College Vaccination Mandates do not Violate Medical Ethics


Nathan Nobis PhD

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Tag(s): Legacy post
Topic(s): COVID-19 pandemic Ethics Vaccines

by Nathan Nobis PhD

In a June 14, 2021 opinion essay in the Wall Street Journal, physician-ethicist Aaron Kheriaty and law professor Gerard V. Bradley argue that “University Vaccine Mandates Violate Medical Ethics” (archived version). Their core claim is that requiring college students to be vaccinated for COVID treats these students as “mere means,” using them like “guinea pigs” for the potential benefit of others, and that’s unethical.

As a medical ethicist, I want to explain why college vaccination requirements decidedly do not violate the core principles of medical ethics which include avoiding or lessening harms, promoting benefits, respecting people and their informed and free choices, and promoting justice and fairness. In particular, vaccine requirements do not violate the respect-related requirement to not selfishly “use” and abuse others as “means” for someone else’s benefit. Since false claims on important issues often have dire consequences, it’s important to explain why medical ethics supports vaccinating college students.

Before we get to these authors’ core ethical claim, let’s review what leads up to it. 

First, although a law professor co-wrote the essay, it’s noteworthy that it doesn’t mention anything about the law. Presumably, this is because there’s just nothing illegal about colleges requiring COVID vaccines for their students, faculty, and staff, especially since they will accommodate medical and religious exemptions. But since what’s legal needn’t be ethical and what’s illegal needn’t be unethical, the law wouldn’t settle any ethical issues here anyway. 

Second, the authors call the COVID vaccines “experimental,” but this is misleading and deceptive since the vaccines are “experimental” in current federal regulatory category only. These vaccines have been rigorously tested: they weren’t cooked up in someone’s basement and so nobody knows if they will work. Indeed, they will likely soon enough be placed into the regulatory category of “fully FDA approved” because, in part, they are not experimental, in any medically relevant sense of the term, even now.

But vaccines’ regulatory status is also irrelevant to whether any vaccine mandates are ethical: the government’s categorization of pharmaceuticals doesn’t determine the ethics of their use. If an unregulated substance was determined to safely and effectively wipe out COVID, it would surely be ethical to use it: to deny this is to “steamroll fundamental liberties,” as the authors put it. 

The authors note that some students have had COVID and so will have natural immunity, but they also seem to recognize potential benefits of vaccination even for these students: e.g., people who have had COVID should also get vaccinated since it’s unclear how long natural immunity will last. Vaccines are also useful to protect against the emergence and spread of new variants of the virus.

But what about students who haven’t had COVID? Should they get vaccinated? 

Yes, of course. 

Nevertheless, although some college students become seriously ill or die from COVID, it is recognized that vaccinations are more for the potential benefit of the older and otherwise more vulnerable people the students will be around—their instructors, college staff, and the broader community—who are at greater risk. And surely these people’s interests, perhaps their rights, in lessening these risks should be respected.

For the sake of people at greater risk, should vaccines be required for college students? The authors write:

We don’t immunize children against diseases that primarily harm the elderly in hope of reducing transmission risks for the elderly. That would use the recipients as a means to another[’s] end, which is unethical.

About their first claim, one response is, “Perhaps we should!” But more importantly, their ethical claim here appeals to 18th-century philosopher Immanuel Kant’s influential concept of using someone as a “mere means,” or treating a person as a mere thing to use and abuse for your own purposes. This is widely thought to be wrong since it involves deception or manipulation or otherwise forcing someone to conform to your will, against their will. If you’ve ever treated someone disrespectfully and got the angry response, “You used me!” you are familiar with this concept, which is a, perhaps the, core value of medical ethics.

Are college students used as “mere means” when vaccinations are required? 

Not at all. 

First, they are fully informed here: there’s no deception. They know about COVID and vaccines and are aware from their personal lives that they can’t, say, meet up with their grandparents until their grandparents are vaccinated and that it’s better for their grandparents if their children and grandchildren are vaccinated also.

Are college students forced to get vaccinated by college mandates? Are they coerced

No more than any current vaccination requirements do this. And most students freely choose to comply with these demands since they are low or minimal risk and offer potential benefits for themselves and others. Some students might prefer not getting these vaccinations, but to get what we want we often have to do some things that we’d rather not do. That doesn’t mean we are forced to do those things in any ethically-objectionable ways.

But what if a student really, really, really doesn’t want to get a COVID vaccination? 

If such a student demands a school allow them to return without any proof of COVID protection then, first, they are demanding something that they have no moral right to. No student has a right to go to any particular college; no school violates students’ rights by saying, “For the good of our community, we have these requirements: if you don’t want to comply, you can’t be here.” 

This is true for private colleges and most, if not all, public schools. Some private schools have religious or behavioral (e.g., no drinking alcohol or using tobacco) requirements. Public military colleges have fitness and weight requirements. Requirements like these are not unethical: it’s no disrespectful violation of autonomy to tell students who don’t want to comply, or can’t comply, that they cannot attend. 

This is true even in the unlikely event that a student had no alternative educational options: a religious school with a one-of-a-kind dream program for some students need not admit students who won’t profess that religion, and that’s not wrong. Indeed, a student demanding to go to a particular school sounds like the student using the school as a mere means, basically saying, “You will give me what I want, regardless of your goals for your community!” which is unethical.

Vaccination requirements give students the opportunity to choose to conform to the ethical principle of beneficence or doing good for others. It’s not unethical for colleges to require low-risk, potentially high-benefit beneficence as a condition for being part of their communities. Community service requirements are sometimes presented as a selling point for certain colleges, and vaccinations can be seen as that.

The issues here can be informed by the Biblical parable of the Good Samaritan. This story involved a man, from Samaria, who made a big effort to help a stranger who was in acute need of medical care and shelter. This “Good Samaritan” is taken to be a moral exemplar, since he admirably went above and beyond the call of duty. 

College vaccination requirements don’t demand that students be Good Samaritans: they only require that students be, as philosopher Judith Thomson put it, “minimally decent Samaritans,” who only do what’s morally required and get vaccinated for their own benefit and the potential benefit of anyone they come in contact with. And any requirement to do what’s ethically required is surely ethical: both medical ethics and the Bible agree.

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