Deference to Preference

I don’t agree with the scientific views of those who think vaccines are harmful. I think the science showing huge net benefits of required vaccines is quite clear, and moreover, I know just where the rumor about supposed vaccine dangers came from originally. Nonetheless, public health ethics requires us to give due deference to people’s opinions, whether we agree with them or not, and that includes scientific opinions.


How far should this deference go? Obviously it’s ok to enforce behavior on people when the health of others is at stake. But what about when only one’s own health is on the line? There is a debate about the role of paternalism in public health, but this debate is anchored in outdated assumptions about sacred and unchanging preferences, and therefore it misses a key dimension.


Because preferences are in fact malleable, it is useful to try to disentangle deeply held beliefs, which deserve full deference, from not-deeply-held beliefs, which it’s ok to gently nudge aside in the interests of better population health.


You don’t see a lot of people raving anymore against seatbelt laws as a communist plot and even those who once adamantly opposed public sewers now strongly support them.


Ethical concerns about forcing sewers and seatbelts on people are modest, since the vast majority of people come to not only accept them without complaint, but recognize their value.


But vaccines appear to be different. For some reason, some people absolutely fear vaccines for their children. And in that case, deference to their preference—within the bounds of protecting population health generally—should be the operating public health value.

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