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Faith
& Reason: The MMR debate is about ethics as well as evidence
The Independent -
United Kingdom; Sep 1, 2001
BY PAUL VALLELY
WHEN CONFLICT occurs
between evidence and assertion, there is often an ethical issue lurking.
The growing controversy over the safety of the triple vaccine for
measles, mumps and rubella is a case in point. Once again it touches on
the relationship of the individual and the state, which has preoccupied
political thinkers since Plato, and on the question of the common good,
which has exercised theologians since Thomas Aquinas.
The controversy over
the safety of the MMR is essentially one
about evidence. But an increasingly emotional tone has entered the debate
in recent months. In part that has come from parents worried about their
precious offspring. But mainly it has comes from spokesmen of the health
establishment who, when challenged on the detail of surveys on the triple
vaccine, respond only by repeating the dogmatic statement that the MMR is safe. And their bald assertions are
reiterated in an increasingly hectoring tone which is beginning to take
on a slightly hysterical edge.
What all this
disguises is a judgement which it would be more honest to articulate. It
is a calculus of benefit against risk. The medical establishment has
decided that, in practical terms, a small risk for individuals is for a
far greater general good. Hesitant parents are therefore brow-beaten with
the argument that it is irresponsible of them to allow their child to be
a free rider on the herd immunity of those children who have undergone
the risk. Parents have a duty to the common good to ensure that their
children are vaccinated.
Yet whether or not
most girls individually benefit from the mumps vaccine - and most boys
from the rubella jab - is rarely discussed. Mumps is most dangerous to
adolescent males who can be made sterile by the disease. Rubella can
fatally affect the development of a foetus if the disease is caught by a
pregnant woman. Children are thus vaccinated primarily for the benefit of
the adults around them, creating a herd immunity from which, if it
continues, they too will eventually benefit.
There is clearly a
history of acceptance of this utilitarian principle. It is enshrined in
Plato's suggestion that the goal of the state ought to be "the
greatest possible happiness of the city as a whole and not that of any
one class". It is hinted at, too, in St Augustine's idea of
"the advantageousness, the common participation in which makes a
people". These were the two great traditions of western culture -
philosophical and theological - which the medieval thinker Thomas Aquinas
synthesised into the notion of the common good, subordinating the good of
the individual to that of the community.
This principle still
lies behind provisions such as that in the Children Act which states that
parents are not the best judge of what is in the interests of their
children; the state is. Judges are empowered to disregard parental
wishes, as in the case of a child of Jehovah's Witnesses whom the courts
decide must have a blood transfusion.
Yet in such a case
there is no dispute about the facts. What is in conflict is two cultural
positions. Jehovah's Witnesses insist that God does not like blood
transfusions. By contrast the mainstream culture asserts that God -
though it will employ non-religious language - actually requires them.
But the MMR is not, despite the heated language of the
medical propagandists, a clash of cultures or of faith statements. By
giving compensation payments to at least three vaccine-damaged children
the government has acknowledged that the MMR
does carry risk, even if it is statistically an infinitesimal one. So
what is the moral basis for eschewing a precautionary approach here, even
if the risk is minute? Parents who are told they cannot opt for single
jabs are being treated as if they were rare eccentrics involved with a
clash of faith rather than normal sane citizens with unanswered questions
about the validity of certain empirical evidence. (That is why
comparisons with compulsory laws on crash helmets or seat belts are
specious here).
The gospels offer an
interesting insight on this question of the sacrifice of the individual
for the group. In deciding that Jesus must die the high priest pronounces
that: "It is expedient that one man should die for the benefit of
the people." Jesus himself has previously seemed to agree in saying
that no-one could show greater love than one who lays down his life for
his friends. Yet there is a key distinction. For sacrifice is not the
same as self-sacrifice. The moral agency is entirely different. Which is
why the Church subsequently refined Aquinas's thinking to insist that the
common good must also encompass respect for the rights of the individual,
which cannot be over-ruled by the dictatorship of the majority.
Since most parents
evidently feel a greater duty to their child even than to themselves
there is clearly an ethical minefield hidden in some of the assumptions
which underlie vaccine chiefs' calculations. For unarticulated within
them are not just suppositions that it is acceptable for the individual
to suffer for the immunity of the herd. They also appear to reinforce the
doctrine that parents are just surrogates for the state with respect to
child care, and what the state gives the state can take away.
There are fundamental
moral objections to all this. If the government's medical mouthpieces
were honest, we should see more clearly why they are wrong. That is why
they prefer simply to shout louder.
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