exemption Archives - Prindle Institute

Consider two different arguments. The first that it was okay for me to travel in early December, the second that I should be given early access to a COVID vaccine.

My Travel: I understand that traveling was irresponsible in general, and that it was important that people not do so. Had COVID been happening in any other year I would have not traveled at all during the holiday season. But since it was this year, I had good reasons to carve out an exception for myself. First, it was really important for my girlfriend to meet my parents in person before we could get engaged, most people did not have such major life plans put on hold by the inability to travel over the holidays. Second, my grandfather is not doing well and so the consequences of delaying a visit could not be known. Third, this was the first time in six years my parents were back in the states for Christmas. Fourth, my girlfriend and I could take steps to minimize the risk: we drove instead of flying, we could travel in between the Thanksgiving and Christmas rushes, we both got tested before the trip, and I was able to aggressively quarantine the week before traveling.

My Vaccine: While I should not get the vaccine before the elderly, I should get it before it is open to the general public. First, I am teaching an in-person class in the spring and doing so, at least in part, because the state government of Florida is pushing to increase the percentage of college classes taught in-person in the spring. I offered to teach in person to help out, but it seems like the least that the state government could do after I agree to be around (I expect) irresponsible undergraduates is help make sure I have access to a vaccine. Second, I have been extremely aggressive in my social distancing. This means I should get the vaccine early since a) I have already taken on more inconvenience than most to help protect the public good and b) I’m more responsible than most, so I’ll be a larger drain on the economy if I remain unvaccinated. Third, I’m hoping to get married fairly soon, and that is an important life event that should qualify me for some priority.

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I think the first argument is pretty good and the second one pretty bad. I really should not get priority vaccine access, but I think it was OK for me to travel in early December. But what I want to discuss in this post are some of the challenges in identifying when you should be an exception to a general rule.

Each argument tries to make out that I am, in some sense, special. And if you are going to exempt yourself from a rule you think others should generally follow, then you need to provide a compelling explanation for what makes your case unique. This follows from a deep moral principle about the moral equality of persons (one of the principles Immanuel Kant was getting at in his first formulation of the categorical imperative).

Suppose I don’t want to wait in line at the coffee shop. Can I jump the line? No. If ‘not wanting to wait’ was an adequate reason for anyone to cut in line, then everyone would cut in line (since basically no one wants to wait). But if everyone cut in line, then there would no longer be any line at all. My impatient cutting in line relies on the patient waiting of everyone else. But here we bring in our deep moral principle: I am not special, which is to say that if I should get to do something, other people should as well. So if ‘not wanting to wait’ is a good reason for me, it must be a good reason for everyone. Since we have already seen it cannot be a good reason for everyone, we can conclude it is not a good reason for me.

So, if I want to cut in line, then I had better have a special reason to do it — a reason that will not apply to everyone else as well. Suppose I arrive at the hospital with a child suffering an anaphylactic shock. I see there is a long line of people waiting to get their severed thumbs reattached (I’ll leave it to you the reader to explain the sudden epidemic of thumb severings).

Here it is permissible for me to cut in front of people waiting to get their thumbs reattached. It is permissible because my reason for cutting will not generalize. If we changed the case so the line was all other parents with children suffering anaphylaxis, then it would not be permissible to cut (since we would otherwise return to our original problem).

Okay, so to carve out an exception there must be something unique about me. Well, there are things that are fairly unique about me, does that mean I should get to jump the vaccine line? Well no. It was not just that anaphylaxis was different from a severed thumb, it also needed to be more important. A broken leg, just because it is a different injury, would not make it okay to cut in line.

And here we come to a problem. While there are some things unique to me that suggest I should take precedence, basically everyone has some reason why they should be an exception. Sure, I’m hoping to get married but others, who are about to have their first child, will need to spend some time in a hospital and could really use the in-person support of grandparents. Sure, I’m teaching in person, but others are taking (more than one) classes in person. Syndrome was right, if everyone is special, no one is — at least in the sense that if everyone can identify reasons why they should be able to skip to the front of the line, then no one gets to skip.

And indeed, even if I decided I really was more special than others, it is still probably a bad idea to let me jump in line. That is because we, as a general rule, do not want society making thousands of fine-grained decisions comparing every possible special exception. It opens up far too many possibilities for bias and corruption, and besides that, it becomes democratically problematic because it is impossible to adequately articulate the thousands of priority decisions to the citizenry.

Alright, so I should not get to cut the vaccine line.

But what about my choice to visit my parents in early December? I think most people should stay home, but I also really thought I had a better reason to travel than others. Is that enough to justify my exception.

Not quite, there are two complications I need to consider.

First, I need to factor in my biases. Lots of biases may play a role, but let’s just look at an availability bias. I know the details of my life quite well; I do not know the details of yours. Thus even if my case looks more exceptional to me, that might not be because it is, but just because my own specialness is easier to see.

Second, even if I factor in all those biases and still think I’m exceptional, there is a problem with taking that as sufficient to make an exception. That is because I’m not only making a first-order decision, I’m also making a second-order decision. I’m not only deciding that my case is exceptional, I’m also regarding myself as a competent judge to decide on my own exception. This creates a problem because I expect most people are biased, and so if most people decide for themselves whether they should be an exception, far too many will make the wrong choice.

One way to see this problem is to note that others will disagree with me about what is an important reason for an exception. Let’s explain this with an analogy. Something like over 90% of teachers believe they are above average. Now, this might be that teachers are biased (I expect that is likely), but there is another explanation. Perhaps Anne and Barnie are above average lecturers and Chloe and Darius are above average mentors. Anne and Barnie think lecturing is the most important part of teaching (thus why they spent time getting good at lecturing) and Chloe and Darius think mentoring is the most important part of being a good teacher (thus why they invest so much in mentoring students). Here, even if each of them accurately judges how good they are at various teaching techniques, we will still get everyone thinking they are an above average teacher.

Similarly, if everyone decides for themselves whether they should be an exception. We could well end up with many people thinking they are one of only a few who deserve an exception. Not because they are wrong about any of the details, but simply because different people have different priorities. So even if 100% of people think only the 5% of people with the most pressing reasons to travel should travel, you could still easily get 30% or 40% people honestly deciding they fall in the 5%.

Of course, I think my priorities are right. I think I am better at thinking these things through then the average person. But is that enough to let myself treat myself as an exception? Probably not, since I also think that others think their priorities are right, and I expect that others think that they are better than average at thinking these issues through. So the question I am forced to ask is not just, am I better at making decisions, but rather should anyone who thinks they are better at making decisions be allowed to decide for themselves. If my answer to that latter question is no, then it might still be wrong to carve out the exception.

So was I wrong to travel in early December? It is hard to say. On the one hand, I really do think I had a good reason to do so. But on the other hand, I do not think most people should get to carve out their own exceptions just because they think the exception is warranted (of course, maybe it is not actually hard to say but I just do not want to admit I made the wrong choice).

On January 28, 2019, Washington Governor Jay Inslee declared a state of emergency in response to a spreading outbreak of measles in Clark County, WA. Measles is a highly contagious airborne infection caused by a virus in the paramyxovirus family. Before a vaccine was developed in 1963, the disease infected over 3 million people a year in the United States and resulted in 400 to 500 deaths annually. In 2000, thanks to a highly effective vaccination system in the U.S., the measles disease was declared eliminated by the Center for Disease Control. However, measle outbreaks have begun to emerge again in recent years due to a growing number of parents who refuse to vaccinate their children—often falsely claiming that vaccinations are either unsafe of unnecessary. Do parents against vaccinations, also called “anti-vaxxers,” have a legal right to refuse vaccinations for their children even if it means jeopardizing public health?

While the history of the anti-vaccination movement can be traced all the way back to the 1800’s, a study released in 1998 that claimed a false link between the measles vaccinations and autism has fueled much of the contemporary anti-vax fire. Author of the study, British doctor Andrew Wakefield, was found to have been paid by a law board to falsify evidence in support of a litigation case that claimed vaccines had harmed children. The study was formally retracted by its publisher in 2010 and Wakefield lost his licence to practice medicine in Great Britain. Since then, numerous studies (including one released on March 5th, 2019) have failed to find any link between vaccines and autism.

There are legitimate medical reasons to delay or avoid vaccinations, but they are rare. While some doctors have decided to profit off the anti-vax craze by selling false medical exemptions to parents, most who refuse vaccinations for their children do so through non-medical, state-issued means. Most common is an exemption based on “religious beliefs.” Overall, no major world-religion has a theological objection to vaccinations. However, certain offshoots of ‘faith-healing’ denominations, such as Christian Science, reject modern medicine altogether. Some religious fundamentalists also claim that vaccines are unnecessary. Gloria Copeland, an Evangelical Christian minister who sat on the Trump campaign’s evangelical advisory board, claimed in a 2018 video on Facebook that Jesus was the best protection against the flu and people can avoid the disease by repeating “I’ll never have the flu.”

Many states also allow for “philosophical” or “personal” vaccine exemptions that do not require religious backing. Much of the motivation to acquire such exemptions stems from the spread of misinformation on social media sites like YouTube, Facebook, and Pinterest. Ethan Lindenberger, an Ohio teen who chose to get vaccinated against his parents wishes spoke of the necessity in addressing misinformation when he testified before congress on March 4th, 2019. Lindenberger said, “For my mother, her love, affection and care as a parent was used to push an agenda to create a false distress, and these sources which spread misinformation should be the primary concern of the American people.”

Non-medical vaccine exemptions (NMEs) endanger public health by reducing “herd immunity.” No vaccine is 100% effective, but when a population is highly vaccinated it prevents the spread of germs from one person to another—effectively protecting the population. The less vaccinated a population becomes the more susceptible both vaccinated and unvaccinated individuals are to diseases. This is why public schools require vaccinations for children who attend. In 2015, the Second Circuit U.S. Court of Appeals in Manhattan upheld a ruling that students who receive religious exemptions can be kept out of the classroom during a disease outbreak. The court stated, “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or to the latter to ill health or death.”

Proponents of NMEs believe public health should not take precedence over individual liberties and that mandated vaccinations are a threat to personal autonomy. However, in the case of public spaces, such as schools, vaccines are analogous to other government mandated safety measures. Exceeding the speed limit, running a red light, or breaking other rules of the road is illegal when driving because it threatens the safety of others. The famous ‘harm principle’ of British political theorist John Stuart Mill argues that infringing on personal liberties is justifiable when it protects others from harm. Under this principle, vaccination exemptions should be highly restricted since they pose a threat to public health.

Dr. Barbara McAneny, the American Medical Association’s president, argues, “Protecting our communities’ health requires that individuals not be permitted to opt out of immunization solely as a matter of convenience or misinformation.” A 2013 measles outbreak in Brooklyn, New York that infected 58 people was caused by a single unvaccinated child. Such an incident shows that, to keep a population best protected from disease, vaccination exemptions should only be allowed for legitimate medical reasons. While preventing the spread of misinformation is paramount to combating the rising rates of NMEs that are endangering both domestic and global health, the most effective means of reducing communicable disease is to do away with NMEs all together.

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