary is a great example. You can quibble over the investigative technique and how they perhaps did not treat her with compassion but the fact is that she was killing people and imprisoning her was the only way to spare others. (Thankfully imprisoning is not necessarily in this case.)

Vaccines usually don't cause problems, but when they do it is very hard to get those statistics collected. I do have a coworker who lost her hearing due to a bad vaccine. My daughter did have a minor side effect from the measle/chicken pox vaccine. The side typical side effects from each of those vaccines are similar, but since it was a combination vaccine, I'll never know which one/both my daughter had a reaction to. The pediatricians did not care and said it's hard to get the CDC to collect feedback like this. I would argue for singular vaccines and blood test for pre-disposed reactions. In my opinion it's hard to push good science to the medical community, so approaches like this seem to go nowhere.

> My daughter did have a minor side effect from the measle/chicken pox vaccine. The side typical side effects from each of those vaccines are similar, but since it was a combination vaccine, I'll never know which one/both my daughter had a reaction to.

Isn't this expected?

Since vaccines are not 100% effective why would it incur liability? You can't prove that the person wouldn't have gotten sick with the vaccine.

People should have the right to refuse medical treatment. Can we sue the FDA for with holding treatments that may have prevented death?

The problem is herd immunity. If you're okay with getting sick and you opt not to get vaccinated, whatever. You can get sick. The problem is that by getting sick you are now able to spread your affliction onto others, and you're compromising herd immunity.

If enough people get vaccinated, it protects the unvaccinated people as well by stopping the spread of disease. So each person who withholds vaccination increases the chance that the disease will be able to spread and reach all the unvaccinated.

EDIT: To give a more simple example, do you think it's okay for people to show up to work badly ill with the Flu or some other transmissible disease? What if they get the whole team sick? Is that okay?

To me vaccines provide enough individual benefit that there is no need for a social solution. Vaccines are not a case of market failure.

Especially in the United States it strikes me as insane that vaccine manufactures are by law not liable for the side effects of vaccines, yet people would propose to hold individual parents liable for not vaccinating their children. (Note: I'm not talking about crazy autism stuff, but the risks that have been proven and for which industry has sought protection)

To me the benefits of herd immunity dramatically outweigh the consequences of minor side effects from vaccines. The immunocompromised have few options other than to rely on the rest of us to get vaccinated.

Ignoring for the moment how totally insane our legal system is, I think it's very debatable it's the right tool to deal with side effects.

The thing is, we know there are going to be side effects, some severe, some fatal. The government licenses these vaccines knowing, statistically, that X number of people will get sick, Y crippled, Z killed. But it does this because the alternative is far worse. So as long as it's not stingy, it makes sense for it to run a system (http://en.wikipedia.org/wiki/Vaccine_court) to pay out to those families affected, rather than the capricious legal system that won't compensate a lot of people.

As I've noted elsewhere, expose manufacturers to unlimited liability and we eventually won't have any left. We were in fact almost there when the compensation system was changed.

Also, you may not be talking about "crazy autism stuff", but lawyers certainly were and would be if set loose again.

They would still have the right to refuse. Others would also be able to sue them for the fallout. You would only need to prove your case beyond a preponderance of the evidence to sue. In this case doing that would be trivial.

If you think vaccines are so effective then take yours, stop worrying, and leave everyone else alone.

Not everyone wants to be part of the herd. Herds get slaughtered.

Now that is what I would call a depraved indifference to human life.

All science is merely a means to an end. The means is knowledge. The end is control. Beyond this remains only one issue: Who will be the beneficiary?

In 1954 this was the issue of primary concern. Although the so-called "moral issues" were raised, in view of the law of natural selection it was agreed that a nation or world of people who will not use their intelligence are no better than animals who do not have intelligence. Such people are beasts of burden and steaks on the table by choice and consent.

Off with you and your conspiration-theory articles. We don't need you here.

The complication is vaccines have two benefits. 1. I am less likely to be infected 2. I am less likely to infect someone who can't be vaccinated. If you want people to leave you alone then you have to convince them that point 2 is less important than something else.

http://rense.com/general86/killa4.htm

We begin to see the true purpose of GAVI once we realize that its official literature contain thousands of papers, journals and textbooks on what is known as "Reproductive Immunology" or to the layman, "how to make women immune to pregnancy." A GAVI article from 1991 has the headline "The WHO Task Force on Vaccine for Fertility Regulation". Numerous institutes have reproductive immunology on their research scheme. And as we see, the method is based solely on vaccination programs and the WHO is deeply involved in their practical implementation.

While I agree that secret mass sterilization would indeed be bad, I found that article to be extremely non-persuasive in making me think that this is the case.

I am not going to argue against vaccination (which seems to be the target of a lot of conspiration theories), but I am really interested on where are the limits of this logic: are we going to "use" only vaccination or any factor that might/could increase the chances of getting somebody else sick?

Who is liable when the child gets sick from the vaccine? It happens. Rarely, but in this country we are supposed to protect the minority and the freedom of choice against coersion, which this is.

The government does through an excise tax on covered vaccines and a no-fault court system to cover claims: http://en.wikipedia.org/wiki/Vaccine_court

And you should at least admit there are two minorities in the balance, children who's parents refuse to get them vaccinated, and children who are not immunized because they can't take them or don't develop a sufficient response. Too many of the former and the "herd affect" stops protecting the latter.

there is a difference between a minority created by inaction and a minority created by forced action.

I don't think bacteria and viri care about such differences.

The issue has to do with free will. Not much else.

This is only acceptable, if vaccinations itself are guaranteed to be 100% safe. Of course then someone should be liable for any damage caused by vaccination.

Nothing is guaranteed to be 100% safe.

I can however guarantee you that a population losing herd immunity will put more lives at risk. Can those who abstain from vaccines be held liable when those who actually cannot get vaccinated fall ill? That seems like a fair compromise; tax anyone who chooses not to vaccinate and use the proceeds to help those who are harmed by their decision. We wouldn't be jailing them, merely holding them accountable for their actions.

Throwing salt onto the icy sidewalk in front of your business can be dangerous, but if you don't do it and somebody gets hurt, you can be sued.

If safeness cannot be guaranteed, then noone should be forced.

Arguing with statistics over a population surely must sound cynical to those who have been negatively affected by vaccination: "Sorry, you're one of the rare people we ignored while forcing everyone to take the medicine which is known to cause problems for 0.00001% of people."

Also, vaccination does not guarantee, that I cannot be an agent of the germ, even if I am imune myself.

Nobody is being forced to vaccinate under this proposal. They are only being opened up for liability if they choose not to vaccinate. If you want to endanger your child and others, then fine; just don't expect there to be no consequences.

NOBODY is claiming that immunization is a guarantee; I don't know where you are getting that nonsense from.

Taxing is a way of enforcement, as well as telling people that they can get sued.

Also, I never asked for the guarantee of immunization, but for guaranteed safety of vaccination. For example I know a child that lost ability to speak due to bad vaccination. Since it doesn't live in the US, it will never get compensation from a fund.

Such a guarantee would be unprecedented, and expecting it is ludicrous. You can get sued for many things that you cannot say you are "forced" to do.

Much popular misinformation notwithstanding, the balance of risk between vaccination and not vaccinating is extremely lopsided. No, vaccination is not perfectly safe. But it is safer than getting sick. And for anyone who is immune compromised (the very young, the very old, people receiving chemotherapy, those with AIDS, etc) their only protection is to have everyone else vaccinated.

The question is at what point your acting on your fringe beliefs are allowed to kill other people, and what liability you should have for it.

And no, this is not a hypothetical point. We have concrete cases of dead babies and known infection vectors. We really can say, "Your decision to not vaccinate killed that baby." In that case why shouldn't you be liable for criminally negligent manslaughter?

> In that case why shouldn't you be liable for criminally negligent manslaughter?

Because causing death through actions which demonstrate depraved indifference to the risk to human life is murder [1], not manslaughter.

[1] http://criminal.findlaw.com/criminal-charges/second-degree-m...

I think that "depraved indifference to the risk to human life" is a hard standard to meet when the person who didn't vaccinate honestly believed that the vaccine posed a larger risk to their child than their unvaccinated child posed to everyone else.

Compare to http://criminal.findlaw.com/criminal-charges/involuntary-man... where the equivalent is "The act either was inherently dangerous to others or done with reckless disregard for human life." The "inherently dangerous to others" standard is much, much easier to prove. And it is easy to prove regardless of the mistaken beliefs of the (ir)responsible parent.

In the general case yes, I think you are right.

It is however fairly easy to conceive of scenarios where an individuals inability to understand risks posed by their actions becomes very blurred with a refusal to understand the risks.

Typhoid Mary for example was informed numerous times that she was posing a risk and the fact that they were able to re-find her after she changed her name by following her carnage should have been proof enough to her that they were probably right. I think you could make a reasonable case that Typhoid Mary had a depraved indifference to the risk to human life, even though she claimed to not believe the doctors.

Edit: If you understand herd immunity and decide that you do not care (such as eip here: https://news.ycombinator.com/item?id=5802206) then you surely have a depraved indifference to human life. Moreso even than Typhoid Mary could be said to have.

For Typhoid Mary, yes. But for most of the cases, you'd have a much harder standard to meet.

Here is an interesting problem. Suppose that we trace a disease through 5 unvaccinated children from the one who picked it up in a foreign country, to the one who passed it on to the baby who died. Who is liable? All 5? The one who passed it on? The one who went to a foreign country while unvaccinated?

All those who reasonably had the opportunity to provide their child with a recommended (recommended by who could be debated. I would throw out the CDC as a first suggestion) vaccine that had the possibility of preventing the outbreak, but chose not to.

I think it would be better to tax or fine those who chose to abstain from vaccinating their children than to wait until an incident occurs and try to sue people. Much easier, and it does a better job of driving home the point that by refusing to vaccinate your child you are damaging herd immunity, not just potentially killing particular people.

We also have concrete cases of negative effects of vaccination and as long this is the case, forcing people to take these risks, just to lower the vague risks for others people's babies is ridiculous. Maybe people shouldn't expose their babies to the public as long as they are so vulnerable. Probably safer than requiring that everybody else is vaccinated...

There is nothing vague about herd immunity; it is very well understood.

By vague I mean that there is no guarantee that babies die, just because I'm not vaccinated. It's not even very likely. Taking the probability of damages due to vaccination into account, we are trading one person's safety against the safety of a baby that shouldn't be in the public as long as it is too vulnerable. So maybe the parents of that baby should be liable at first. Nobody will ever be able to guarantee a germ-free world out there.

If the baby was killed by something that you, a willfully unvaccinated person (or your child, who you willfully did not vaccinate), were carrying, and the source of the infection can be said be you (or your child) more likely than not, then that should be more than enough for a civil trial. Were we talking about criminal charges, then the evidence would need to be stronger.

In reality, we can track the progression of disease much better than "more likely than not". This is something that we have gotten quite good at doing.

The importance of "100% guarantees" exists only in your imagination. Nothing in the real world works that way.

Even in my imagination there is no 100% guarantee. And so there is no 100% safe and germ-free world for babies out there. If people take their vulnerable babies to the public, then nobody but them is responsible if this is too much for the baby. People can be agents of germs, even if they are vaccinated, so vaccination is not really protecting these babies and especially not by 100%.

Requiring (or pushing) people to take medicine to protect others people's health is like putting the cart before the horse.

> If people take their vulnerable babies to the public

If?!?! Your expectations have no relation to reality.

> People can be agents of germs, even if they are vaccinated,

1) Viruses.

2) If you are knowingly making the decision to be a greater risk, then you are being reckless and should be considered liable for the outcome.

> Requiring (or pushing) people to take medicine to protect others people's health is like putting the cart before the horse.

No it is not. Herd immunity allows us to eradicate disease. Your suggestion of "live and let live" does not.

> If?!?! Your expectations have no relation to reality.

Whose reality? Seeing people taking newborns to malls makes me feel very uncomfortable. I know cultures where people keep their babies at home for the first few months.

> 2) If you are knowingly making the decision to be a greater risk, then you are being reckless and should be considered liable for the outcome.

Sorry, but that's just nonsense. Deciding to not get vaccinated is not deciding to be a greater risk, but in the first place a decision against a specific treatment for the personal body. Especially if this treatment has its own risks. Calling someone reckless for deciding against a specific medical treatment is simply impertinent.

>Whose reality?

The reality of western life. The reality where both genders are in the workplace and where people visit the homes of others. The reality where single parents are plentiful and where both parents working is common.

You could perversely wish all of these things were not so, but that would not change the nature of reality.

This is absurd before we even get into the fact that it is not only newborns that benifit from herd immunity...

> Deciding to not get vaccinated is not deciding to be a greater risk

Of course it is. It is empirically.

https://en.wikipedia.org/wiki/Fallacy_of_quoting_out_of_cont...

You are still not facing facts.

We give babies the MMR vaccine at 12-15 months. I do not know of any cultures where 10 month olds are kept indoors. And even if YOU think that OTHERS should do so to protect them from YOUR BAD DECISIONS, the fact is that they do not.

Furthermore babies of that age get sick. (In fact for their long-term health it is good that a baby gets a serious cold in their first year, it helps their immune system out.) And sick babies will go to the pediatrician. Where, inevitably, you'll find other sick kids.

Let's take a real near miss. In 2008 in San Diego a 10 month old baby boy (too young for the measles vaccine) went to the pediatrician where there was a kid with measles. The baby, too young for a vaccine, spent 3 days in the hospital, and the parents had to take a month off from work to nurse him back to health. You can verify these details at http://children.webmd.com/vaccines/news/20100322/vaccination....

So what are your expectations? That 10 month old babies be kept inside? That babies not go to the pediatrician for fear that your decisions will put their lives at risk?

Now let me turn it around. Were I on a jury and Megan Campbell was suing YOU for her child's suffering, her hospital bills, and her lost wages accrued due to YOU NOT FOLLOWING STANDARD MEDICAL ADVICE, I'd support her side.

If her baby had died and it was a criminal trial, I know that I'd be entirely in favor of a manslaughter charge against you.

And your protestations that people with young children should keep up a good enough bubble would not endear you to me at all. Because I'm a parent, I know how hard parents work at it, and I know that the kind of bubble you're recommending is essentially impossible for real working families to do.

I can understand your sentiment, but basically you are the one who tries to create a risk-free bubble for your children by forcing others to take risks for themselves. So before asking me to face facts, please check your own view: if you want a risk free environment for your children, then you actually have to create such a bubble. It's the only way. Even if you convinced me, there will always be unvaccinated people possibly endangering your kids. Reality.

As long as you ignore the possible risks of vaccination itself, accusing me of manslaughter due to accepting the risk of infection is simply ridiculous. If my child died from vaccination would it be manslaughter by the doctor, or maybe by you, because you told me I should take the risk of vaccination? Google for "died from vaccination" and you will find tons of cases. Is dying from vaccination any better than dying from an infection?

Asking me to take risks, to lower your risks, is just not ok.

If we were talking about someone who is knowingly infected (like Typhoid Mary), then there is a completely different situation. I agree that such people should be forced into quarantine. Relating avoidance of vaccination to manslaughter is like relating not installing cameras to terrorism: BS.

You, in public increase the risk of a) yourself dying and b) the risk of others dying. Please stay home unless you wish to be liable for living.

Can you not see how ludicrous this line of thinking gets?

Way ahead of you:

http://www.hrsa.gov/vaccinecompensation/index.html

Interesting, but looks very US-centric to me.

Well yes, it is a program of the US government. I imagine other countries have similar things.

For 90% of countries in the world: dream on... :(

Diversity is good. A few children who are not vaccinated is probably in the best interest of humanity. Imagine at some point in the future a vaccine does cause genetic problems, what then? Do you want to risk 100% of the population on that?

How much of the population do you want to risk on a comeback by whooping cough or polio or smallpox?

You can/have to put the kids that don't have vaccines under a special surveillance and work around the issue. Should society subsidize those costs? Perhaps.

For their entire lives, though?

The potential damage of a viral pandemic is well documented and well known while the damage from vaccination seems, to say the least, controversial. I'm aware of one study linking vaccinations to autism having been debunked as a hoax, for instance[1].

[1]http://thechart.blogs.cnn.com/2013/03/29/vaccine-autism-conn...

  | damage from vaccination seems, to say the
  | least, controversial

Vaccines aren't 100% side-effect free. Combine the fact that the government shields manufacturers from liability for vaccines, and the fact that no one cares to collect statistics on side-effects from the vaccines, it's clear that no one wants to really evaluate the risks objectively. Presumably the side-effects are out-weighed by the benefits, but is there data to back this up? Not really.

Our government does this shielding because otherwise our legal system is so crazy no company would be selling vaccines in the US.

the fact that no one cares to collect statistics on side-effects from the vaccines

Doesn't the existence of a fund to cover those with really bad side effects suggest that we actually do have those statistics? They're certainly collected during FDA mandated testing, which is particularly extensive for vaccines because the tradeoffs are so stark, you're giving them to an generically healthy population, it's not a "take an antibiotic or die" kind of thing.

  | FDA mandated testing, which is particularly
  | extensive for vaccines

Is that really the case for the flu vaccines that they have to make 'on the fly' specific to each flu season and the new strains out there?

What about the other vaccines mentioned here, where children get 3 or 4 vaccines at once by convention? How do you know which ones are causing adverse reactions?

Yes, because the vaccines are the same year to year except for the precise seed strains used (and those are developed by specialists who provide some degree of regularity), which provide the precise sequences of amino acids that make up the two relevant viral proteins.

Otherwise they're as identical as possible, the least reasonable amount of chicken "stuff" left in, the preservatives used, etc. And I'm pretty sure there is some testing done before new batches are tried out on the whole population.

As for "how do you know which ones are causing adverse reactions", why do we care? I would assume if they're bad enough the child isn't given any more, so which causes what is irrelevant (remember, we know this is going to happen, these vaccines are licensed with that understanding). If less severe, I'm sure there are protocols to address this so the child can get further vaccinations with reasonable safety (e.g. you can test with a very small amount to see if one causes a reactions ... and, hmmm, that should do for the severe reactions as well).

I would expect that data regarding the rates of mortality from viruses over, say, the last century would be readily available somewhere.

So i'll suggest the null hypothesis -- assuming that vaccines do at least as much, if not more, harm than good (of which we're unaware because of politics and whatnot) then there should be evidence of lethality due to vaccinations on a scale approaching that of viral pandemics. The evidence of the good should be indisputible - how many people still get polio? The onus is on the other side to demonstrate harm.

You and others are ignoring those who's vaccinations don't "take", they silently don't result in a sufficient immune system response for whatever reasons. Herd immunity is the only thing protecting them since don't know ahead of time who they are (those who you know aren't protected can e.g. get a gamma globulin shot if exposure is suspected).

http://op12no2.me/toys/herd/index.php?scenario=intro

There will always be a few unvaccinated children; some kids can't get vaccinated due to other issues. We don't need more people voluntarily exposing their own children to needless risk.

I think there has to be a level of tolerance which is justifiable by science and working around the issue by other means -- for instance only so many kids without a certain vaccine can be in the same peer group. Else you are a totalitarian and we've seen that this type of thinking produces problems.

Don't get me wrong -- I'm not certain I'm comfortable with the idea of forcing parents to vaccinate their children either. There are serious issues with personal autonomy there. But please, please let's not fool ourselves with lies about how it might be for the best. That direction lies nothing but FUD and pseudoscience. The question is whether or not parents should be have the right to put their children at risk because they disagree with reality.

Government-enforced mandatory vaccination is what really made inroads into smallpox, a disease which is now eradicated.

Respecting the "diversity" of opinions on the issue would have achieved the opposite.

That level of tolerance has traditionally been given, but it has recently begun to be abused. A few fringe religious nuts who want to abstain from modern medicine are fine; they don't threaten herd immunity. However as soon as not vaccinating your children becomes the trendy thing for young parents to do, it can become necessary to take a hardline stance in order to protect those who do not have the luxury of choosing to be vaccinated.

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