Compulsory child vaccination and the conscientious objection business

Ontario’s health minister Deb Matthews announced this week that she is adding three further diseases to the list of illnesses against which children in the province must be vaccinated. It’s mandatory. Her move has been widely lauded by public health experts and medical ethicists. We have seen in recent months outbreaks of preventable illnesses in communities with unusually low vaccination rates. You might recall the most recent outbreak of measles in BC’s Fraser Valley where more than 200 children came down with the measles. The situation seems directly linked to a community objecting to vaccines on religious grounds. Don’t think of measles as a harmless kind of infection. More than 100.000 children die each year worldwide of this entirely preventable disease.

Why on earth would parents not wish to protect their children against a serious infectious but preventable disease? Well, some parents likely will simply forget, or think that it’s not that important. After all, if we have herd immunity you can with reasonable confidence become a non-vaccinated free-rider on your responsibly vaccinated fellow citizens. However, if lots of us choose to become such free-riders the risk of a disease outbreak increases quite dramatically. It’s simple maths really. In any case, it is probably fair to say that not getting your children vaccinated simply because you were too lazy or too selfish, aren’t terribly good ethical justifications for your omission to get your kids vaccinated.

Another possibility is that you belong to those misguided parents out there who have decided, typically based on conspiracy websites that I won’t even be mentioning here, that vaccines do all kinds of evil things and really you mean to protect your child from these evils. No doubt you’ll mention autism as an example of the evils caused by vaccines. Well, let me just tell you that the only peer reviewed research output supporting these claims has since been withdrawn by the journal that published it initially. The researcher who wrote the piece was found guilty of misconduct by a statutory medical council. Shown to be a fraudster he was barred from ever practicing medicine again in Britain. He still remains the posterboy of current-day anti-vaccine activists. What better hero than a medical researcher ‘censored’ by the ‘establishment’. In light of this, to my mind, it makes perfect sense for governments to protect children from parents prone to listening to conspiracy theorists. This is so because if you choose to run with the views of one convicted fraudster against the rest of the biomedical and public health research establishment you haven’t quite done your due diligence. It is that simple.

Let’s assume you’re neither too lazy to have your kids vaccinated nor prone to buying into, however ludicrous, conspiracy theories. What’s left? Funny enough, there is a reason left to you that our health minister (no doubt based on good legal advice) thinks is an acceptable reason. Deb Matthews notes that it could be acceptable for you to object on grounds of conscience, or, as she describes it: religious or philosophical reasons. Fair enough, you need to make your case and apply for an exemption. But, what kind of religious reason could that be? That your god kind of had it in for your kids and that if they catch the measles (and pass them on), it’s ‘God’s will’? Or is the idea that because your imaginary friend in the sky is defined as ‘perfect’ by you, and that that perfect being would not create us as anything other than perfect. So, why bother with vaccines then? Is that it?

I’m flabbergasted about the tolerance we show toward folks objecting – against all the available evidence – to the compulsory vaccination of their children on religious grounds. They are not only risking their children’s health, they are also risking other people’s children’s health. There are always kids who suffer from a weakened immune system or who suffer from illnesses (such as cancer) that do not permit us to vaccinate them. They are put at grave risk by conscientiously objecting anti-vaccine parents.

What’s bothersome here is that, as a society, we ultimately prioritize the value of the parents’ religious convictions over their children’s well-being. I cannot see how that could possibly be ethically defended. Are we really saying that people’s clearly mistaken views about the universe matter more than the well-being of their children – and, indeed, that of other children? That’s what Minister Matthews’ religious and philosophical exemption clause ultimately boils down to. It is one thing to permit legally competent adults to make such choices for themselves, provided they are the only ones seriously affected by the consequences of their actions. Adult Jehovah’s Witnesses come to mind. If they wish to refuse life-preserving blood transfusions and bet on their imaginary friend in the sky, we should respect their choices, however, if they wish to place that bet for their vulnerable children, then surely society needs to step in and protect those children. The same holds true for children whose health is gambled with by their anti-vaccine parents. We should not tolerate religious cop-outs anymore than we tolerate parental convictions based on nonsensical conspiracy theories. Irresponsible parental conduct that is putting their children’s well-being at risk does not deserve societal accommodation.

Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

Why tax funding for Catholic schools is wrong

This week's column in the Kingston Whig-Standard.

Ontario doesn’t have just one publicly funded school system. We actually afford ourselves the luxury of a public school system and a taxpayer-funded sectarian school system, namely a Catholic school system. The reasons for this are historical, and they are well known. The Confederation pact included a deal that guaranteed the Catholic minority in Ontario a publicly funded school system. It was defended at the time as a means to ensure religious freedom for the Catholic minority in the province.

The reality is that genuine freedom of conscience — as opposed to mere religious freedom — can only be sensibly guaranteed in a society operating a strict separation of state and church(es). The state has no business in funding or subsidizing sectarian educational outlets, hospitals and other institutions. If a religious organization wishes to run its own school or hospital, well, it should put up the cash for it or go away if it is unable to find it. It cannot be that in the 21st century huge amounts of scarce tax monies are provided to religious, ideological educational outfits that preach values that contradict what modern Canada stands for in the world. On anything from reproductive rights to end-of-life issues to marriage equality, the Catholic Church consistently finds itself not only on the wrong side of history, but it also propagates views that the majority of us don’t share. And that is putting it mildly. The very nature of Catholic ideology puts it at loggerheads with anti-discrimination legislation in the province. I am sure you have not forgotten, either, how Catholic school boards across Canada tried to prevent girls in their schools from getting access to the cervical cancer preventing HPV vaccine. The usual Catholic hangups about sex came in the way of protecting girls efficiently from cervical cancer. That kind of nonsense is what our tax monies provide financial backing for in Ontario.

A promotional video produced by Ontario’s Catholic schools has been making the rounds on the Internet during the last few weeks. It features a bunch of students, parents and teachers working in these schools, praising their superior moral education. A lot has rightly been made of the fact that this video implicitly claims to provide a superior education due to the religious values it transmits to its students. Religious organizations, and the Catholic Church is not a unique case here, have always had a keen interest in getting their hands on children. Long-term survival of these ideologies depends on being able to indoctrinate young people at an early age, while they are still impressionable. Despite claims to the contrary by the Ontario Catholic schools that used this video to promote themselves to prospective students and their parents, it is clear that their proposition is that not only are their schools better, but also that their graduates are better human beings courtesy of their ideological religious indoctrination. This is surely offensive to anyone who went to a public school who doesn’t share these particular sectarian values — that would be most of us.

You cannot help but marvel at the guts these marketers of all things Catholic clearly possess. There they are, representatives of an organization whose senior staff spent decades protecting child-molesting pedophiles among its staff across the globe. The German historian Karlheinz Deschner produced a 10-volume opus magnum dedicated to the criminal history of the Roman Catholic Church. Bits and pieces of his detective work are available in English translations, I do recommend them to your attention if you are interested in this issue at all. Even if only half of the horrors he documents in those volumes are true reflections of what actually happened, there can be no doubt at all that the Catholic Church and its representatives should really spend more time reflecting on their own organizational misconduct than on telling us how we ought to live our lives. We certainly should not deliver our children into their schools, and we certainly should not provide tax monies to them in order to ensure the indoctrination of future generations of children with this particular ideology.

The United Nations Human Rights Commission (www.cbc.ca/ontariovotes2007/features/features-faith.html) reportedly agreed in 1999 that Ontario’s exclusive funding for Catholic schools and no funding for other religious organizations’ educational outfits discriminates unfairly against non-Catholics. That said, the situation is worse than it looks. Catholic schools actively discriminate against non-Catholic teachers for employment purposes — using our tax monies to do so — while Catholic teachers are, of course, welcome in our public system. The result is a significant overrepresentation of Catholic educators in the school system.

Sectarian schools are divisive. The video I mentioned earlier features a number of students clearly feeling superior over their public school counterparts, because of the Catholic values that they have internalized courtesy of years of indoctrination. What they ought to have learned is that there is a variety of competing religious ideologies, what these ideologies preach, what their histories are, and so on and so forth. What they shouldn’t have been taught year after year after year is that a particular ideology is true. Cohesive societies are impossible to build under such circumstances. It is obviously unjust to financially privilege Catholic schools only. Seemingly, the Roman Catholic Church sees nothing quite wrong with being in such a privileged situation. It’s this understanding of morality, of course, that has given this particular church such a bad reputation in most developed nations. And don’t take my word for it, the last leader of the church, Pope Benedict (www.dailymail.co.uk/news/article-2041638/Pope-admits-questionable-reputation-Catholic-church-final-day-Germany.html) conceded that the church these days has a “questionable reputation.”

Konrad Yakabuski, in a www.theglobeandmail.com/globe-debate/chapter-and-verse-catholic-school-fundings-unfair/article16462714/ commentary penned for Toronto’s Globe and Mail newspaper, argued this week that public funding for Catholic schools in Ontario ought to end. We should have a debate in Ontario about a school system that we clearly cannot afford any longer and that surely is not fit for purpose. We face declining enrolments, a result of our changing demographics, yet we continue to run a school system that was conceived in very different times indeed. It is time to end public funding for Catholic schools. The majority of Ontarians agree. Consistently, opinion polls indicate that the majority of us want to see public funding for Catholic schools gone sooner rather than later.

Udo Schuklenk is a philosophy professor at Queen’s University, his most recent book is “50 Great Myths About Atheism” (co-authored with Russell Blackford, Wiley-Blackwell 2013). He tweets @schuklenk.

Against taxpayer funded access to IVF services

This weekend's column in the Kingston Whig-Standard, on IVF funding and adoption.

More than a few of my friends, colleagues and even family members think I am wrong on the issue of in vitro fertilization (IVF) funding for infertile couples.

For the life of me I cannot see what interest the state should have in paying significant amounts of money to satisfy some people’s interest in having their own genetically-linked children. I do understand that some people want to have a child that is biologically linked to them. I think the desire is irrational, but evolutionary pressures probably explain this drive to get hold of their ‘own’ child as opposed to opting for an adoptive kid.

My objection to IVF is not religiously motivated. Regular readers of this column will know that I am as secular in approaching ethical issues as they come. So I don’t care strongly about how babies are made, whether it’s by sexual intercourse, IVF, or any number of other means, including reproductive human cloning when that comes eventually about. My argument is not about prohibiting access to IVF. I am concerned about ongoing discussions – even court cases – aimed at getting taxpayers to pay for this sort of thing through our public health care system. In Canada, health care being a provincial matter, we see very different approaches. Wealthier provinces such as Quebec – just kidding – pay for IVF treatment cycles while poorer provinces such as Ontario have chosen not to. Well, who is right?

Given that the question is whether the public health care system ought to provide free-to-user IVF treatment cycles, it’s worth asking: is infertility a disease? I guess it depends on how you define disease. Some infertile people campaigning for taxpayer-funded access to IVF compare their infertility to cancer and other serious illnesses. You might want to ask someone struggling with life-threatening cancer what they make of that kind of comparison. Clearly, infertile people can live perfectly healthy lives very much like other people who choose not to reproduce. The latter choose not to reproduce, the former cannot, but both are able to live healthy lives. If you think that not being able to reproduce biologically is a sign of illness justifiably demanding tax monies to be thrown at it you will obviously disagree. At a minimum though it isn’t self-evident that infertility is an illness. It is also unclear whether we could find a sensible cut-off-point for IVF treatments that ought not to be funded. The oldest woman carrying an IVF caused pregnancy to term was a 74 years old. The sky is the limit and profit maximization is the name of the game for the fertility industry. Unsurprisingly the fertility industry is keen to see IVF treatment cycles paid for by taxpayers as that would increase its income.

Even if infertility was uncontroversially an illness it still wouldn’t follow that tax monies ought to be expended on it. We make resource allocation decisions in health care systems (public and private) all the time. More needs to be said to justify public expense than merely ‘I want my own genetically-linked child, so you pay for my IVF treatment cycles.’ Some cash-strapped parents-to-be argued that it truly is unfair of society to expect of them to pay the $15,000-$20,000 for IVF treatment cycles. I do think to describe this as unfortunate would be correct, that it is unfair is far from self-evident. Indeed, some went so far as to say that they would not have been able to have children if it hadn’t been for someone else paying the bill for the IVF treatment. Here’s my problem with this line of reasoning: The cost of raising a child to the age of 18 currently is in the average about $250,000 in Canada. You can’t tell me that a down payment of $15,000-$20,000 is beyond anyone considering that kind of overall expenditure. If it were, perhaps that would be a good reason to reconsider your spending priorities in life, or better even, your life-plan.

An expert panel working on behalf the last Liberal government in Ontario recommended that IVF treatment cycles be provided free of charge through the public health care system. It noted that some people who rely on their own funds to pay for the treatment, implant too many embryos to ensure a pregnancy. This leads to costly complications in some cases. My response to this argument would be that folks engaging in such risk-taking ought to be required to take out insurance to cover any health care cost their irresponsible behavior requires.

Be that as it may, my broader objection to IVF goes beyond merely bickering about scarce health care resources being wasted on people’s preferences for biologically linked children over – say – adoptive children. I think it’s actually a morally problematic choice to produce more children by costly artificial means while children in need of adoptive parents exist in the country. Yes, I’m not talking Madonna-style purchases of babies in the developing world, but needy children in our own backyard.

At the moment tens of thousands of children in Canada are in need of adoptive parents. They are still looking for a family to call their own. Most of these kids were biologically conceived by people unable to look after them. It remains true that it is for most of us a tad bit easier to make children than to look after them. To my mind it would be decadent of any public health care system to subsidize IVF procedures while in its jurisdiction large numbers of children are in need of permanent homes. It just does not make sense to me. I readily acknowledge that the non-commercial adoption system in this country is far from perfect, but I doubt – given what’s at stake – that there can be a perfect system.

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s, he tweets @schuklenk

Ooops, our oil reserves are finite - what a surprise

Quite funny, the Green movement has told us (well, at the time I was a very active part of it) some 20 years ago that we're running out of oil, and that - among other things - we need to reconsider our predominant modes of transport (a 1 ton vehicle to transport a 70kg body to the supermarket around the corner; academics like myself flying frequently to a far-flung corner of the world to give a 15-20 min presentation that could have been presented just as well by audio-videolink - but hey, what else do we have to feel good about ourselves :-).

It goes without saying we Greenies were variously called tree-huggers, stupid, romantic, naive or a combination of these things. Well, we were right, of course, our resources on this planet are very much finite (hence the idea that we need continuing economic growth to be happy is so remarkably and so obviously silly, yet it drives everything that we do).

So, fast forward to mid 2008. The oil price has reached breathtaking heights, and while we should be mostly concerned about the impact this will have on the affordability of food products, if you watch TV (presumably on your giant flat screen TV, which happens to have replaced ovens in many homes because they're emanating so much heat) you will be forgiven for thinking that the oil price issue is really about airline survival and the Hummer (the ridiculous GM car still produced for the Homer Simpson types of the real world - reportedly men with really really small penises). There is some good news, though, airlines shut down plenty of planes; here is hoping that Air Canada might fall by the wayside altogether, but things are not looking promising because the airline has long since begun to treat its customers particularly badly, so it might survive longer than some of its better behaved competitors.

There's also some huha about GM shutting down car factories in various countries. The truth is, of course, that this is a small reason for celebrations as it will bring us closer to keeping much-needed energy reserves for longer. Of course, for some bizarre reason, those in power (let's call them our 'representatives') do not seem to bother about putting efficient public transport systems in place. I live currently a lot of the time in Kingston, a medium-sized city in Ontario. The public transport system does arguably not even deserve the name system. The bus stops don't display information as to the route of the buses that happen to stop there on the odd occasion, indeed, even information about when buses can be expected to stop there (it's called a timetable in Europe) is not on display. Surely it can't surprise then that people take their giant American car out for a ride to the supermarket. So, decades after we knew we couldn't go on like we did, we chose collectively to stick our head in the sand and voted for GM's Hummer, Chrysler's 300C (incidentally a car driven by Barack Obama the supposedly so clever US Senator trying to become the next President of the USA), and my all-time favourite car, the Maserati Sedan.

Ok, I'm getting off my soap box now. Guess all I'm saying is, ask yourself more often what the impact of your action on the environment and future generations is. If your action is incompatible with a high-quality environment and existing future generations of people, don't do it unless you really have no choice (slight inconvenience isn't the same as saying that you really have no choice).

Conflict of interest declaration: I can't drive, so decent public transport would make a big difference to my life.