Autonomy vs. Public Health. Gilbert G. Berdine, M.D. Associate Prof. of Medicine, TTUHSC September 18, 2015

Transcription

1 Autonomy vs. Public Health Gilbert G. Berdine, M.D. Associate Prof. of Medicine, TTUHSC September 18, 2015

2 About Me Board CerGfied in Internal Medicine and Pulmonary Diseases PracGGoner of medicine since 1978 Personal experience with Polio vaccine, swine flu vaccine, and current mandates about vaccines for health care workers

3 The QuesGon RESOLVED: When in conflict, an individual's right of self- ought to be valued above public health concerns. AffirmaGve Debate Resource: I think it is a bit difficult to defend the AffirmaGve. NegaGve Debate Resource: debagng on the AffirmaGve will be difficult. My own opinion is that defense of the negagve is IMPOSSIBLE, so here is my contrary viewpoint.

4 Public Health the health of the populagon as a whole, especially as monitored, regulated, and promoted by the state. This is a meaningless definigon. It is not possible, even in theory, to determine the health of an individual since health includes subjecgve values such as pain, sense of well being. Given that it is impossible to determine the health of an individual, it is impossible to determine the health of a populagon. In pracgce, Public Health is an euphemism to jusgfy capricious and arbitrary decisions by government officials.

5 Mandatory Vaccine Polio vaccine was voluntary. No government force was required to distribute the vaccine. Some people are reluctant to accept some newer vaccines. Why? Is the reluctance ragonal? It is argued that force is necessary to protect people from those who are not vaccinated. Does this argument have merit?

6 Vaccine: Theory Exposure to protein leads to an immune response against the protein. Some immune cells retain memory of the exposure and will respond rapidly to re- exposure. If a disease presents the idengcal protein or a similar protein, the previous vaccinagon can lead to a rapid immune response and prevent an infecgon from becoming an illness. A vaccine can contain an infecgon and prevent illness; it cannot possibly prevent infecgon.

7 Polio Polio was a debilitagng disease without any effecgve treatment. The populagon feared polio. The best form of the vaccine was a protein coat that, by itself, had no disease potengal. People feared polio more than they feared the vaccine, so they voluntarily accepted the vaccine.

8 Influenza Flu is for most people a self limited nuisance. Only a small percentage of people with flu get serious illness or die. Past flu vaccines have been deadly, though the government tries to cover up past history. Some people accept the vaccine voluntarily; nobody is against these people having the opgon to be vaccinated. Some people fear the vaccine more than they fear flu. The jusgficagon for mandatory vaccine is that unvaccinated people pose a risk to Public Health.

9 Mandatory Flu Vaccine If the vaccine is 100% effecgve, then an unvaccinated person cannot possibly pose a risk to a vaccinated person. If the vaccine is 0% effecgve, then there is no reason for anyone to accept the vaccine. There must be some magic number for effecgveness where authority can claim benefit to Public Health yet the calculagon is never shown to the public. In effect, the Public Health assumes that the vaccine works only in those who do not want to accept it and fails in those who are willing to take it. As was demonstrated this past year, CDC and other authoriges have no idea what the effecgveness of the vaccine will be ungl ager the fact.

10 Safety or Conformity The State of Texas passed a law requiring health care workers to receive flu vaccine. UMC policy was that anyone who declined the flu vaccine (previous adverse reacgon) was required to wear a mask in the hospital from 11/1/2015 to 4/30/2015. The vaccine was not available ungl 11/6/2015. Only those who declined the vaccine were required to wear a mask from 11/1 11/6. This vaccine was so good that it conferred protecgon for pagents even before it was administered; the regulagons had nothing to do about safety and everything to do about conformity and obedience to authority.

11 Risk of Vaccine There are risks to vaccines even if the risks are small. Vaccines are most accepted for diseases without therapy and with high case fatality rates. Vaccines are less accepted for self- limited diseases with very low case fatality rates. Even small risks of vaccine can lead to greater deaths from the vaccine than the disease due to large populagons vaccinated and low case fatality from the target disease.

12 Measles

13 QuaranGne Consider the Ebola outbreak in Dallas Should suspected Ebola pagents be under quarangne? What if the pagent declines quarangne? This is not a conflict between self determinagon and Public Health. Rather it is an example of how Public Property does not work.

14 QuaranGne Suppose a suspected Ebola pagent knocked on your front door. Would you be required or obligated to let the pagent into your house? Nobody would suggest such a thing. There is no conflict between self determinagon and Public Health on private property. What about the sidewalk or a road? This is why Public Property does not work.

15 Property Rights The owner of something decides how it will be used. Many things can only have one use at a Gme. The quarangne conflict is really a conflict over who owns the public property. The reality is that the government owns the property and the public has zero claim to the property. The government will make a poligcal decision on how to use the property rather than an economic or ethical decision. There is nothing public about public property. It is government property no different from a military base.

16 Mandatory Vaccine and Private Property What if a private nursing home decides that vaccinagon is required for employment? Certainly new workers could be required to agree to vaccinagon, drug screens or other things as a condigon of employment. The prospecgve employee does not have to seek employment at any pargcular private enterprise. Once again, the problem only exists on public property where government mandate makes it impossible for someone to pracgce his trade unless they submit.

17 Obesity Gestapo Let s say, hypothegcally, that sciengsts agree that a certain BMI is bad for your health? Can society force an individual exceeding this BMI to a weight reducgon diet against his will? The argument in favor states that the economic burden to Public Health Care of future disease in an obese individual permits a mandatory diet. As before, this is not a conflict of self determinagon with Public Health. This is a well known economic effect of subsidies; if you subsidize the consequences of obesity, you will see an increase in obesity. The moral solugon is to require people to accept the financial consequences of their own health decisions.

18 QuesGons I hope that you find something useful here in the fortunate event that you must defend the affirmagve posigon. I hope that those in the unenviable posigon of defending the negagve see what you are up against. I will take quesgons on the material or anything else related to the topic. Feel free to e- mail me if you have quesgons.