As an infectious-disease specialist, I will be called on to be
vaccinated early to counter any terrorist smallpox attack. I believe the
chances of this are vanishingly small and that the policy is primarily an
effort to spread fear and build support for a war with Iraq. If I am
vaccinated, I will be complicit with a policy I morally oppose and
unnecessarily endanger my own health. (The vaccine is one of the most
dangerous available.) Yet I feel dutybound to be available to those
suffering adverse effects from the vaccine. Should I be vaccinated? Hal
Martin, M.D., M.P.H., Minneapolis
hile
your decision has political implications, it is above all a medical matter.
You are not being asked to endorse the president's Iraq policy but to decide
if vaccination is called for in your circumstances. Believing as you do that
there is no medical necessity, you have no ethical obligation to be
vaccinated simply because the president urges it.
As a doctor, you can judge the risks of vaccination. As a citizen of a
democracy, you must decide if the president has made a persuasive case that
a smallpox attack is likely enough to justify that risk. If you and your
colleagues overwhelmingly reject the president's call, this may indeed be
interpreted as a rebuff of his policy, but that should be a byproduct of
your decision, not your reason for making it.
Right now, you must weigh your duty to your fellow health-care workers,
only a small percentage of whom are expected to become ill from the vaccine.
This means that the vast majority of those health-care workers who choose to
be vaccinated will be available to attend that ailing few -- a
self-selecting, self-treating group -- and thus your participation is not
essential.
You would face a tougher choice if the president called for the
vaccination of the general population. You might feel an obligation to your
longtime patients to be available to treat those affected by the vaccine.
This would mean either being vaccinated yourself or remaining unvaccinated
and accepting the hazard of exposure as a matter of conscience.
And if you are wrong and there is a smallpox attack? That would be
horrific. But you cannot escape the burden of choice by simply following
orders.
There is another aspect of this question that concerns not only
physicians but all Americans. Financing an expensive smallpox vaccination
program necessarily means neglecting many pressing medical problems, both
here and abroad. In our era of tight budgets, deciding how to allocate
health-care resources is a question with both moral and political
dimensions.
I recently borrowed my brother's car. As I left the parking garage, a
police car pulled me over. One headlight was out, and I received a ticket
for $75. My brother said that he would repair the light, but he wants me to
pay the ticket! I think he should pay it; after all, he lent me damaged
goods! Who's right? Jennifer Wider, Brooklyn
If your brother knew the headlight was out but failed to tell you, he
should cover the ticket. But if he didn't know, you're on your own.
Unexpected breakage is a risk any driver faces, no matter the owner. And of
course if he knew and he alerted you, you're doubly stuck -- with both the
ticket and a flush of embarrassment for not heeding his warning.
Send your queries to
ethicist@nytimes.com or The Ethicist, The New York Times Magazine, 229
West 43rd Street, New York, N.Y. 10036, and include a daytime phone number.