An Ethical Evaluation of Mandates

Within bioethics, four principles of descending importance are discussed when weighing risks and benefits of a proposed intervention. These four principles are:

Autonomy, beneficence, nonmaleficence, and justice.

Autonomy speaks to your ability to make your own health decisions, and supersedes all other principles on this list. We as a society have shifted so much towards autonomy that we allow schizophrenics to create third world conditions in our cities, because forcing them into mental hospitals to provide treatment for them could override their autonomy. Does this level of autonomy correlate with the autonomy given to Americans regarding Covid vaccines? Not even close.

Beneficence speaks to the potential benefits an intervention provides. Answers regarding how efficacious our Covid vaccines perform in real life would speak to beneficence. In my medical opinion, the vaccines seem to help prevent serious complications and hospitalizations. However, the timeline of this efficacy, and whether or not there is any gained benefit to patients with natural immunity, remains unconvincing to me. These important pieces of information will continue to elude me, since asking questions regarding vaccine efficacy puts both my license and board certification at risk. If you are doubtful on this point, please look up the ABIM joint statement on misinformation, and understand that punishment for misinformation only goes one way -if you accidentally make false statements that support vaccine efficacy you will not be punished (see NEJM preliminary report for vaccines on pregnant persons).

Nonmaleficence is a strong counterweight to beneficence -does this intervention cause harm? This speaks to the risks of the vaccines. Why would Nordic countries restrict the Moderna vaccine? They believe that the small risk of cardiac complications outweighs the potential benefits of the vaccine, especially in these early stages when the risks and benefits are not exactly clear.

As in the fog of war, Americans have been baptized in the fog of medicine; where diseases and interventions have murky knowledge, and presentation of data is filtered through compromised media sources. Do you believe NEJM or JAMA is almost becoming as contentious as whether you watch Fox News or MSNBC? In the past, the FDA has prided itself on its ability to withstand political pressure to green light new therapies because of how they initially treated thalidomide. The FDA knew about the fog of medicine, which clears over time and allows for data to leak out when you are not an early adopter. Back when thalidomide came out, the FDA dragged their feet and watched as complications rolled in from other countries regarding serious fetal abnormalities. Yet the FDA has moved with light speed on the applications of Covid vaccines, and for the majority of these vaccines we are still talking about emergency use authorization.

How clear is the risk for these vaccines? I posit that the risks are not fully clear from the fog of medicine yet, and that when evaluating risks, you should err on the side of caution. That would be the moral position.

However for many people, Justice overrides potential reservations that I might have. In speaking with my colleagues who understand that there are tangible risks associated with the vaccine and that the efficacy may not last very long (hence potential need for ongoing boosters), they truly believe that the ‘few broken eggs to make the omelet’ are necessary.

Personally, I do not believe the burden to override autonomy has been met for these vaccines, and the honest discussion I have with my colleagues regarding how many eggs will be broken to make this unappetizing omelet are not reflected by the discussions in our media. According to the media, the vaccines are fully efficacious, (thereby creating some cognitive dissonance for the reasons behind boosters) and the risks are minuscule. Questioning risks becomes tarred with misinformation and is relegated to political disagreements, only to be discussed on political shows such as Tucker Carlson, though never in an honest medical discussion.

One more worrisome consideration that has become clear: our elites have already made up their minds on these issues. Even when the fog of medicine has cleared, it does not seem to change anything, and the narrative rolls along without even a speed bump. Did FDA officials resign because of political pressure? It appears so, yet the media cannot even agree on that because to do so raises the question of political interference at the FDA.

Does anyone seriously believe that there is NOT political intervention at the FDA? When Trump was pushing the FDA to rush vaccines it was presented by the narrative as yet another fault of Trump and reason for removal. Yet the evidence seems clear that there is no change of direction from the Biden administration to slow down vaccine approval.

Objective analysis of Autonomy, beneficence, nonmaleficence and justice would lean towards waiting for the fog of medicine to clear, and eliminating political interference. That would be best for Americans, and best for restoring the trust in our medical profession. Best case scenario would be avoiding thalidomide complications. Worst case scenario would be widespread natural immunity like India.

On a national scale, I am pessimistic about these issues, yet on a micro level these nuanced discussions have already helped many Americans make decisions regarding their healthcare.

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