Aaron Kheriaty (Former professor of psychiatry at the UCI School of Medicine and director, medical ethics at UCI Health.)
Commentary
Japan’s ministry of health is taking a sensible, ethical approach to Covid vaccines. They recently labeled the vaccines with a warning about myocarditis and other risks. They also reaffirmed their commitment to adverse event reporting to document potential side-effects.
Japan’s ministry of health states: “Although we encourage all citizens to receive the COVID-19 vaccination, it is not compulsory or mandatory. Vaccination will be given only with the consent of the person to be vaccinated after the information provided.”
Furthermore, they state: “Please get vaccinated of your own decision, understanding both the effectiveness in preventing infectious diseases and the risk of side effects. No vaccination will be given without consent.”
Finally, they clearly state: “Please do not force anyone in your workplace or those who around you to be vaccinated, and do not discriminate against those who have not been vaccinated.”
They also link to a “Human Rights Advice” page that includes instructions for handling any complaints if individuals face vaccine discrimination at work.
Other nations would do well to follow Japan’s lead with this balanced and ethical approach.
This policy appropriately places the responsibility for this healthcare decision with the individual or family.
We can contrast this with the vaccine mandate approach adopted in many other Western nations. The United States provides a case study in the anatomy of medical coercion exercised by a faceless bureaucratic network.
A bureaucracy is an institution that exercises enormous power over you but with no locus of responsibility. This leads to the familiar frustration, often encountered on a small scale at the local DMV, that you can go round in bureaucratic circles trying to troubleshoot problems or rectify unfair practices. No actual person seems to be able to help you get to the bottom of things—even if a well-meaning person sincerely wants to assist you.
Here’s how this dynamic is playing out with coercive vaccine mandates in the United States. The CDC makes vaccine recommendations. But the ethically crucial distinction between a recommendation and mandate immediately collapses when institutions (e.g., a government agency, a business, employer, university, or school) require you to be vaccinated based on the CDC recommendation.
Try to contest the rationality of these mandates, e.g., in federal court, and the mandating institution just points back to CDC recommendation as the rational basis for the mandate. The court will typically agree, deferring to the CDC’s authority on public health. The school, business, etc., thus disclaims responsibility for the decision to mandate the vaccine: “We’re just following CDC recommendations, after all. What can we do?”
But CDC likewise disclaims responsibility: “We don’t make policy; we just make recommendations, after all.”
Meanwhile, the vaccine manufacturer is immune and indemnified from all liability or harm under federal law. No use going to them if their product—a product that you did not freely decide to take—harms you.
You are now dizzy from going round in circles trying to identify the actual decision-maker: it’s impossible to pinpoint the relevant authority. You know that enormous power is being exercised over your body and your health, but with no locus of responsibility for the decision and no liability for the outcomes.
You are thus left with the consequences of a decision that nobody claims to have made. The only certainty is that you did not make the decision and you were not given the choice.
Japan’s policy avoids most of these problems simply placing responsibility for the decision on the individual receiving the intervention, or the parent in the case of a child who is not old enough to consent.
Incidentally, this focus on choice and freedom was somewhat reflected in Japan’s policies throughout the pandemic, which were less stringent that most countries, including those in the United States.
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