Vaccination of individuals lacking capacity during a public health emergency

Dr G. Owen Schaeffer2, Ms Tess Johnson1, Mr Ryan Friets2, Dr Jonathan Pugh1, Dr Sumytra Menon2, Professor Julian Savulescu1

1Oxford Uehiro Centre for Practical Ethics, University Of Oxford, United Kingdom, 2Centre for Biomedical Ethics, National University of Singapore, , Singapore

Imposing medical treatments, including vaccination, on individuals lacking capacity to consent is highly controversial, particularly during the COVID-19 pandemic. The ethical acceptability of vaccinating such individuals has yet to be determined. Thus far, deliberations have been based solely or primarily on individuals’ best interests, where they cannot validly consent. Best interests take into account both in an individual’s past preferences and present wishes, along with medical and other considerations. Whilst an individual’s values may extend to include a public interest in reduced disease burden or disease spread, this is not always the case. Where this is not the case, legal uses of the Mental Capacity Act restrict our consideration of the public interest (the well-being of others) as a relevant factor.  In this paper, we explore whether public interest should indeed feature as an additional ethical consideration decision-makers’ deliberation. Specifically, where an incapacitous individual’s own best interests are not decisive concerning whether to vaccinate, considering a public interest in their vaccination may tip the balance in favour of vaccinating. We illustrate our argument using recent legal cases surrounding individuals’ best interests in not/being vaccinated against COVID-19. An ethical decision-making algorithm is proposed, to show how public interest might be incorporated in deliberation. Our work highlights how different decisions may be reached concerning the vaccination of those lacking capacity during public health emergencies, considering both the individual’s best interests and public interests. We argue this is reasonable when there is only a small individual cost and significant public interest.


Tess Johnson is a DPhil candidate in Philosophy at the Oxford Uehiro Centre for Practical Ethics. Her current research takes a novel public health ethics approach to questions surrounding the pursuit of human genomic enhancement, framing enhancements as potential future public health interventions.

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