Decision-Making in Pediatric Vaccination: The Permissibility of Vaccinating Children Without Parental Consent

Abstract: A measles outbreak in Philadelphia during 1990 and 1991 killed nine children and infected over 1400 people—six of the dead were from churches that practiced “faith-healing.” When parents at these churches refused to treat or vaccinate their children on religious grounds, a court ordered the compulsory treatment and vaccination of the children. Despite the court’s willingness to intervene in this case, the political debate over who has legitimate decision-making power in pediatric vaccination continues: Is it parents, the government, doctors, or the child? With outbreaks of measles and other vaccine-preventable diseases on the rise, and declining rates of childhood vaccination, the question takes on a new seriousness. We gathered several experts for this panel from a variety of professional disciplines to articulate the tension over legitimate decision-making in pediatric vaccination. First, a legal expert will evaluate the legality and justifiability of pediatric vaccination by the government without parental consent through a survey of laws and legal precedents. Second, a philosopher will explore whether the unique qualities of vaccines (e.g., collective benefit) create morally relevant differences that preclude standard pediatric consent requirements. Third, an ethicist will argue herd immunity does not change the permissibility of non-medical exemptions (e.g., religious exemptions) for children, and that non-medical exemptions always constitute a wrong to the child. Finally, a theologian will discuss the concerns of persons of faith with regards to mandated vaccines, especially vaccines with a morally complex development. They will conclude with recommendations for encouraging vaccine uptake as aligned with religious principles.

Keywords: pediatric ethics, vaccine exemptions, vaccine hesitancy