In a paper I’ve mentioned here before, Pierre LeMorvan and Barbara Stock discuss a moral dilemma that arises from the ubiquity, in health care, of what they call “the medical learning curve.” The idea is that neophyte health care workers face a learning curve that puts patients at risk: the earlier I am in my career as a health care worker, the less skilled and knowledgeable I’m apt to be, and the more prone to error. The more error-prone I am, the more likely to impose medically dangerous risks on patients. Since health care workers need to practice their knowledge and skills on patients in order to achieve proficiency, this situation is ineliminable, even with the best supervision by more experienced practitioners.
If I’m a neophyte surgeon, for instance, I have to practice surgery on actual patients. Even if I do so under the supervision of a more experienced surgeon, the fact remains that in many or most cases, only one surgeon can actually perform the surgery–by hypothesis, me, the neophyte. The supervisor only steps in if the neophyte makes a mistake or needs help–i.e., at the precise moment when the neophyte has already imposed extra risk on the patient. But the overall medical set-up can’t in principle be controlled in such a way as to eliminate the risks presented by neophytes’ need to master the learning curve in the first-person, in vivo, on actual risk-bearing patients.
As a health care worker, I happened to get the Pfizer-BioNTech COVID-19 vaccine this past Friday. Because we were informed early in the week that it would be available, I was able to overhear maybe a dozen conversations in the hallway or break room among my co-workers about whether or not to get it, and if so, when. Many of the people I overheard or spoke with said that they were willing to get the vaccine, but only after others had first gotten it, the idea being to wait and see whether the first-comers suffered adverse side-effects from the vaccine. In a very clear and explicit way, these would-be latecomers were saying that they wanted to exploit (or more neutrally, rely on) the risk-calculus of the first-comers, using them as experimental vaccine subjects before deciding whether or not to get the vaccine themselves.
At some level, this may well seem morally unproblematic. The first-comers received the vaccine under conditions of explicit, informed consent. We all got several emails explaining the process of getting the vaccine, plus the pros and cons of getting it, along with an account of the knowns and unknowns of getting it. We then received a 5+ page hard copy “Fact Sheet for Recipients and Caregivers” explaining the basics, with links to websites that went into more detail. I read the whole thing through and found it clear, to the point, and unobjectionable. We were also required, more than once, to give explicit, signed consent to get the vaccine (I lost count of how many times it ended up being, but I seem to recall at least three separate occasions).
So it might seem implausible to think that the would-be latecomers were treating the first-comers as mere means: the first-comers were consenting to the vaccine and assuming the risks of getting it; the would-be latecomers were assuming a “watch and wait” posture on that consenting behavior. That may be a case of the one group treating the other as a means, but not as mere means, with informed consent and voluntarily-assumed risk differentiating the one thing from the other. You can’t be treated as a mere means (one might think) if you explicitly consent to being treated a certain way.
Fair enough,* but I do think there’s something at least slightly morally dodgy about the would-be latecomers’ approach. Take the case in which I refuse to take the vaccine because I think the risks of taking it are generally too high. Recall that the vaccine was released for distribution under an Emergency Use Authorization (EUA) that involved a waiver of FDA approval. So the release was a dramatic departure from the usual protocols. Suppose I happen to believe that the usual non-emergency protocols are a necessary condition for a proper assessment of the risks of taking a vaccine (any vaccine), and then infer that vaccines released under EUA waivers are ipso facto overly risky to take.
Notice that what I believe in this case is that I should not get the vaccine because no one should get it: my refusal to get it follows, not from some idiosyncratic fact about me, but from a set of entirely general facts applicable to humans qua humans, or human patients qua patients (or some medically general category broader than “me”). In this case, it seems like there’s something morally problematic about my relying on others’ getting the vaccine, especially if I cheerfully encourage them to take it, while also believing that no one should be taking it. It’s as though I were to say:
Yeah, definitely: take some of that shit that I would never take, so that I can see whether you die or get paralyzed or HIV from it. If you do, I won’t take it; if you don’t, I’ll consider taking it. Meanwhile, I’ll congratulate you for taking it while concealing the fact that I regard you as a human guinea pig of sorts.
If this attitude amounts to moral delinquency, many, many people out there are morally delinquent.
What is the delinquency? How do we characterize it? It probably isn’t a case of treating someone as a mere means. Perhaps it’s an invidious case of exploitation? Or of free-riding? Sort of, but not quite. I can’t think of a term or formulation that perfectly fits the bill. I just know moral trouble when I see it.
I can’t say that I’m all that exercised about this. I find it interesting, but feel little indignation or outrage. You could, after all, plausibly accuse people like me–health care workers facing moderate risk, in First World countries where the vaccine is readily available–of monopolizing the earliest doses of the vaccine. But hell, somebody’s got to get the earliest doses, right? I’m grateful for the fact that one of those people is me. As for guilt, well–that’s not a side-effect I’ve experienced. But I’ll keep you-all posted if I experience any. LOL.
*I say “fair enough” simply for expository purposes, to get from the one topic to the next in the post, but it isn’t really clear to me that consent is a sufficient condition for not treating someone as a mere means. In other words, it seems possible to treat a consenting person as a mere means. At any rate, it seems obvious (to me) that a person can be treated unjustly even if she consents to the mistreatment. But discussing this complication here would have taken me too far afield.
I want to express my gratitude to everyone involved in the production and release of the vaccine, from Pfizer-Biontech down to the Hunterdon Medical Center ER. This post was written solely to express my personal views, and is not intended represent the views of Hunterdon Healthcare, any of its affiliates, or any department or unit within the Hunterdon Healthcare organization (including the HMC OR, where I’m employed).
And no, I’ve suffered no side-effects whatsoever.
Postscript, January 10, 2021: I got the second dose on January 6. No side effects, not even the proverbial “sore arm.”
Policy of Truth 
I think people can differ from one another in their level of risk-aversion (whether in general or with regard to particular types of risk) without any of them being unreasonable. And so someone can prefer to wait for others with a lower degree of risk-aversion to try the risky thing, without any Kantian problem arising.
A related example: Before I was in a serious car accident in 1998, I often didn’t wear a seatbelt; now I always do. I don’t think my earlier conduct was unreasonable; I don’t think my present conduct is unreasonable either. My assessment of the risk level hasn’t changed, but the salience of the risk has.
LikeLiked by 1 person
I don’t quite understand your car accident example. The most natural reading of the example is that you underestimated the risk of serious injury before the accident, then had the accident, then (as a result of the accident) corrected for your earlier underestimation by wearing seatbelts. Not wearing seatbelts seems to me a paradigm case of miscalculation: that you weren’t seriously injured (assuming you weren’t) was just good fortune. Almost everyone has a traffic collision once in their career as a driver, and there is no a priori reason to think that yours will be minor. Not wearing a seatbelt increases the risks of injury in a huge way; wearing one demonstrably reduces them. So the natural reading of your example is one that goes from error to jarring event to behavior expressing a calculation of risk closer to some objective truth about risk.
I grant in principle that there can be other interpretations, but I don’t really see how they would work.
At any rate, the specific case I had in mind is one in which the person has an objective conception of risk, regards a certain activity as objectively too risky, then relies on others’ performing the activity. That does seem somehow wrong. What the person is doing is relying for his own well-being on others’ irrationality. It’s one thing to do that in specifically adversarial contexts, where someone has initiated some kind of hostility toward you, and you look to undermine them by playing to their weaknesses (irrationality being a weakness). But it’s different to exploit the irrationality of others in non-adversarial contexts, like the vaccine one. In Kantian terms, I don’t think you can universalize a maxim that involves reliance on the irrationality of others. In Aristotelianish terms, justice requires us to seek a commonality of interests with others and act on that, not to act on interests specifically conceived as conflicting with the interests of others qua human. But this demand may be misplaced; I’m not sure.
LikeLike
Pingback: Nightcap | Notes On Liberty
And really both the earlier vacciners and the later ones are taking a risk: the early vacciners (is there such a word?) are risking complications from the vaccine. The later ones are risking infections and possible death by catching Covid-19 because they did not take the vaccine. . So both are making a free choice about which risk to incur.
LikeLiked by 1 person
Both the firstcomers and the latecomers are taking a risk, but only the latecomers are using the firstcomers with respect to risk: they are using the firstcomers’ voluntary exposure to risk to figure out whether to take the vaccine; they are also (if the vaccine is available to them) imposing the risk of COVID on others when they have the chance to reduce it. By contrast, the firstcomers aren’t using the latecomers (where “latecomers” refers to those offered the vaccine but refusing to do so).
LikeLike
I do see why you have reservations about this, but I don’t see this as “using” the firstcomers. The latecomers are merely observing the outcomes of the firstcomers who have decided they want to be firstcomers. If the firstcomers have bad side effects, then the latecomers were prudent to wait. If the firstcomers have no side effects and avoid dying from covid, then the latecomers have wasted time in seeking their own protection. They let others get the vaccine that they declined, so they did a good deed for those who are eager to be vaccinated. I am not sure the wary observers of a novel thing are morally compromised. They might have good physical reasons to self-select by being extra cautious. Some people don’t like to fly in airplanes (sardine cans in the sky), but they are hardly using frequent fliers as experiments. They weigh the advantages and disadvantages to them, like everyone else does, and fly only when they decide to.
LikeLiked by 1 person
You make a good point. Wary observation of another person’s voluntary and consenting action isn’t using them, and doesn’t seem wrong, even in the case where the action leads to harm. So perhaps the vast majority of latecomers are doing nothing wrong. But I do think there is something problematic about a very specific sort of case: Suppose I strongly suspect that something is harmful for you, but am not entirely sure, and am curious to know what the effects will be. So I encourage you to do it in the hopes of finding out whether or not it harms you. The stronger my suspicion that it will harm you, the more questionable my motives. Whereas if I am simply agnostic about the probability of harm, and I wait until you get it before I get it, that seems unproblematic.
Your comment clarifies to me that the issue isn’t really firstcomers versus latecomers, per se, but firstcomers versus latecomers with skeptical beliefs about the safety of the vaccine, and cynical motives vis-a-vis the firstcomers. I’m focused on a specific kind of latecomer, not latecomers as such.
Put it this way: imagine that I think that the vaccine is unsafe, and encourage you to take it in order to confirm my belief in its riskiness. That certainly is using you in a morally invidious sense. By contrast, imagine that I think the vaccine is probably safe, but I’m just not ready to take it yet. I then decide to watch warily what happens to you when you take it in the hopes that it will succeed. That seems unproblematic.
My real target is the malevolence involved in encouraging you to take the vaccine while thinking it will fail, not in being a latecomer per se. I might not have seen that clearly but for your comment, so thank you.
LikeLike
I later figured out that the name of the nurse who gave me the shot was Melissa Hanscin.
https://www.nj.com/news/2020/12/cant-stop-us-nj-nurse-says-healthcare-workers-give-it-our-all-all-day-every-day.html
LikeLike
Here’s an exchange I had on Facebook with a Facebook friend, Pamela Olson.
LikeLike
I think the moral hazard comes when people refuse the vaccine and then continue to be more dangerous vectors for the virus. Whatever the reason.
If it was just for their own health / benefit, they could choose to do whatever they wanted and I wouldn’t care. There’s nothing wrong with “wait and see” as long as it doesn’t actively (potentially) hurt others.
LikeLike
You may be right. I have to think about it more. In some ways, I think your point has more bite than mine. (I might have to steal it.) But there is something wrong with thinking the vaccine is risky, then hoping that others take it so that one can confirm that it was risky. “The vaccine causes anaphylaxis, so I hope Pam takes it. That way, when she goes into anaphylaxis, I’ll confirm I was right!” Waiting and seeing is one thing, but my point is waiting and seeing can be done with a sinister intention. And I think it often is. The person in question isn’t doing harm but is half-wishing it so they can be proven right that the vaccine was harmful. That said, your point is clearer and more straightforward.
LikeLike
As far as your point about people *hoping* there will be bad side effects to prove their worldview… I hadn’t even thought of people being that awful in this particular case. I don’t know why not. It is, sadly, completely plausible.
LikeLike
Pingback: Vox Populi: Arguments Against In-Person Schooling | Policy of Truth
Pingback: Public Health Monopoly Meets COVID Booster Shots | Policy of Truth
Pingback: COVID Booster Shot Meets Health Care Monopoly | Policy of Truth