What The Harm Principle Says About Vaccination and Healthcare Rationing

33 Pages Posted: 26 May 2022

See all articles by Christopher T. Robertson

Christopher T. Robertson

Boston University; University of Arizona - James E. Rogers College of Law

Date Written: May 25, 2022


Clinical ethicists hold near consensus on the view that healthcare should be provided regardless of patients’ past behaviors. In classic cases, the consensus can be explained by two key rationales – a lack of acute scarcity and the intractability of the facts around those behaviors, which make discrimination on past behavior gratuitous and infeasible to do fairly. Healthcare providers have a duty to help those who can be helped. In contrast, the COVID-19 pandemic suggests the possible recurrence of a very different situation, where a foreseeable acute shortage of healthcare resources means that some cannot be helped. And that shortage is exacerbated by the discrete decision of some to decline a free, safe, and highly effective vaccine, where the facts are clear. In such a future case, if healthcare must be denied to some patients, rationers who ignore vaccination status will become complicit in externalizing the consequences of refusing vaccination onto those who did not refuse. I argue that giving the unvaccinated person healthcare resources that would have otherwise gone to other patients is to wrongfully setback the interests, or harm, those patients. The article considers rejoinders around the voluntariness of the vaccination choice, which impinges both access and information, and how to scale this criterion proportionally with other rationing criteria that serve utility. Ultimately, the article speculates on why there will be some cognitive dissonance under this approach, while upholding a more general solidarity with and concern for all those seeking healthcare.

Funding Information: None to declare.

Conflict of Interests: None to declare.

Keywords: bioethics, health law, health policy

JEL Classification: I18

Suggested Citation

Robertson, Christopher T., What The Harm Principle Says About Vaccination and Healthcare Rationing (May 25, 2022). Journal of Law and Biosciences, Boston Univ. School of Law Research Paper No. 22-11, Available at SSRN: https://ssrn.com/abstract=4117894

Christopher T. Robertson (Contact Author)

Boston University ( email )

765 Commonwealth Avenue
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02215 (Fax)

University of Arizona - James E. Rogers College of Law ( email )

P.O. Box 210176
Tucson, AZ 85721-0176
United States

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