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Late in 2014, news outlets were abuzz with reports of a measles outbreak originating in California’s Disneyland theme park, with the disease ultimately infecting hundreds of people and spreading to several states. This rapid spread of measles was facilitated by lax policies on vaccinations, which enable parents to cite a “personal belief” as a state-sanctioned reason to opt out of vaccinating their children. California has a particularly high rate of exemptions. In some pockets of the state, including Orange County — home to Disneyland — more than 5% of public school kindergarteners do not receive vaccinations because of their parents’ “personal beliefs”.
Vaccination Bill SB 277, which institutes a moratorium on the use of “personal belief” exemptions, recently passed in California’s Senate. Governor Jerry Brown signed the bill into law this morning (June 30th, 2015). California is now one of only three states, including Mississippi and West Virginia, that only permit vaccination exemptions for medical reasons and not "personal beliefs."
Dr. James Colgrove recently met with the Voices in Bioethics team to outline the nuances of vaccination ethics. Dr. Colgrove is a professor of Sociomedical Sciences at the Mailman School of Public Health at Columbia University, where he also serves as the Deputy Chair of the department’s master’s program. He has authored several books on ethical issues in public health administration, with a focus on the politics of persuasion and coercion. We began our conversation with a focus on the recent measles outbreak in California.
Sources cited in this interview include:
Paper on Autism and MMR Vaccine:Jain, Anjali, Jaclyn Marshall, Ami Buikema, Tim Bancroft, Jonathan P. Kelly, Craig J. Newschaffer. “Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism.” Journal of the American Medical Association 313, No 15(2015):1534-1540. doi:10.1001/jama.2015.3077
Paper on Vaccine Exemption:Wang, Eileen, Jessica Clymer, Cecilia Davis-Haynes, Alison Buttenheim. “Nonmedical Exemptions From School Immunization Requirements A Systematic Review.” American Journal of Public Health 104(2014):e62-e84. doi:10.2105/AJPH.2014.302190
Paper on emotional appeals:Nyhan, Brendan, Jason Reifler, Sean Richey, and Gary L. Freedman. “Effective Messages in Vaccine Promotion: A Randomized Trial.” Pediatrics 133, No. 4 (2014):1-8. doi: 10.1542/peds.2013-2365
In the three decades since In re Baby M (1988)—the first legal battle concerning the legitimacy of surrogacy contracts—many states have adopted laws to deal with gestational surrogacy. In New York, it is currently illegal to compensate a woman to bear a child on behalf of commissioning parents.
A new law sponsored by state legislators Amy Paulin and Brad Hoylman could change that. The Child-Parent Security Act (first introduced in the 2013–14 legislative cycle) would allow for intended parents to commission and pay for a surrogate pregnancy. Hoylman himself paid a gestational surrogate in California to bear his daughter Silvia, now three, and he wants to make it easier for prospective parents in New York to do so as well.
The most noteworthy part of the legislation is Section 5A, the part of the bill that deals with compensation for paid gestational surrogates. It reads:
Compensation may be paid to a donor or gestational carrier based on services rendered, expenses that have been or will be incurred, time, and inconvenience. Under no circumstances may compensation be paid to purchase gametes or embryos or to pay for the relinquishment of a parental interest in a child.Recently, Voices in Bioethics editorial staff members Derek Ayeh and Kevin Van Geem sat down with podcast host Rachel Bloom to discuss the ethics of paid gestational surrogacy.
To read the Child-Parent Security Act in its entirety, and to get updates on the status of the bill, please visit:www.nysenate.gov/legislation/bills/2013/s4617
For the case details and philosophical issues at stake in the Baby M matter, please read:Steinbock, Bonnie. “Surrogate Motherhood as Prenatal Adoption.” Journal of Law, Medicine, and Ethics 16, no. 1–2 (1988): 44–50. Doi: 10.1111/j.1748-720X.1988.tb01049.x
For more on how market norms crowd out other moral considerations, including the corruption of human life due to gestational surrogacy contracts, please read:Sandel, Michael J. What Money Can't Buy: The Moral Limits on the Market. New York: Farrar, Straus and Giroux, 2012.
To read Gary Becker and Julio Jorge Elías’ argument in favor of a market for organs, please read:Becker, Gary S. and Julio Jorge Elías. “Introducing Incentives in the Market for Live and Cadaveric Organ Donations.” The Journal of Economic Perspectives 21, no. 3 (Summer 2007): 3–24.
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