Social Exclusion of People Who Abstain from Mandatory COVID-19 Vaccination for Medical Reasons: A Contemporary Ethical Conflict

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Published: Jun 30, 2024
DOI: https://doi.org/10.12681/cjp.31650
Keywords:
utilitarianism human rights vaccination hesitancy social exclusion Aristotle’s golden rule
Virginia Grigoriadou
National Technical University of Athens, Greece
https://orcid.org/0000-0002-0940-1922
Sofianna Alifieri
National Technical University of Athens, Greece
https://orcid.org/0009-0003-9196-922X
Sofia Tsagdi
National Technical University of Athens, Greece
https://orcid.org/0000-0002-9515-7283
Maria Balatsou
National Technical University of Athens, Greece
https://orcid.org/0009-0007-6147-8293
Kostas Theologou
National Technical University of Athens, Greece
https://orcid.org/0000-0002-3883-601X
Abstract

The measures of obligatory vaccination against COVID-19 disease in Greece, have failed to cater to people, who for serious medical reasons, were prohibited by their private doctors to be vaccinated. This fact, however, leads to their unwilling social seclusion, since they cannot obtain the vaccination certificate that ensures access to all social activities. They are, therefore, faced with the dilemma of consenting to vaccination, disregarding possible health or even fatal consequences, or social exclusion and isolation. This research study aims to discuss this ethical conflict, between what is considered ethical for society in contrast to restriction of personal will and health. It wishes to rediscover the very essence of the commitment to protecting human rights-health and social well-being. This dilemma will be viewed and examined under the scope of core ethical values and principles met in Hippocrates’ oath and the fundamental ethical theory of Utilitarianism. The study will try, drawing from these ethical theories and definitions, to test these questions and conclude on what the indicative ethical choice is. The study wishes to propose suggestions of measures that can be taken to ensure equal operations for all citizens, based on medical ethics and self-disposition principles. It will also propose actions that should be put in the equation, sensitive groups. We feel that a balanced ethical approach that does not accentuate disparities within and among different groups, could ensure health equality, better social resilience, and commitment to effective prospective preparedness.

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Author Biography
Virginia Grigoriadou , National Technical University of Athens, Greece

Υποψήφια Διδάκτωρ Εθνικού Μετσόβιου Πολυτεχνείου, Σχολή Εφαρμοσμένων Μαθηματικών και Φυσικών Επιστημών, Τομέας Ανθρωπιστικών, Κοινωνικών Επιστημών και Δικαίου

References
Andorno, Roberto, and George Boutlas. “Global Bioethics in the Post-Coronavirus Era: A Discussion with Roberto Andorno.” Conatus - Journal of Philosophy 7, no.1 (2022): 185-200. doi: https://doi.org/10.12681/cjp.27999.
Aristotle. Nicomachean Ethics ΙΙ. Translated by Dimitris Lipourlis. Thessaloniki: Zitros, 2006 [in Greek].
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. Oxford: Oxford University Press, 2001.
Bilanakis, Nikos. Psychiatric Treatment and Human Rights in Greece. Athens: Odysseas, 2004 [in Greek].
Broniatowski, David A., Amelia M. Jamison, SiHua Qi, Lulwah AlKulaib, Tao Chen, Adrian Benton, Sandra C. Quinn, and Mark Dredze. “Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.” American Journal of Public Health 108, no. 10 (2018): 1378-1384. doi: https://doi.org/10.2105/AJPH.2018.304567.
Capurro, Daniel, Kate Cole, Maria I. Echavarría, Jonathan Joe, Tina Neogi, and Anne M. Turner. “The Use of Social Networking Sites for Public Health Practice and Research: A Systematic Review.” Journal of Medical Internet Research 16, no. 3 (2014): 79. doi: https://doi.org/10.2196/jmir.2679.
Davies, Paul, Simon Chapman, and Julie Leask. “Antivaccination Activists on the World Wide Web.” Archives of Disease in Childhood 87, no. 1 (2002): 22-25. doi: https://doi.org/10.1136/adc.87.1.22.
Dragona-Monachou, Myrto. “Ethics and Bioethics.” Science and Society 8 (2015): 1-26 [in Greek].
Dubé, Eve, Dominique Gagnon, Emily Nickels, Stanley Jeram, and Melanie Schuster. “Mapping Vaccine Hesitancy – Country-specific Characteristics of a Global Phenomenon.” Vaccine 32, no. 49 (2014): 6649-6654. doi: https://doi.org/10.1016/j.vaccine.2014.09.039.
Gasparini, Roberto, Donatella Panatto, Piero Luigi Lai, and Daniela Amicizia. “The ‘Urban Myth’ of the Association between Neurological Disorders and Vaccinations.” Journal of Preventive Medicine and Hygiene 56, no. 1 (2015): 1-8.
Goffi, Emmanuel Roberto. “Back to Eudaimonia as a Social Relation: What Does the Covid Crisis Teach Us about Individualism and Its Limits?” Conatus - Journal of Philosophy 7, no. 2 (2022): 105-118. doi: https://doi.org/10.12681/cjp.26698.
Government Gazette. “Emergency Measures for the Protection of Public Health from the Risk of further Spread of the Coronavirus SARS-CoV-2 throughout the Territory for the Period from Thursday, March 4, 2021.” Δ1α/Γ.Π.οικ. 18877/2021 – ΦΕΚ Β΄ 1194/27.03.2021.
Hoffman, Beth L., Elizabeth M. Felter, Kar-Hai Chu, Ariel Shensa, Daria Williams, Rachel Himmel, Riley Wolynn, Chad Hermann, Todd Wolynn, and Brian A. Primack. “The Emerging Landscape of Anti-vaccination Sentiment on Facebook.” Journal of Adolescent Health 64, no. 2 (2019): 95-140. doi: https://doi.org/10.1016/j.jadohealth.2018.10.283.
Holmes, Emily A., Rory C. O’Connor, Hugh Perry, Irene Tracey, Simon Wessely, Louise Arseneault, Clive Ballard, Helen Christensen, Roxane Cohen Silver, Ian Everall, Tamsin Ford, Ann John, Thomas Kabir, Kate King, Ira Madan, Susan Michie, Andrew K Przybylski, Roz Shafran, Angela Sweeney, Carol M Worthman, Lucy Yardley, Katherine Cowan, Claire Cope, Matthew Hotopf, and Ed Bullmore. “Multidisciplinary Research Priorities for the COVID-19 Pandemic: A Call for Action for Mental Health Science.” The Lancet Psychiatry 7, no. 6 (2020): 547-560. doi: https://doi.org/10.1016/S2215-0366(20)30168-1.
Jacobson, Robert M., Jennifer L. St. Sauver, and Lila J. Finney Rutten. “Vaccine Hesitancy.” Mayo Clinic Proceedings 90, no. 11 (2015): 1562-1568. doi: https://doi.org/10.1016/j.mayocp.2015.09.006.
Jarrett, Caitlin, Rose Wilson, Maureen O’Leary, Elisabeth Eckersberger, and Heidi J. Larson. “Strategies for Addressing Vaccine Hesitancy – A Systematic Review.” Vaccine 33, no. 34 (2015): 4180-4190. doi: https://doi.org/10.1016/j.vaccine.2015.04.040.
Kata, Anna. “Anti-vaccine Activists, Web 2.0, and the Postmodern Paradigm – An Overview of Tactics and Tropes Used Online by the Anti-vaccination Movement.” Vaccine 30, no. 25 (2012): 3778-3789. doi: https://doi.org/10.1016/j.vaccine.2011.11.112.
Keelan, Jennifer, Vera Pavri-Garcia, George Tomlinson, and Kumanan Wilson. “YouTube as a Source of Information on Immunization: A Content Analysis.” JAMA 298, no. 21 (2007): 2482-2484. doi: https://doi.org/10.1001/jama.298.21.2482.
Kraut, Richard. “Aristotle’s Ethics.” The Stanford Encyclopedia of Philosophy (Fall 2022 Edition), edited by Edward N. Zalta and Uri Nodelman. https://plato.stanford.edu/archives/fall2022/entries/aristotle-ethics/.
Kuczewski, Mark G. “Ethics in Long-term Care: Are the Principles Different?” Theoretical Medicine and Bioethics 20 (1990): 15-29. doi: https://doi.org/10.1023/A:1009967723214.
Kumar, Dewesh, Rahul Chandra, Medha Mathur, Saurabh Samdariya, and Neelesh Kapoor. “Vaccine Hesitancy: Understanding Better to Address Better.” Israel Journal of Health Policy Research 5, no. 1 (2016): 1-8. doi: https://doi.org/10.1186/s13584-016-0062-y.
Lane, Sarah, Noni E. MacDonald, Melanie Marti, and Laure Dumolard. “Vaccine Hesitancy around the Globe: Analysis of Three Years of WHO/UNICEF Joint Reporting Form Data 2015-2017.” Vaccine 36, no. 26 (2018): 3861-3867. doi: https://doi.org/10.1016/j.vaccine.2018.03.063.
Lipourlis, Dimitrios. Hippocratic Medicine. Athens: Epikendro, 1983 [in Greek].
MacDonald, Noni E. “Vaccine Hesitancy: Definition, Scope, and Determinants.” Vaccine 33, no. 34 (2015): 4161-4164. doi: https://doi.org/10.1016/j.vaccine.2015.04.036.
Marks, Jay W. “Medical Definition of Hippocratic Oath.” https://www.medicinenet.com/hippocratic_oath/definition.htm
Mesch, Gustavo S., and Kent P. Schwirian. “Social and Political Determinants of Vaccine Hesitancy: Lessons Learned from the H1N1 Pandemic of 2009-2010.” American Journal of Infection Control 43, no. 11 (2015): 1161-1165. doi: https://doi.org/10.1016/j.ajic.2015.06.031.
Moorhead, Anne S., Diane E. Hazlett, Laura Harrison, Jennifer K. Carroll, Anthea Irwin, and Ciska Hoving. “A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication.” Journal of Medical Internet Research 15, no. 4 (2013): 85. doi: https://doi.org/10.2196/jmir.1933.
Morgan, William E. “Hippocrates on Ethical Practice Management.” Journal of Chiropractic Humanities 11 (2004): 44-48. doi: https://doi.org/10.1016/S1556-3499(13)60145-X.
Ochoa, Alma G. “Content Attributes of Vaccine Promotion Websites as Compared to Claims Made by Anti-vaccine Groups.” PhD diss., The University of Texas School of Public Health, 2015.
Öncel, Selim, and Müge Alvur. “How Reliable is the Internet for Caregivers on Their Decision to Vaccinate Their Child against Influenza? Results from Googling in Two Languages.” European Journal of Pediatrics 172, no. 3 (2013): 401-404. doi: https://doi.org/10.1007/s00431-012-1889-z.
Paraskevopoulou, Stavroula. “Human Rights and Mental Illness: The Limits of the Freedom of Persons with Mental Illness.” Ethics – Journal of Philosophy no. 12 (2019): 66-74 [in Greek]. doi: https://doi.org/10.12681/ethiki.22779.
Pelegrinis, Theodosios. Medical Ethics. Athens: Ellinika Grammata, 2009 [in Greek].
Pelegrino, Edmund D., Richard J. Hart, Sharon R. Henderson, Stephen E. Loeb, and Gary Edwards. “Relevance and Utility of Courses in Medical Ethics: A Survey of Physicians’ Perceptions.” JAMA 253, no 1 (1985): 49-53. doi: https://doi.org/10.1001/jama.1985.03350250057022.
Pence, Greg. “Virtue Theory.” In A Companion to Ethics, edited by Peter Singer, 249-258. Oxford: Blackwell, 1993.
Pineda, Diego, and Martin G. Myers. “Finding Reliable Information about Vaccines.” Pediatrics 127, no. 1 (2011): 134-137. doi: https://doi.org/10.1542/peds.2010-1722T.
Pogue, Kendall, Jamie L. Jensen, Carter K. Stancil, Daniel G. Ferguson, Savvanah J. Hughes, Emily J. Mello, Ryan Burgess, Bradford K. Berges, Abraham Quaye, and Brian D Poole. “Influences on Attitudes Regarding Potential COVID-19 Vaccination in the United States.” Vaccines 8, no. 4 (2020): 582. doi: https://doi.org/10.3390/vaccines8040582.
Poulis, Ioannis, and Eugenia Vlachou. Bioethics: Ethics and Law in Medical Sciences. Athens: Κonstandaras, 2016 [in Greek].
Rivera, John. “Finding Aristotle’s Golden Mean: Social Justice and Academic Excellence.” The Journal of Education 186, no. 1 (2005): 79-85. doi: https://doi.org/10.1177/002205740618600108.
Sak, Gabriele, Nicola Diviani, Ahmed Allam, and Peter J. Schulz. “Comparing the Quality of Pro- and Anti-vaccination Online Information: A Content Analysis of Vaccination-related Webpages.” BMC Public Health 16, no. 38 (2015): 1-12. doi: https://doi.org/10.1186/s12889-016-2722-9.
Salali, Gul Deniz, and Mete Sefa Uysal. “COVID-19 Vaccine Hesitancy is Associated with Beliefs on the Origin of the Novel Coronavirus in the UK and Turkey.” Psychological Medicine 52, no. 15 (2020): 3750-3752. doi: https://doi.org/10.1017/S0033291720004067.
Savulescu, Julian, and Evangelos D. Protopapadakis. “‘Ehical Minefields’ and the Voice of Common Sense: A Discussion with Julian Savulescu.” Conatus - Journal of Philosophy 4, no 1. (2019): 125-133. doi: https://doi.org/10.12681/cjp.19712.
Shuster, Evelyne. “The Nuremberg Code: Hippocratic Ethics and Human Rights.” The Lancet 351, no. 9107 (1998): 974-977. doi: https://doi.org/10.1016/S0140-6736(00)80046-X.
Stefanopoulos, Theodoros K., Stavros Tsitsiridis, Lena Antzouli, and Kritseli Giota. “Hippocratic Οath.” Anthology of Ancient Greek Literature, https://www.greek-language.gr/digitalResources/ancient_greek/anthology/literature/browse.html?text_id=220 [in Greek].
Taylor, Steven, Caeleigh A. Landry, Michelle M. Paluszek, Rosalind Groenewoud, Geoffrey S. Rachor, and Gordon J. G. Asmundson. “A Proactive Approach for Managing COVID-19: The Importance of Understanding the Motivational Roots of Vaccination Hesitancy for SARS-CoV-2.” Frontiers in Psychology 11 (2020): 57-59. doi: https://doi.org/10.3389/fpsyg.2020.575950.
United Nations. “Universal Declaration of Human Rights.” UN General Assembly 302, no. 2 (1948): 14-25.
Vance, Karl, William Howe, and Robert P. Dellavalle. “Social Internet Sites as a Source of Public Health Information.” Dermatologic Clinics 27, no. 2 (2009): 133-136. doi: https://doi.org/10.1016/j.det.2008.11.010.
Viafora, Corrado. “Toward a Methodology for the Ethical Analysis of Clinical Practice.” Medicine, Health Care and Philosophy 2, no. 3 (1999): 283-297. doi: https://doi.org/10.1023/A:1009909613820.
Ward, Jeremy K., Caroline Alleaume, Patrick Peretti-Watel, Valérie Seror, Sébastien Cortaredona, Odile Launay, and Jocelyn Raude. “The French Public’s Attitudes to a Future COVID-19 Vaccine: The Politicization of a Public Health Issue.” Social Science and Medicine 265 (2020): 113-114. doi: https://doi.org/10.1016/j.socscimed.2020.113414.
World Health Organization. “Addressing Vaccine Hesitancy.” https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes.
Zhou, Yuetong. “Aristotle’s Golden Mean: Vague and Inapplicable?” In Proceedings of the 2nd International Conference on Language, Art and Cultural Exchange, edited by H. Ma, N. W. Lam, M. Ganapathy, and K. Tarigan, 1-5. Amsterdam and Paris: Atlantis Press, 2021.
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