Liberty and the Childhood Measles Vaccine Controversy

In recent months there has been an ongoing controversy over the measles vaccine and whether it should be legally mandated or not. Public policy on childhood vaccines raises the classic moral conflict between Liberty and Utility. Several other issues contribute to that debate, including: the moral status of children, responsibility of parents, competent research ethics, and role of physicians and other health care professionals in forging public policy.

Vaccines for childhood diseases such as measles, mumps, rubella, influenza provide children with the opportunity to avoid contacting these diseases. Over time, with the advancement of Science, the number of childhood immunization possibilities has increased substantially. The most important public policy issues today include which, if any, vaccines should be voluntary (subject to parental consent) or mandatory (subject to local, state, or federal laws). Although I won't cover the following issues in this blog, we might also question how effective the FDA is at regulating vaccine research, the high cost of vaccinations, and who pays that price and why?

In all Liberty-Utility conflicts libertarians side with "liberty," unless the adult chooser is demonstrably incompetent. If an adult is misinformed by third parties, the mantra is always "buyer beware." That means that we all must be wary of both public and private information (and misinformation) filtered though public and private institutions, including the mass media. In parental decisions involving the welfare of children, libertarians tend to defer decision-making to rational/competent parents over the state and/or the medical profession. They also argue that (in general) any reference to "utility" or the "greater good" tends to mask relationships of power that advance the interests government and/or corporations. Worldwide, the pharmaceutical industry is among the the most profitable, and the most politically powerful. Much of it's power can be traced to it's highly effective marketing strategies and it's generous support of pharma-friendly politicians.

Therefore, libertarian-based public policy on vaccines gives parents the right to decide whether or not to vaccinate their children along with the responsibilities that accompany that decision. Some parents will take this responsibility seriously and look into the scientific research that establishes both safety and effectiveness. Other parents will simply believe what the media and/or other sources say. Authorities might include: governmental institutions like the FDA, religious authorities, and health care authorities, especially physicians.

In the case of the ongoing measles epidemic at schools, libertarian parents reserve the right to send their children to whatever schools they choose. That choice would include public or private schools that require vaccinations and those that do not. If you send your kid to a school that does not mandate vaccinations, and if your child contracts the measles, then you alone must pay the price in terms of time, energy, and resources. If you choose to vaccinate your child and he/she suffers from known (or unknown) side-effects you are also responsible. In the final analysis, the free market will determine whether childhood vaccines are worth the cost.

Before the measles vaccine was invented, measles infected entire schools. Many years ago, I missed a week of school with measles and later with chicken pox and got to stay home and watch daytime TV with my mother. Other kids were hospitalized and some students died,, although I didn't know them. I also contracted the flu every year until the flu vaccine was invented. I haven't had the flu in many years, despite the fact that I have contact with about 300 students a year. Both of my children and my grand daughter were vaccinated for a variety of childhood diseases including measles and influenza. No one forced us. 

                      

Cass R. Sunstein, On Freedom (Princeton University Press: 2019)

Review for

Politics and the Life Sciences.

Cass R. Sunstein, On Freedom (Princeton University Press: 2019)

127 pp. ISBN: 978-0-691-19115-7. Hardcover $12.95.

Ronald F, White, Ph.D., Professor of Philosophy, Mount St. Joseph University.

Areas of Expertise: Social and Political Philosophy, Ethics

Cass R. Sunstein is founder and director of Harvard University’s Program on Behavior Economics and Public Policy. He is also a world-renowned legal scholar, and an extraordinarily prolific author. He is best known as the co-author (with Richard H. Thaler) of the best-selling book Nudge: Improving Decisions about Health, Wealth, and Happiness (2009). Since then, Sunstein has authored and/or co-authored countless journal articles and at least three other books that reiterate, and/or expand upon what Sunstein and Thaler originally referred to as “Libertarian Paternalism.”  Those three books include: Why Nudge: The Politics of Libertarian Paternalism (Yale: 2014), The Ethics of Influence: Government in the Age of Behavioral Science (Cambridge:  2016); and Human Agency and Behavioral Economics: Nudging Fast and Slow (Palgrave MacMillan: 2017). It is noteworthy that these three accounts of Libertarian Paternalism build a common conceptual framework and cover similar ground.  Back in 2018, I contributed to a multi-authored forum for PLS that explored the framework we entitled “Nudge Science.” (White 2018) This review will build upon the conceptual framework explored in those review essays, especially my introductory essay. Henceforth, I’ll refer to the collective content of those four earlier works, as “Nudge Science.”

First of all, it is important to note that On Freedom is a tiny, hard-cover book: 5 x 7 inches with 118 pages of narrative. And like all of Sunstein’s books, it is well-crafted, easy-to- read, interesting, and targets both scholarly and popular audiences. It is priced by Princeton University Press at $12.95 and available at Amazon for $9.58. This review will address two main questions. First, how much of On Freedom elaborates upon and/or recapitulates the conceptual framework previously published in Nudge Science; and how much (if anything) is altogether new and a worthwhile addition to that body of work? Second, in light of these first two answers, who (if anyone) would be interested in this book and what (if anything) would they get out of it?   

Obviously, the title On Freedom is in direct reference to John Stuart Mill’s classic work On Liberty (1859), which is widely regarded as the primary source of anti-paternalism within the Classical Liberal tradition. For Mill and his libertarian followers, legally restricting the liberty of a rational, and competent adult, in order to provide an unwanted benefit and/or prevent self-induced harm is a priori unacceptable. Nudge Science (including On Freedom) revisits that argument and asks the question:  Under what circumstances (if any) can a liberty-loving, self-governed society deploy bans, mandates, and/or nudges to promote/advance the welfare of rational competent adults without their consent? Nudge Science has consistently argued that there is more room for paternalistic intervention within the Classical Liberal tradition than most libertarians are willing to acknowledge.

So how do we go about morally evaluating the ethics of governmental actions? In The Ethics of Influence, Sunstein argued that government actions must be evaluated in light of four, often-conflicting values. That is, by asking whether the action under consideration…”increases welfare, promotes autonomy, respects dignity, and promotes self-government.” (p. 53) On Freedom focuses primarily on the moral conflict between his principles of autonomy (freedom) and welfare conflict (well-being).  Mill and most Classical Liberals argue that individual freedom of choice necessarily promotes human well-being of both individuals and the collective. After all, rational, competent adults would to be the best judge of what will or will not promote our own well-being; and, therefore we be allowed to go our own way, so long as we do not harm others. (p. 3) On Freedom challenges several key aspects of that libertarian argument.  

Nudge Science reexamines freedom of choice in light of the recent findings of social science, namely, that all of our “choices” are influenced (if not determined) by choice architecture, erected by either Mother Nature, and/or by individuals and groups within our socio-political environment. Our vulnerability to the influence of competing choice architects has been enhanced by advancements in behavioral economics, especially the discovery of “behavioral biases” and other fallacies that predispose us to make choices based on pre-determined patterns, including present bias (our natural tendency to pursue our immediate, short-term personal well-being, often at the expense of our long-term well-being. So, whether we are consciously aware of it or not, we are constantly being “nudged,” often by competing choice architects. Not all of those architects seek to advance our personal welfare. Many nudge us one way or another in order to benefit themselves, their family, and/or friends. Sunstein argues that, if all of our choices have been nudged by choice architects, and if many of those nudges are hostile to our welfare, then welfare advancing political nudges are, obviously, morally  preferable to welfare invading nudges.

On Freedom, therefore, argues that under conditions of self-government, the state can (and ought to) nudge us toward advancing our personal welfare. But this raises a number of longstanding libertarian issues. How can well-meaning choice architects know whether their paternalistic interventions will (in fact) advance our well-being?  Sunstein argues that the value of welfare enhancing nudges can only be assessed by the intended beneficiary. But when? Before the benefits are experienced or after? If “after,” how long after?  Thus Sunstein points out that the “as judged by themselves” principle contains hidden complexities. For example, prior to being nudged, drug and alcohol addicts might object to being nudged away from those freedom-reducing addictions, but most of us would not, subsequently, object to having been nudged away from those addictions, and/or having been nudged toward eating healthy foods, exercising regularly, donating our organs, or saving toward retirement.  

So what, if anything, does On Freedom contribute to the lexicon of Nudge Science? Sunstein introduces two innovative features: one is stylistic, the other more substantive. Stylistically, On Freedom is different from his earlier books, in that he employs several expository case studies to reveal hidden complexities. He also uses several illustrative examples drawn from classic literature. His recent interest in drawing upon works of popular culture is reflected in another recent best-selling book, The World According to Star Wars (2016).  Neither of these stylistic innovations are particularly problematic. However, at least some scientists and philosophers will be less-than enthusiastic about his expository references to the arts and humanities.

On Freedom’s more substantive innovation consists in introducing a new set of “navigational metaphors” intended to clarify and/or expand upon his earlier “architectural metaphors.”  As Sunstein put it: “Obstacles to navigability have been the great blind spot in the Western philosophical tradition?” (p.2) Therefore, the over-riding question addressed in On Freedom is whether the institutions of democratic government can effectively help us navigate through the architectural maze of modern life without violating our personal autonomy.  He argues that the effectiveness of our individual pursuit of well-being requires more than freedom of choice. We must also be able to “navigate” our way through an ever-growing maze of architectural variables.

At first glance, Sunstein’s navigational metaphors, such as “navigation” and “navigators,” seem to elucidate Nudge Science. Suppose, based on my own current interests, I decide to take a vacation in Hawaii.  I know where I want to go, but lack the navigational knowledge/skills necessary to get there. Thus, I might willingly choose to employ an airplane pilot, rather than, say a cruise ship pilot. But to what degree does life in general resemble a voyage?  The expanded use of navigational metaphors suggest that life is about “going somewhere,” (either literally or figuratively); that we know where we want to go; and that we willingly employ skilled navigators to help us get there. So far, so good. However, the closer we look at these navigational metaphors, knowledge problems arise.  After all, there are (in fact) more-skilled and less-skilled navigators, and we do not always know how to distinguish between the two. Even if our chosen navigators are (in fact) skilled, we may not know whether they intend to employ their navigational skills in order to advance or undermine our individual welfare and/or the welfare of others.  

Those navigational metaphors begin to break down when various kinds of institutionalized navigators (public/ private) not only nudge us toward our chosen destination, but also surreptitiously choose “where we want to go.” Most of us would not object to be reminded of the likelihood of volcanic activity, in Hawaii, which may or may not influence us to change vacation plans.  But those metaphors irrevocably break down when that navigator possesses the knowledge and ability to surreptitiously “nudge” us toward an alternative destination. To what extent do those navigators violate our autonomy when they nudge us toward that alternative destination, even if it might improve my well-being? Do those actions contradict the very concept of a navigator?   

Sunstein argues that in a democratic society, navigators often violate our autonomy when they employ the coercive power of legally enforced bans and mandates to increase our self-regarding welfare interests. So while coercive bans and mandates can play a role in a liberty-loving society, they must be limited to preventing harm to others. However, according to Sunstein, welfare-enhancing nudges are non-coercive, autonomy-preserving, and morally acceptable.  However, when that navigator violates our autonomy by taking us places where we do not want to go, in order to advance our personal welfare, we might subsequently prefer “by our own lights” that alternative welfare-enhancing destination. Life can be either easy or difficult to navigate, depending on choice architecture that underlies our choices. Helpful choice architecture simplifies navigation. His overall claim is that government can play a role in “nudging” us toward decisions that advance our individual well-being.  

So what, exactly, does the Sunstein’s use of navigational metaphors contribute to Nudge Science? Do those metaphors elucidate or obfuscate the autonomy-welfare conflict? Most Nudge Scholars will agree that, beyond the introduction of those navigational metaphors, there is not a lot of new philosophical analysis and/or research within its pages.  Pundits will question whether mixing those “architectural” and “navigational” metaphors elucidates or obfuscates Nudge Science.    

So despite the fact that some critics will ultimately object to its stylistic and/or substantive innovations, most audiences will appreciate and benefit reading On Freedom. Scholars who are actively engaged in Nudge Science will appreciate it as an up-to-date summary of those four previous works that comprise “Nudge Science.” Social scientists, philosophers, and readers of popular science, who have not yet explored Nudge Science, will certainly benefit from On Freedom, as a concise, well-written, up-to-date introduction. In the final analysis, although this little book really does not break new scholarly ground, it will serve as a brief, inexpensive, and well-crafted summary of the current state of Nudge Science.

References

C. R. Sunstein and R. Thaler, Nudge: Improving Decisions about Health, Wealth, and Happiness (New Haven: Yale University Press, 2008).

C.R. Sunstein, Why Nudge: The Politics of Libertarian Paternalism (New Haven: Yale University Press, 2014).

C.R. Sunstein, The Ethics of Influence: Government in the Age of Behavioral Science. (New York: Cambridge University Press, 2016)

C.R. Sunstein, Human Agency and Behavioral Economics: Nudging Fast and Slow (Switzerland: Palgrave McMillan, 2017).

C.R. Sunstein, The World According to Star Wars (New York: Harper Collins, 2016)

J.S. Mill, On Liberty (Indianapolis, IN: Hackett, 1978), 1859; repr.

R.F. White, Eliah J. White, Charles Kroncke, Edward Sankowski, David Vanderburgh. “Cass R. Sunstein’s “Nudge Science”: Ethics, Influence, and Public Policy” Politics and the Life Sciences, Volume 37, Issue 1, 2018, pp.113-.

R.F. White, “An Introduction to Nudge Science and the Ethics of Influence” (in) R.F. White et.al “Cass R. Sunstein’s “Nudge Science”: Ethics, Influence, and Public Policy” Politics and the Life Sciences, Volume 37, Issue 1, 2018, pp.113-118.