"Fuck lawsuits"? Lawsuits and jail time are the chocolate and peanut butter of our system. Why not both?
Shit given. Seriously, I'm surprised you think we agree on nothing. I actually think we agree on a great deal. I only comment when we disagree, so it's reasonable to interpret my silence on many of your comments/posts as relative agreement.
And I don't necessarily disagree with you on the merits of the decision. I just think chalking it up to "stupidity" is both reductionist and unhelpful. There are superior ways to trying to ameliorate "irrational" health care decisions than telling the parents they are essentially child abusers.
Daniel, a few thoughts, mostly about your comment in Amber's post (I think I'll cross-comment this):
- I'm not sure how the 300-year heritage of opposition to vaccination is relevant? 300 years ago, we were barely starting the Enlightenment. Also, according to an old page by the WHO, the first vaccines were only in 1798. Also, there's been at least as much opposition to many other good things (like birth control).
- Moreover, a longer history of opposition is better, for my point. Because that means more scientific attention, and thus a higher subjective probability, given the failure of science to find the bogeyman, that the bogeyman doesn't exist.
- I'm not trying to convince anti-vaccinators. Frankly, I've given up hope for convincing a lot of people about a lot of things, and that giving up starts with the religious. (There's more hope for those with good-faith opposition based on incorrect scientific worries, but how much hope? And what are the relevant proportions?)
I'm trying to convince the rest of us to pass laws coercing anti-vaccinators. That's exactly the sort of blunt quote that just begs to be taken out of context, but it's true. It's appropriate to coerce people to stop harming others (like their children, and the public) when persuasion fails. Even John Stuart Mill would approve: this is straight down the middle of the harm principle.
- And for the purpose of convincing the rest of us to coerce anti-vaccinators, I think the child abuse description is helpful. For one thing, it's accurate. When parents intentionally (as with the religious who know vaccination will be better for their children but don't do it), or negligently (as with those who participate in public scares) risk serious physical injury to their children, we call that child abuse. And people who care about other kinds of child abuse, and who vote, ought to care about this kind as well. Using the label reveals the similarity.
(Picking a state at random... how about California penal code 270 et seq?
If a parent of a minor child willfully omits, without lawful
excuse, to furnish necessary clothing, food, shelter or medical
attendance, or other remedial care for his or her child, he or she is
guilty of a misdemeanor punishable by a fine not exceeding two
thousand dollars ($2,000), or by imprisonment in the county jail not
exceeding one year, or by both such fine and imprisonment. If a
court of competent jurisdiction has made a final adjudication in
either a civil or a criminal action that a person is the parent of a
minor child and the person has notice of such adjudication and he or
she then willfully omits, without lawful excuse, to furnish necessary
clothing, food, shelter, medical attendance or other remedial care
for his or her child, this conduct is punishable by imprisonment in
the county jail not exceeding one year or in a state prison for a
determinate term of one year and one day, or by a fine not exceeding
two thousand dollars ($2,000), or by both such fine and imprisonment.
This statute shall not be construed so as to relieve such parent
from the criminal liability defined herein for such omission merely
because the other parent of such child is legally entitled to the
custody of such child nor because the other parent of such child or
any other person or organization voluntarily or involuntarily
furnishes such necessary food, clothing, shelter or medical
attendance or other remedial care for such child or undertakes to do
so.
Proof of abandonment or desertion of a child by such parent, or
the omission by such parent to furnish necessary food, clothing,
shelter or medical attendance or other remedial care for his or her
child is prima facie evidence that such abandonment or desertion or
omission to furnish necessary food, clothing, shelter or medical
attendance or other remedial care is willful and without lawful
excuse.
Cross-posted from Amber's blog:
Paul,
Thanks for the correction; Jenner invented smallpox inoculation in the late 18th century, so it should be 200 years, not 300 years.
As for what can the history teach us, I'd say it can teach any one of a number of things. The first is that vaccinations and inoculations -- like most forms of health care -- often reflect deeply held and entrenched political, social, and cultural beliefs. The fears of many 19th century immigrants that public health officials meant them harm is actually not that far off given the prevaling attitudes and opinions towards those immigrants.
This suggests that opposition to vaccination is not inherently and absolutely rooted in ignorance and idiocy, as you seem to imply, but is reflected in a much more complex picture of social and cultural status.
Now, certainly the fact of such longstanding opposition alone hardly justifies it, nor did I imply to the contrary. But it is certainly relevant to understanding why so many seem to oppose vaccination, which you don't seem to have any interest in doing.
As for probability, you're relying way too much on the principle of uniformity for my liking. The fact is, expert medical opinion -- even consensus -- gets things badly wrong, all the time. That doesn't mean it's useless; quite the contrary. But you seem far too comfortable relying on the mere fact that we haven't established any causal link between vaccines and autism as proof positive that there exists no such link. That's fallacious. And we certainly have not been looking for such a link for 200 years. In fact, we haven't been looking for a general link at all -- all we've done is look for and disproved a link between thimerosal and autism. Good. But that does not establish the lack of any other causal links.
Moreover, we know that vaccines actually can be dangerous. Oshinsky's book on polio and the bitter controversy between live and killed virus vaccines makes this eminently clear. Edward Hooper's book, while properly discredited as a reasonable theory for the origin of AIDS, correctly points out the risks of using animal substrates to culture vaccines, since if we by definition are unaware of any particular zoonosis we can't very well screen for it, can we?
Whether it is ethically appropriate to coerce vaccinations and whether it is, as a matter of policy, likely to be effective to coerce such vaccinations are entirely different questions. We coerce auto insurance as well, and estimates are generally that at least 25% of most state populations are uninsured at any point in time.
Again, you insistence that anti-vaccinators are equivalent to child abusers rests far too comfortably on what to me seems like a monolithic and reductionistic view of prevailing scientific information. Medical experts get many, many things wrong, and there is plenty of instances in which patient and caregiver narratives of illness suggested causal linkages long before scientists and
cont'd
physicians had even imagined that any such link existed. Medical science is a very powerful way of knowing, but it is certainly not the only valid way of knowing, and its reliance on inductions means that there is an irreducible uncertainty in whether event X causes effect Y.
There's also a decidedly anti-religious strain to your perspective, which bothers me for a variety of reasons, not least of which is because it seems to me to be inconsistent with the ethos of at least some of the Founders, some of whom, IMO, would not support your apparent willingness to transgress persons' and communities' cherished and deeply held religious beliefs by coercing vaccination without even bothering to engage the adherents of those beliefs.
Look, for the record, I think vaccination is proper both an ethical and policy grounds, and I'm perfectly happy to concede that a plausible case for coercive case for vaccination can be made, though I'm far less certain that Mill would sanction without hesitation the application of the harm principle in this case.
What I disagree with most of all is your seeming unwillingness to exercise the moral imagination to try to understand why so many for such a long period of time have opposed vaccination before labeling them idiots and child abusers, which seems to me to be inconsistent with the classical conception of virtue and the duties required of policymakers in the polis.
Whatever the merits of your proposed policies -- which, to repeat, are tenable, to me -- the attitude you seem comfortable adopting, and your unwillingness to actually, as a matter of phenomenology, engage the humans whose lives will be deeply and directly affected by the coercion -- on the psychological and emotional level, if nothing else -- is neither the wisest nor the most appropriate manner of proceeding.
And sur-crossposted:
Daniel,
- I reject the idea that we can learn anything relevant to today's policy debate from the fact that immigrants, who were the objects of vaccination policy a hundred years ago, were also the objects of a variety of nasty policies. That's an inappropriate generalization: from the fact that the objects of vaccination policy then were right to think that officials were out to get them, to the idea that there's anything at all rational in similar contemporary beliefs. Sure, opposition to vaccination isn't inherently an absolutely rooted in ignorance and idiocy across time, but today it is.
- As for the monolithic and reductionist view of prevailing scientific information, etc., that way lieth absolute social quietism. There's a difference -- a big difference between the two following claims:
a) This claim is infallibly true;
b) This claim has the highest probability of being true, and the expected social utility from acting in accordance is much higher than the expected utility from taking the other choice.
My claim is only that b) is true, and that b) justifies coercive policy.
I agree with you on the effectiveness issue, alas... but I imagine more are insured with coerced auto insurance than without.
As for the anti-religious strain: guilty and proud of it. I'm not all that concerned with what the founders would say; in my more frustrated moments, I mull over the idea of repealing the free exercise clause. Religion seems to me like nothing more than an expensive taste, and demanding that society accommodate it seems like nothing more than the claim that society is obligated to give me caviar for lunch. (And that doesn't change because people feel that religion is very important: many expensive tastes are felt very strongly: consider compulsions and addictions.)
Finally, on the moral imagination point: I don't see the relevance at all. Child abuse is a crime primarily of action, and only secondarily of state of mind. If a parent doesn't give medical care or food to their children, it's no defense to say "I thought the doctor/grocer was plotting against me." (Well, it might be an insanity defense, but I assume that's not your claim.) If I model the mind of the person who refuses to vaccinate his or her children, and I find that the only reasons given are irrational ones, then it's no failure of moral imagination or understanding to call it irrational child abuse.
Wheeeee, this is fun, just like Usenet, except I actually respect both Paul and his views:
Paul,
-The example from history was just that, and was meant to be illustrative, not defintive. I did not say that the fact that immigrants had good reason to oppose various efforts of public health officials (see Mallon, Mary) necessarily implies that today's opponents also have good reason. What I said is that delving deeply into the history of opposition to vaccination is instructive because it demonstrates that, at various times and in various contexts, opposition to vaccination -- like opposition to anesthesia, for example -- was rooted in perfectly plausible accounts.
The example of immigration is only one such justification; vaccines were even more dangerous throughout the 19th century than they are today. If opposition to vaccination has always been the province of idiots and religious nutcases, then you're essentially committing yourself to labeling as such wide swaths of Western society, given that vaccination was discovered in 1798, but did not become widespread until the 1870s.
People knew darn well about vaccination and its effectiveness against certain illnesses since 1798, but systematically and generally refused it. In fact, those who welcomed it with open arms were the exception, not the rule, for over 100 years.
Maybe they were all benighted and stupid, or perhaps it might be fruitful to engage the historical narratives and attempt to assess why so many opposed vaccination for so long. If you don't see how such an effort might be relevant to today's context, I'm afraid there's not much more I can say that will convince you.
As for whether today's opponents are bigoted and idiotic, I wonder how you would know this since you don't seem to have the slightest inclination to actually engage those opponents to learn why they are doing as such.
I note you did not say much in response to my point that vaccines actually are by nature dangerous -- though, again, there is NO evidence they cause autism. This point suggests that just maybe opposition to vaccination has more of a basis than you are willing to grant. But even if you disagree, my general criticism of your POV is your unwillingness to even engage the opposing point of view. Instead, they're child-abusers, religious nutcases, and idiots.
Respectfully, you're not getting what I'm saying about the moral imagination at all, and it's probably my fault for failing to say more about what I mean there. I don't have the time to explain what I mean by it in a blog comment; but I continue to think your view is reductionistic and inconsistent not just with the Founders' ethos, but with the notion of the principle of charity that I take to be quite important to discourse.
Again, as for justifying coercive social policy, please note my comment above that there is a plausible case to be made for coercive vaccination, and the thought of it hardly makes me recoil with horror. However, there is a disastrous record of using scientific "facts" to justify coercive public health policy in the West in the 20th century; one need only take a passing glance at the history of eugenics and scientific racism in the West to see this (don’t accuse me of Godwin’s Law, either, as it is irresponsible to discuss the ethics of coercive public health policy without engaging eugenics and Nazi science – no, you’re not a Nazi if you like coercive public health policy, but no, we can’t ignore the dangers there, eiter).
There are good reasons to be deeply suspicious of state coercion on the basis of "neutral" scientific consensus that is most assuredly value-laden and in retrospect often turns out to be grievously mistaken. What I would prefer to see, even if you support coercive vaccination, is an acknowledgment of the dangers in treading such a path, as well as the importance of actually engaging and hearing the voices of those upon whom you would visit such coercion.
And if you're not interested in that, and it doesn't sound like you are, then I think Mill would very likely be more comfortable supporting my perspective than yours, given his fears of state oppression.
(Yes, ditto, both on the similarity to usenet and the respect.)
But Daniel, that whole line of reasoning ignores the difference between today and the past, and between the government we have now, in the U.S., and the governments of the past and of -- of all places -- Nazi Germany. We don't have a eugenics policy, and we don't have public health policies that discriminate unduly against immigrants (I say unduly, because, of course, we sometimes do things like quarantines, like any state).
With all due respect, the idea that we should be -- or that it is rational for someone to be -- skeptical of well-intentioned policy based on our best scientific knowledge just because policymakers in the past misused science for wicked ends is a complete abandonment of reason. The cases are profoundly disanalogous. For one thing, there's no ascriptive social category in play here, as there was in those previous cases. You can't generalize from "here's a case where there was reason to be suspicious of the state, because it was making policies that targeted specific, ascriptive, groups of people on the pretext of science," to "we should always be suspicious of lawmaking on the basis of science, even when we're talking about generally applicable laws." The rule of law matters -- it makes a difference that I'm talking about a policy that says "vaccinate everyone" not one that says "vaccinate the Jews." (I never thought I'd say this, but I suggest F.A. Hayek's The Constitution of Liberty on this point.)
I can't emphasize this point strongly enough. To make a generalization from X to Y, you need sufficient similarity between X and Y. That level of similarity depends on the type of generalization, but there's no -- nada -- reason for anyone to believe there's any similarity between the eugenics policies put forth by a less enlightened U.S., or Nazi science, beyond the mere fact that the words "health" and "science" are used in each. For heaven's sake!
Or, if you want to generalize like that, why not generalize still further? Perhaps we can exercise our "moral imaginations" to concieve of the opponents of global warming legislation as being afraid of Nazi eugenics. After all, both are cases of government coercion based on claims about science. And if it's reasonable to suspect all cases of government coercion based on claims about the science of medicine because of Nazi eugenics, why isn't it reasonable to suspect all cases of government coercion based on claims about science in general?
(As for the importance of actually engaging and hearing the voices of those who object -- of course, that's a basic prerequisite of living in a democracy. But the form of engagement and voice hearing should be "let's have a discussion on this legislation, and then vote," not "let me futilely try and convince you that you should believe your doctor instead of your bible/the clerk at the local 'natural foods store' who convinced you that vaccines will make your kid autistic, and if I can't convince you, well, bring the viruses on!" And you have no basis to interpret my disagreeing with them in strong terms as an unwillingness to engage with them in the first way, though I am unwilling to engage with them in the second.)
What I said is that delving deeply into the history of opposition to vaccination is instructive because it demonstrates that, at various times and in various contexts, opposition to vaccination -- like opposition to anesthesia, for example -- was rooted in perfectly plausible accounts.
But that's a non sequitur. Instructive with respect to what? Instructive with respect to the fact of the matter then, yes. But we're talking about the fact of the matter now. Likewise for the dangers of vaccines in the 19th century.
perhaps it might be fruitful to engage the historical narratives and attempt to assess why so many opposed vaccination for so long. If you don't see how such an effort might be relevant to today's context, I'm afraid there's not much more I can say that will convince you.
We might be at that point. Facts give rise to reasons. In the 19th century, there were a variety of facts that gave rise to reason to oppose vaccination policy. I fully accept your claim that those reasons were good ones. But the facts have changed. The facts being changed, the reasons aren't there anymore.
I note you did not say much in response to my point that vaccines actually are by nature dangerous
Walking across the street is dangerous. The question is what is least dangerous. For example, the smallpox vaccine has saved countless millions of lives: the risk would have to be staggering to make it rational to refuse, at least in a world where everyone else is also refusing it. And in a world where others are NOT refusing it, to refuse it yourself/for your children in the face of some danger is to be a free-rider in a collective action problem: everyone would rather that everyone bear the cost of being vaccinated and decline it themselves. And solving collective action problems through coercive force is exactly what the state is for. (Well, one of the things.) Also, being a free rider in that kind of collective action problem is frankly immoral by any reasonable standard -- consider the categorical imperative as an easy one.
I think, Paul, that this discussion is rapidly nearing the end of its usefulness for me, at least in context of blog comments. A different medium might be more productive for me -- I'll be in the S.F. area over the summer; perhaps we can continue this conversation then.
I think it's pretty clear that we differ quite profoundly on our conception of the appropriate model for public health policy, and the wisdom and legitimacy of thinking deeply about why people do what they do -- and on actually engaging them even if we disagree.
Yeah, perhaps that's for the best. Though I really don't think we disagree that profoundly -- I think you're (uncharitably) reading my strong criticism as some kind of exclusion from the democratic process -- interestingly enough, the same mistake that I think Rawlsians make generally: strongly disagreeing with someone does not equal refusing to listen to them.
O... M... G.
Belle.
I've met these guys.
I staffed at their summer camps
(rest of my comment got cut off)
I spent summer of 2003 helping chaperone these tours. I still have the freaking t-shirt.
*mortified*
*yet morbidly amused*
sigh. What a difference 5 years makes.
Commenting by HaloScan
