2009-04-29 22:22:17 | mother, philosophy, science, tv | By: Arthur Zey

In this week’s Law and Order: Special Victims Unit (Season 10, Episode 19: “Selfish”–now there’s a bad name for this episode), A.D.A. Alex Cabot put a mother on trial for failing to vaccinate her son against measles, resulting in its spread to a little girl, killing her. Although ultimately, the anti-vaccination mother was acquitted (and I’m sympathetic to this result), this episode did raise a number of interesting issues…or at least, I find them interesting because I myself am not immunized.

Let me start out with the following disclosure: my mother started to immunize me when I was born, but discontinued soon after. I’ve been given a number of reasons for this, including (supposed) bad reactions that I had and research (supposedly) proving the danger of vaccines. I think it boils down to the same faulty epistemological methods that lead my mother to believe in homeopathy. My mother is suspicious of Western medicine in general and of big pharma in particular–in her view, it’s one big conspiracy to make people sick, motivated by greed. (Yeah, right, and teachers make themselves more needed by secretly making their students dumber.)

That having been said, there is a valid issue here: one cannot be rationally faulted for not taking completely seriously the claims of a scientific community whose incentives are so severely perverted by government intrusion and regulation–and that’s to say nothing of taking seriously the claims of actual government agencies like the FDA or the CDC. It is definitely a difficult task to know whom to trust when it comes to complex scientific questions, and I therefore find completely sympathetic an honest abstention from taking medical action (e.g., vaccination). (More disclosure: I am completely unfamiliar with any science surrounding the safety of vaccines, and I don’t take SVU‘s political proselytization to be scientific fact. When I’m a parent and it actually matters, I’ll inform myself about such issues.)

As was made clear in the episode of SVU, a parent who decides to forgo vaccinating their child must realize that this will entail being ever-more vigilant when it comes to protecting their child’s health. After all, the human immune system is quite powerful, and when otherwise healthy, can fight off most diseases.

There’s another issue here about medicine–a point that I want to make in the context of this post. Many of my friends give me a hard time about refusing to take medication for various ailments. There’s a very good reason for this. Symptom relief can be very dangerous: it allows one to ignore that there is a root problem and to engage in behavior that can worsen the underlying condition. For instance, if one takes headache relief medication for a headache brought on by lack of sleep, it may bring about short-term relief, but encourages bad sleeping habits in the long-run. Even if one must, given other values, be chronically sleep-deprived, better that the headache serve as a reminder that one’s health–also a high value to a rational man–is still at stake, rather than to ignore the necessity of sleep and engage in further non-sleep activities. Even catching a cold, which may not be the result of intentional behaviors like losing sleep, requires that one stay home in bed instead of taking some decongestants and putting further stress on one’s body by going about one’s normal daily routines. Just recently, I began taking an antihistamine version of Visine for some severe eye allergies. When my eyes would itch, I would rub them, resulting in further irritation and pain, and then administer a few drops into each eye. After about a week of this, I misplaced the Visine, and I realized that I had better not rub my eyes anymore, since the Visine was no longer handy to relieve the consequences of my idiotic behavior. Within a few days, I stopped rubbing my eyes, and the consequences of the initially mild allergic reaction became negligible. Moral of the story: don’t take medication to alleviate symptoms caused by dumbassery–it only encourages more of the same. That having been said, I completely acknowledge that there may be cases where symptom relief is necessary (e.g., in isolated instances or pursuant to a chronic problem that cannot be treated at root): I’m only railing against symptom relief used as a matter of course.

Back to this week’s SVU. I’m not entirely certain where I stand on the issue of whether a parent who doesn’t vaccinate their child then assumes responsibility for any diseases that are spread by their child. Let’s look at a few simpler cases. If one has AIDS and infects others with HIV, is one liable for damage caused to them? What difference does it make whether it was done intentionally, knowingly, recklessly (consciously disregarding substantial risk), negligently (disregarding a substantial risk that should have been known but wasn’t), or “innocently” (unknowingly and without even negligence)? I haven’t come to a final conclusion, but I’m disinclined to hold legally responsible someone who spread the virus “innocently” (I’ll drop the scare quotes from here on out), and I’d hold guilty one who spread it intentionally (i.e., to inflict harm), knowingly (e.g., having unprotected sex knowing one is infected), recklessly (e.g., having unprotected sex consciously disregarding the fact that one recently had unprotected sex with someone else and without first getting a clean STD screening), or negligently (e.g., having unprotected sex after recently having unprotected sex with someone else). Although all cases, innocence included, involve a non-consensual harm done to another person, I separate out the cases of innocence because of an important fact: we live in a society where we come into contact with others and we know of the possibility of diseases, including horrible ones like HIV. Living among and interacting with other humans carries the risk of infection, and as such, imposes a certain amount of responsibility on each of us. I don’t believe that ordinary, rational interactions can be classified as violations of rights. As a parallel, I wouldn’t call it a violation of rights if a person taps another person on the shoulder to get his attention, and accidentally causes him to have a heart attack from fright. (I suspect that to maintain that the innocent cases also constitutes violating individual rights would be somewhat rationalistic.) Similarly, I think that my AIDS/HIV analysis holds for all sorts of communicable diseases, even the common cold (though the compensation would likely be drastically less than for someone who had HIV trusted upon them.)

Like I said, this is all quite tentative in my own mind, but it make sense. In this day and age, it is difficult to be unaware of the risks associated with not vaccinating (setting aside the potential risks of vaccinating). Although I find myself unsympathetic to a parent who allows his obviously sick child to interact with other children, what about infected children who are still in the incubation stage of the illness? (After all, SVU said that it was 7- to 21-day incubation period for measles.) Is that even negligence? My gut tells me “no”, but I guess that’s a question for legal philosophy to figure out: just what constitutes a substantial risk in this context? And what about whoever infected the child of our anti-vaccination parent in question? Isn’t our anti-vaccination parent (or rather, the child) the victim from a certain perspective? And what of the child our anti-vaccination parent’s child infected–why didn’t that parent vaccinate his child? It seems like all parents are implicitly “on notice” that communicable diseases are out there, even if rare, and that they should be prepared to take immediate medical action if something serious arises. The fact that some other parent didn’t vaccinate his kid and he got sick isn’t an excuse to not care for one’s own child…

I’d appreciate your thought in the comments section.

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Comment from Dr. Matthew
Time 2010-06-23 at 15:02:16

I also happened to catch this episode, and it raised some good questions. The trouble in this situation is that there are a number of relatively well-funded (Jenny McCarthy and Jim Carrey are both high dollar patrons) anti-vaccination organizations promoting false information about the ingredients and risks associated with childhood vaccinations. This led to a number of recent, multiyear, millions-of-dollar tax-payer funded studies to establish whether or not any of the cognitive disorders or impairments alleged by these groups have a factual basis, many of them even involving members of faux-Autism prevention groups in order to make sure the study design was as comprehensive as possible. This extensive research has managed to show no risk under the current schedule of childhood vaccinations. When parents attempt to assess risks associated with vaccinations, I do think that in the competing realms of well-polished, sleek, and highly funded parent-oriented scare sites advocating no vaccinations vs. the occasional dry government report, Google University graduates are going to choose the former and only wind up more ignorant than before they started. The problem then is blame.

When you look at the cases of childhood outbreaks that have occurred of preventable disease in the U.S., there’s a pattern. Children of parents who love care for vaccinate their children yet still fall sick are either a) too young to be vaccinated, or b) are in the minority that is still susceptible to that disease in spite of vaccination. It is this latter segment that concerns public health offices, because a relatively large number of children could contract and die from preventable diseases, despite being vaccinated, if exposed – so we rely on “herd immunity.” Once 95% or so of children in a community are immunized (though the percentage varies based on the vaccine and size of the local population), it effectively works to protect all the children in the community. A small drop in the percentage of vaccinated children can, through playgrounds, clinics, etc., bring large numbers of children into contact with lethal diseases, and infect many more than just the unvaccinated or partially vaccinated child.

The worst case scenario? These parents then bring their sick children to MDs, who weren’t trained, and shouldn’t be expected to, recognize symptoms of diseases we’ve been able to prevent since the 1940s, and expose all the infants and mothers passing through the same clinic. This is such a concern that growing numbers of pediatricians are refusing to accept unvaccinated children on their caseload.

While the anti-vaccinationist campaigns are sleek, there are numerous resources, including the pediatrician of virtually every child with healthcare in the nation, willing to address the concerns of worried parents. The only real criminal here is the parent who refuses to vaccinate their child out of misplaced wishes to see their own child die hatred of mankind desires to kill other people’s children fear of easily dispelled risks.

I do take issue with your point, however, that “one cannot be rationally faulted for not taking completely seriously the claims of a scientific community whose incentives are so severely perverted by government intrusion and regulation–and that’s to say nothing of taking seriously the claims of actual government agencies like the FDA or the CDC.” One CAN be rationally faulted for this irrational idea, in that there are numerous non-governmental sources of information, and the vast majority of vaccines are non-patented and exist in the public domain. No one person or entity is profiting off of some vaccine racket, and most the benefit actually accrues to the individual who is vaccinated, and the community spared the expense of caring for and providing resources to maintain a population riddled with debilitating diseases.

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