Parents of young children are routinely faced with ethical decision making in the course of routine medical care, and the ethics of childhood vaccination are a contentious topic. Every major medical organization in the United States recommends the vaccination of children on a set schedule
that is regularly reviewed and updated based on ongoing research. There are, however, many parents who object to vaccinations. The question for every ethically minded parent must be answered in due time, “Should I vaccinate my child?”
I’m Married to A Physician.
I am married to a licensed family medicine physician. Alison is well credentialed and licensed to practice medicine independently. Most of my medical questions are answered, in depth, by her. After our discussions, I typically go and do some further reading. We fully vaccinate our children, and I will explain, in detail, how we’re ethically able to do so in accordance with our values, morals, and faith.
That being said, I’ve been through the healthcare system as a patient with an unknown diagnosis, and so I fully recognize that the quality of the healthcare that you receive depends largely on the individual in the white coat. I lost four years of my life to undiagnosed migraines as I shuffled from specialist to specialist and endured three hospitalizations. I understand how experiences like this can cause mistrust of medicine, but let me reiterate, the quality of medicine largely depends on the doctor you’re consulting for treatment.
Having also lived through the vigorous, exhausting, and life consuming process that is the training of a physician, I know all too well the total commitment that it takes, and how many just don’t make it through. Four years of medical school involves constant study, preparation, and tests. Those years also include three comprehensive exams, with a fourth during the first year of residency. After medical school comes additional years, three at a minimum, for board certification. Not everyone who starts this journey completes it, so if you do consult with a board certified physician, you should know that they have proven themselves competent in that particular field of medicine, even if it doesn’t feel that way in the moment.
Risks in Medicine
The most common answer in medicine is, “It depends.” I’m often frustrated when Alison gives me that answer, but it’s for good reason. The human body is the most complex organism ever created and the potential for disorder is certain. Like a fingerprint, every body is different and so two patients receiving the exact same treatment may experience two opposite outcomes.
The National Institutes of Health admits that, “no vaccine is perfectly safe or effective.”
That is to be expected, again, because of the uniqueness of each of our bodies.
That being said, the approved and recommended vaccines are so because they have the best potential to be the most efficacious. Medicine is both a science and an art, both of which are researched, reviewed, revised, and honed by respected practitioners and institutions across the globe on an ongoing basis.
When Felicity was born and it was decided that she needed to be admitted to the Neonatal Intensive Care Unit, the attending physician, suspecting a diagnosis but lacking evidentiary support, started her on an aggressive course of antibiotics, just in case she had an undetected infection. There was a risk that she could become permanently deaf as a result of the antibiotics, which are quite hard on newborns. The greater risk was that she had an infection and, without treatment, would die. These are decisions that parents and caregivers must make routinely in medicine. What are the risks of a particular course and are they outweighed by the risks of not following a particular course?
To be sure, the diseases that we vaccinate against are lethal
. We have not experienced them at scale as a society in the modern era because widespread vaccination has resulted in eradication. An outbreak, then, presents a unique danger in that the medical community is part and parcel unexperienced in the practical treatment of these deadly diseases, though they are trained in the theoretical treatment. One needs only to look at the California Measles Outbreak of 2014-2015
to see the reality that an eradicated disease can return with serious consequences.
Vaccinations are not mandated by law. However, that doesn’t mean that parental choice is always respected. In the United States, each state sets out vaccination requirements for public school students
. While not part of the state educational system, most private schools have their own requirements. In this subtle way, parents may be coerced into vaccinating their children in order to utilize the public school system. There’s been a tradition of waivers with which parents can object on religious or personal beliefs, but there are some policymakers who believe that these exemptions are abused. California, Mississippi, and West Virginia currently have no state-wide exemptions to their vaccination requirements
due to religious or personal belief. The trend seems to be in favor of ending all exemptions for students. Philosophically and ethically, taking away parental autonomy in making medical decisions for their children is wrong, and quite frankly, sets a very dangerous precedent.
While parents may or may not face pushback from school districts, many pediatricians opt not to treat unvaccinated patients. This, too, is wrong. It’s not the role of the physician to mandate and overrule parental autonomy, except in rare life and death situations where the courts have spoken. The role of the medical professional is to advise and assist. In these cases, parents should find another pediatrician that they can work with who is willing to advise and respect their final decisions.
The parents have the ultimate agency on behalf of their children. If the parents decide that a medical course of treatment, vaccination or otherwise, should not be pursued, even in the face of strenuous objection, their autonomy must be respected.
The Source of Many Vaccines
There are a number of vaccines today that have been derived from aborted fetal cell lines. As of November 2015, there are 21 vaccines available in the United States and Canada that have aborted fetal cell lines as their source
. Ethically conscious parents who object to abortion should have grave concern over this reality.
What’s in A Vaccine?
Vaccines are highly regulated, carefully manufactured, peer and government reviewed, clinically tested formulations intended to prevent the spread of dangerous communicable diseases. They are composed of chemical and organic matter which, in concert, can reasonably prevent a patient from becoming ill or dying from a particular illness. After a vaccine is approved, it is continually monitored
and studied to ensure safety.
There are two kinds of vaccines, one has a live but weakened virus and the other has broken down parts of the virus or bacteria. By introducing the virus to the body in a controlled environment, the immune system can learn how to defeat that particular virus on a small scale, and remember it for the future. As a nerdy analogy, it’s like playing Super Mario and beating the big boss for the first time. You remember how you beat the boss, so the next time you play the game, you win handedly. In the same way, the virus is defeated by the immune system, which stores that information for next time.
There is concern about the chemical component of the vaccines. The chemicals serve three general purposes
, as a suspending fluid, a preservative and stabilizer, and as an enhancer to increase the effectiveness of a vaccine. The Centers for Disease Control notes that the addition of these chemicals is necessary in order to maintain the vaccination’s potency, sterility, and safety and that the amount added is “minute.”
These chemicals are FDA approved, food-grade chemicals that serve a very specific purpose. The CDC has published an entire list of chemicals contained in all of the vaccines
that are on the market today.
Vaccines Derived from Aborted Humans
To say that a vaccine was derived from an aborted cell line sounds both clinical and perhaps even a bit benign. What does it mean and why should it be concerning?
Modern vaccines, those developed since the 1960s, have been developed from cells taken from two aborted humans. Researchers, after the abortions were performed, obtained parental consent to use the human remains for medical research. They extracted cells and cultured them in order to grow organic material. It's important to note that vaccines that we use today are derived from cells from these two aborted persons alone, which is to say that abortions are not being used today, or at scale, for vaccination research and production.
What does it mean to say that certain vaccines are developed from aborted cell lines? A cell line is a sort of molecular genealogy. I started, as you did, as a single totipotent cell. As that cell divided, and over the course of my life as cells have broken down, new cells have formed. The cells that make up my body today are of the same “cell line,” in that they can all be traced back to the same original cell. The vaccines that are being manufacturing today are grown using tissue from aborted cell lines. Again, abortions being performed today are not necessary for the continued production of vaccinations.
The bioethical concerns of vaccinating children stems from the tainted research done in order to develop these vaccines. It is solely because the source of research were the remains of aborted humans that we have a bioethical concern. Had the vaccinations been developed from humans who suffered from spontaneous abortion (commonly referred to as a miscarriage), there would be no ethical issues. In this case, there was the proper consent of the parents, the proper treatment of the remains, but unfortunately, the cause of death was unethical, thus tainting the results.
There is some concern among the general public about the possibility of some of the DNA from these aborted human embryos ending up in the patient through the vaccine. According to Dr. Paul Offit, the chief of infectious disease at Children’s Hospital of Philadelphia and co-inventor of the rotavirus vaccine, it is unlikely due to the weakness of the DNA structure that is destroyed in the manufacturing process and the fact that, “DNA from the vaccine is not able to incorporate itself into the cellular DNA.”
As an analogy, I’ve never opened an orange and found tree bark. The organic matter that is harvested from the aborted fetal cell lines makes up the “fruit” while the aborted fetal cell line itself, “the tree,” remains, producing more organic matter. This callous example is repugnant and disregards the dignity of the human person, but it is meant purely to be illustrative.
While a good has been derived from the morally illicit act of abortion, that does not negate the evil that has occurred. The ends do not justify the means. These human persons were denied a suitable environment and nutrition, their lives were electively and willfully ended at the very beginning. Their parents did give the proper consent for the research that was undertaken. Taking the cells from their remains and using them for scientific research is akin to harvesting human organs from a recently deceased person who consented to donate them. This parallel alone is what makes this question grey in the remotest possible sense. In both cases, consenting authorities granted the use of the remains for scientific purposes, the only difference being the manner and morality of the cause of death.
If the vaccines were being derived from a human embryo which was scientifically being prevented from either growing or dying, there would be no possible ethical way for any person of conscience to use that particular vaccine. In the same way, if the development of these vaccines required a steady supply of aborted human tissue, there would be no morally licit way of using any vaccine. The fact that the vaccines are derived from two aborted persons over 50 years ago presents the smallest of ethical openings in which we can search for an ethical way to vaccinate our children.
Thankfully, there are readily available ethical alternatives to most of the 21 vaccines
that are derived from the aborted fetal cell lines. These alternatives are just as regulated and just as efficacious, but instead of being derived from aborted embryos, they are derived from a variety of sources including monkeys, hen eggs, yeast, and, interestingly, tobacco. These alternative vaccines are morally and ethically licit.
In five of the 21 vaccines, there are no ethical alternatives. In routine childhood vaccinations, the ones that parents should be concerned about are the chickenpox, Hepatitis A, and the chickenpox & MMR combined vaccines. There is no ethical alternative for the Hepatitis A vaccine in the United States and Canada, but there is one available in Asia and Europe.
Principles of Double Effect and Subsidiarity
Now that the medical facts have been firmly established, we can seek to answer our question. I believe that two ethical principles are at play in this parental decision, which must be studied and decided upon by both parents.
St. Thomas Aquinas is credited with the development of the principle of double effect
. In short, if an action has two possible consequences, it is permissible to choose with the intention of achieving the good consequence of an action even if there will also be a negative consequence. Consider this example. As we approached the births of both of our children, I recognized there is a risk in childbirth is that complications may result in Alison's and/or the child's death. We have great maternal saints in the Church, most recently St. Gianna
, who gave her life in childbirth in order to save the life of her child. I knew that there was the possibility that I might need to make a medical decision that would have serious consequences. Say, for example, there was a complication and Alison needed an emergency procedure that would save the life of our child, but could possibly put hers in peril. The alternative, do nothing, would result in both Alison and our child dying. If I chose to allow the procedure to be performed with the intention of saving both lives, but as a result Alison did not survive, that would still be a morally licit decision. The principle of double effect applies because I chose with the intention of saving both mother and child, but in this case, heartbreakingly only the child survived. Thankfully, I was not put in this position and all of us are home and happy!
When a parent chooses to have their child vaccinated with a vaccine derived from an aborted human, in the cases where there is no ethical alternative, they intend to protect the life of their child from a lethal illness and they do not intend the death by elective abortion of the human from which the vaccine was derived. The principle of double effect applies, and the parent’s action is morally and ethically licit in this case.
The principle of subsidiarity
is unique in Catholic thinking, and it holds that in a community, results are best achieved from the bottom up. This principle would state that the community should not wait for a government program to solve local homelessness, but rather on a local level, they should solve the problem in their own community by pooling resources. In the same way, since there are currently no ethically derived alternatives for five types of immunizations in the United States and Canada, it’s the moral imperative of parents and people of conscience to advocate for and demand the creation of these ethical alternatives. It should be noted that the Ebola vaccine, which is currently in development, has an ethical alternative. Happily, there's also a new ethical vaccine for Shingles in development. Pharmaceutical companies largely operate in the free market, and so when the market demands these alternatives, they will be developed. The principle of subsidiarity applies here because we cannot simply wait for executives or governments to decide to pursue these vaccines in new research. We must demand them from the consumer level.
Moral Culpability of Using Vaccines Derived from Aborted Cell Lines
The organization Children of God for Life
is an active proponent among people of faith for the vaccination of their children. In 2003, they wrote to then Cardinal Joseph Ratzinger, who would become Pope Benedict XVI, and the Congregation for the Doctrine of Faith asking for clarification on whether or not Catholics could, in the course of practicing their faith, use vaccinations for which there were no ethical alternatives. Two years later, the Congregation responded.
In a study titled “Moral Reflections on Vaccines Prepared from Cells Derived from Aborted Human Fetuses,”
the ethicists and moral theologians held that indeed, Catholics can in good conscience vaccinate their children using vaccines derived from aborted humans in cases in which there are no ethical alternatives. In doing so, the parents participate in the remotest possible way in the abortion, but their culpability in this participation is outweighed by their grave responsibility to protect the lives of their children and those who may come into contact with their children. Said another way, the risk of causing the death of their child or someone else outweighs the responsibility that the parents bear for using the proceeds of an abortion, the unjust taking of a human life. This is particularly so because the parent seeking the vaccination had no involvement in the choice to solicit the elective abortion, nor would the parent have chosen abortion in those circumstances.
The bishops also note, again, that we have a responsibility to advocate for the development of ethical vaccinations.
Catholics, and indeed all ethically minded parents, can ethically vaccinate their children with the five vaccines for which there are no ethical alternatives in good faith and without troubling their conscience, so long as they advocate for the development of ethical alternatives.
Talking to Your Doctor about Vaccination
When your child is due for vaccinations, print out the list of ethical alternative vaccines
and discuss them with your healthcare provider. Healthcare is all about communication. Explain to the provider that you object to the use of vaccines developed from the aborted fetal cell lines, and that you would like to use the ethical alternatives listed on the chart. In my experience, the vaccines that are usually given are unethical, but the office typically stocks, or can readily order, the ethical alternative for your child. A follow-up appointment in a few days, or a referral to the local health department may be required.
Most importantly, verify with the nurse administering the vaccine that it is, in fact, the proper ethical alternative. Sometimes information gets missed or isn’t passed along, and so, as the parent, you need to ensure that the vaccine is the correct one.
Vaccination is extremely important and is a serious matter to consider; even more important is the ethical vaccination of your child. Review the facts, discuss with your spouse, evaluate the risks against the latest research, and decide together on the course of action. Medical research can vary widely and a single study is not sufficient for decision making. Instead, consider the entire body of research before reaching a conclusion.
Parents can protect the lives of their children and those whom they come into contact with by choosing to vaccinate in an ethical way.