Which has priority, Individual Rights or Collective Needs?
Broadly speaking, we can reframe the inquiry: which has priority - individual rights or collective needs? We must be mindful that we can get different answers depending on the context in which the question arises, and care should be taken to avoid blind adherence to group-think or party platforms, as a position apropos in one area may not be appropriate in another.
For example, in economics, prioritizing individual rights manifests as “capitalism” (defined as private ownership of the means of production), incentivizing individual decisions and rights. By contrast, communism/socialism (public ownership of the means of production) favors the needs of the collective. As any devotee of Ayn Rand and “trickle-down” economists will tell you, supporting and encouraging individual economic endeavors also provides greater resources for the collective and achieves dual ends not obtainable in other modalities.
Prioritizing individual rights, however, may not be appropriate in the public health arena when individual decisions directly harm the populace, for example, during an infectious disease epidemic when refusing to vaccinate (or mask or maintain social distance) fosters transmission, spread, and mortality in the vulnerable, or where the pathogen is so virulent and lethal that transmission bears the potential of decimating an entire society.
The UNESCO Declaration of Bioethics and Human Rights
European Bioethics looks to other paradigms, including the UNESCO Universal Declaration on Bioethics and Human Rights, to resolve health and medical ethical disputes and related legal conflicts. These 27 Articles consider a broader range of ethical and moral principles than the American ethical pillars
At first glance, the UNESCO paradigm seems to favor the individual choices advocated by the medical freedom movement over the needs of society. However, looking more closely, we see that only if the matter involves solely societal concerns will individual rights supersede those of the collective; when other considerations are involved, societal interests may prevail over those of the individual.
“Human dignity, human rights, and fundamental freedoms are to be fully respected. …The interests and welfare of the individual should have priority over the sole interest of science or society.”
– Article 3
The Declaration identifies three additional principles triggered by our public health scenario, which, if applicable, weighs the equation against individual choice: respecting autonomy, which includes respecting the autonomy of others, protecting the vulnerable, and solidarity.
Free Riders and Protecting the Vulnerable
“Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected.”
– Article 8
The epidemiological principle of herd immunity limits the spread of disease; when most are immune, fewer can become infected, and there is less transmission. The percentage of the population that must be vaccinated to protect the “herd” is determined by the pathogen's virulence. With the highly contagious measles virus, for example, the required coverage to achieve herd immunity is 95%; 5% of the population can remain “vaccine-free,” and the disease can still be controlled.
In economics, someone advantaging themselves of a social benefit without commensurate contribution or assuming their fair share of risk is called a “free rider.” Medically vulnerable individuals for whom vaccines are contraindicated by virtue of their health have no choice and cannot be vaccinated. Those are the ones for whom we typically reserve “vaccine-free” status. “Medical freedom fighters” who voluntarily refuse vaccination based on personal choice would be considered, in societal terms, free riders. In bioethical terms, the principle requiring protection of the vulnerable offsets their rights of individual autonomy.
One for All and All for One: Solidarity
Solidarity, the unity of agreement, action, or sentiment as expressed in Article 13, the third of the countervailing forces, is a moral value that unites all members of a population. Today, many Americans don’t value solidarity. Instead, we embrace identity politics, with people defining (and separating) themselves by a narrow parochial status, often as “victims,” resulting in an “us vs. them” mentality. The concept of solidarity attempts to minimize that frisson as the individual must act for all and vice versa. However, as honorable as this sounds, achieving this value accrues at the expense of elevating the collective over the individual, which many find odious.
“In recent years, solidarity has been in retreat, in theory and in practice. In fact, today Solidarity has a quaint, almost archaic ring.” - Professor Michael Sandel
Generally, we see solidarity work in America only when our very existence is threatened, say in war, which generates the principle of patriotism, a type of solidarity. Our challenge is to realize that this principle may be relevant in public health crises. Appreciating that an out-of-control epidemic rivals the threat presented in wartime might convince the individualist that in this situation, foregoing individual rights may be prudent, not just for society’s sake but for the individual’s as well. Indeed, we’ve seen society come together to be vaccinated during the 1947 New York smallpox epidemic, where five million people were immunized over two weeks. Similar cohesion was apparent with vaccination during the polio epidemic, despite the tragic infection of children by a contaminated batch of vaccines.
When considered holistically, the principles of protecting the rights of others, especially the vulnerable, and pursuing the moral imperative of solidarity weighs the equation against allowing “medical freedom” in cases where damage or risk to society is severe, as in an infectious disease epidemic. Yet even here, commonly, solidarity does not accrue the weight that it might deserve in segments of the population.
How do we foster solidarity?
A recent study by scientists at the Weizmann Institute of Science might provide some guidance, especially in light of the Darwinian principles of evolution and survival. If people see the survival benefit solidarity confers, they might consider suspending their individualistic impulses.
Identifying traits or behaviors conferring an evolutionary advantage is often accomplished in observing animals. “For instance, the sweeping and elongated wings of soaring birds like eagles and albatrosses have influenced the design of gliders and long-range airplanes.. to optimize lift and endurance, enabling airplanes to cover vast distances with minimal effort….In contrast, … short and pointed wings of birds like falcons and hawks have inspired fighter jet designs… allow[ing] … quick maneuverability and high-speed flight, essential for aerial combat and evasive maneuvers. ”
Consider the Ant:
Ants and humans consistently cooperate in transporting large loads that greatly exceed their individual abilities. But who can do it better – and why?
Researchers used a large T-shaped object and assigned ants and humans the task of moving the object across a maze. Two mazes were created to match the sizes of the test subjects (animals and humans). No verbal communication (in humans) was allowed.
When one human was pitted against one ant, the human did better. No surprise there. But in the team challenge, the ants, “working strategically and using collective memory to stay on course and avoid mistakes,” outperformed the humans!
According to the researchers, humans “tended to opt for "greedy solutions which were not beneficial in the long term….” akin to the motivation of medical freedom members. By comparison, ‘the ant colony functioned as a family, all members having common interests, [and] … cooperation greatly outweigh[ed] competition.” [emphasis added] The researchers concluded that “the findings … highlight.. the advantages … of cooperation compared to individual effort.”
Medical freedom advocates take note. Solidarity has its place. When it comes to vaccination, you might be better off acting cooperatively and aligning with the collective – for your own sake and society’s. Bioethical analysis agrees.
