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Ethicist Dr. Art Caplan on V-Mandates for Covid

EthicsBy Anne Dachel

Dr. Arthur Caplan is the head of the Division of Medical Ethics at NYU Grossman School of Medicine in New York. He is an ardent proponent of vaccines and strongly denies any link between vaccines and the development of autism.

Dr. Caplan has an interesting view on ethical issues and mandating the COVID vaccine, as shown in this piece, Considerations in mandating a new Covid-19 vaccine in the USA for children and adults from May 2020, co-authored with Dorit Reiss from the University of California, Hastings.

 Autonomy focuses on the right of individuals to govern their own behavior and requires both ability to comprehend the choice, the alternatives, the consequences, and freedom from outside limitations. Children generally have less autonomy than adults, because their capacity to make decisions is less. The autonomy in question here is that of parents to make medical decisions for their children and that autonomy is more limited, since the primary focus is on the child’s benefit, with the parent or guardian acting as their agent.

It is unclear what age COVID-19 vaccines will be recommended for, but if adolescents, there may be more of an argument for autonomy and in that case, it is worth considering not just a mandate, but the right of a minor to consent to a vaccine over parental opposition. …

While the risk to healthy children is less, healthy unvaccinated children who do not receive the vaccine can get—and transmit—the virus both to vulnerable classmates, for example, children with medical conditions that put them at high risk if they get COVID-19, and to high-risk teachers (such as the teacher, administrator, or janitor who is over 60 years old, those who are immunocompromised or have conditions like diabetes or heart disease). There may be additional risks not yet discovered, for example, recent findings from the UK suggest that COVID-19 may cause a severe but rare syndrome in children, though the data are yet too limited to be certain.

… utilitarianism—acting for the benefit of the greatest number for society as a whole—supports a COVID-19 mandate, as it supports other vaccine mandates….

The lengthy piece basically concluded that in the case of a COVID-19 vaccine, mandating it is the way to go.

In short, depending on the features of the vaccine, there may be good ethical grounds to mandate a COVID-19 vaccine, as long as the risk is low, and access is readily available. Our jurisprudence suggests that states will face few, if any, legal barriers in doing so, and the past political fights brought on by anti-vaccination groups are likely to be significantly weakened by the unparalleled intensity of the COVID-19 crisis.

A week later, Dr. Caplan was featured on a 60 Minutes Australia interview. Caplan basically rejected the feasibility of a vaccine for COVID-19 in the near future.

Here was a top expert in the U.S. casting serious doubt on our mad rush for a massive vaccine rollout and he doesn’t get top story coverage here. Instead we have vaccine researcher Peter Hotez .

telling us that not only will the COVID-19 vaccines protect us against the current virus but also new variants coming along.

Over seven months ago Arthur Caplan said that just isn’t going to happen.

May 17, 2020, 60 Minutes, Australia: Scientist says a coronavirus vaccine in just 12 months is 'fake news'

60 Minutes Australia: Right now there‘s one thing all 8 billion of us on earth wish for, a vaccine for COVID-19.

Around the world political leaders, sweating on getting us to the other side of the pandemic, promise it will happen within 12 to 18 months.

But hold on a minute. Vaccines normally take decades to formulate, and quite often success never comes.

So why should we be so optimistic now?

…Some scientists say talk of a coronavirus vaccine is not only raising false hope; it’s fake news….

For a planet and its population in lockdown, it’s our one sure way back to normal. …

But are we being sold a lie? After all, COVID-19 is the seventh coronavirus to strike mankind, and we’ve never found a vaccine for any of them. …

Dr. Arthur Caplan: To quote a famous President, ‘It’s fake news.’

The shortest time anybody’s ever found a vaccine against any disease that I’m familiar with is about 7 years.

The average time is 20.

To be talking about a magic bullet coming in months, it borders on the absurd.

60 Minutes Australia: Professor Arthur Caplan is director of medical ethics at New York University.

Dr. Caplan: I’m not saying don’t spend the money. I’m not saying don’t do the research. But we can’t plan public policy on a miracle.

60 Minutes Australia:  Right now there are about a hundred medical teams around the world, including Australia, chasing that miracle, the Holy Grail of a COVID vaccine.

Surely one of them will find it.

Dr. Caplan: Look, viruses are very clever. We have no AIDS vaccine right now. We’ve been looking for that for more than 25 years.

There’s no vaccine for hepatitis C.

Even the flu vaccine we’ve got, which we’ve been working on for decades, is about 40 percent effective in a good year.

There’s no guarantee we will find something to beat this virus.

The idea that just because a lot of teams work on this, it’s going to give somebody the breakthrough, that doesn’t follow.

Dr. Frances Lund: You have the whole world working on it, so this is not a disease that is a neglected disease. Everybody and their brother is working on it, right?

So there are about a hundred vaccines that people are looking at very hard right now.

I think one of them will work. …

We’re one of only a couple that are doing it as a nasal vaccine. …

You develop immunity at the site where you’re going to get infected….

Dr. Caplan: I don’t think the hunt for a vaccine is a waste of time, but I think it’s a waste of time to act as if we’re going to get something in six months or 12 months or 18 months for everyone in the world.

And we will need billions of doses of whatever they find if we’re going to knock the plague out.

Just in the U.S., you’d need 300 million or more doses

60 Minutes Australia: But this company in Canada may have found a way of producing vaccine doses in the tens of millions quickly and cheaply. …

7:17

60 Minutes Australia: Finding a vaccine, as impossible as that may sound right now, is only the first step.

Remember, this is something that’s going to have to be injected, somehow delivered to most of the world’s population.

If we get it wrong, we could turn a catastrophe into a medical apocalypse.

Dr. Caplan: You get one shot and one shot only. You get one opportunity here.

If you create something that isn’t safe and it sickens people, getting people to go for the next vaccine will be next to impossible.

To achieve the impossible both in the time frame the timeframe the politicians are promising and to ensure the safety of the vaccine, some, like Professor Caplan, are advocating a radical and highly risky strategy: deliberately infecting healthy volunteers to determine if the vaccine works.

It’s called a challenge study and it’s rarely been done in medical history.

Dr. Caplan: If you immunize people and then deliberately give them the virus, deliberately you infect them, pick people who are young and very unlikely to die, then you know. You get an answer.

We have, if you will, a setup to speed up by months, if not years, the ability to find that vaccine. …

Right now there’s a website that’s started to ask for volunteers for challenge studies. I do think the problem is not going to be getting the volunteers; it’s going to be making the decision that it’s ethical to do this….

I think you could the process by anywhere from six months to a couple of years because, remember you’re talking about tens and tens of thousands, if not hundreds of thousands of people dying over that period of time. …

I think it’s time, given this enormous plague and the damage it’s causing and the deaths it’s causing, to look for that kind of heroism again.

60 Minutes Australia: In a sense, the world doesn’t have a choice. The question can’t be IF we find a vaccine, but when, no matter how many billions of dollars and man hours it takes.

If we don’t, we face a future of lockdowns, social distancing and recurring COVID pandemics for years, if not decades to come. …

12:04

Dr.Caplan:  Politicians, whether it’s in the U.S.A., the U.K., Australia, other countries, they want to be optimistic.

Telling people to lock themselves up for a year and a half while we try to wait this thing out, is probably impossible and they know that.

So they quickly turned to talk about vaccines and magic bullets as a way to give us hope.

I’m not against hope, but when you talk about vaccinating the world in 12 months, I think you’re fantasizing.  

I wrote about Dr. Caplan for Age of Autism back in 2010. Valid Concern for 60 Year Old Medical Travesty: What About Today's?

(This is the link to the 2010 article by Dr. Caplan that I refer to in my AoA story.)

 

 

 

 

 

 

 

 

 

 

Comments

From Dr Noel Thomas BMJ on-line

Rapid Response:
Re: Covid-19: Health secretary vows to reduce bureaucracy faced by vaccination volunteers
Dear Editor,

However splendid Dr Head’s intentions may be using Critical Path Analysis to vaccinate 1000 people before lunch, one wonders if the problems posed by UK law on informed consent, and recent GMC advice on decision making and consent, might not slow his initiative, somewhat ?

His requirement for “Adequate clerical staff to book people in, consent them,“ assumes that those clerical staff would need to be well versed in vaccine knowledge, especially relating to Covid vaccines. Even if they explain that the vaccine makers are contactually free of any compensation liability, further queries may be put to them, about that peculiarity ? The lack of medium and long term safety and efficacy information makes them, in some respects, experimental vaccines, another area of uncertainty for clerical staff. Courts might also expect them to explain at least some of the emerging uncertainties, as Doshi has illustrated (1). Are clerical staff likely to be that conversant with the emerging literature ?

The doctor’s medical protection organisation might obstruct matters further, by pointing out that gaining informed consent is normally the responsibility of the person performing the procedure, who is wise to record the advice he or she gives, lest those actions are ever tested in court.

Vaccinating doctors need to consider that courts, following the Montgomery judgement in 2015, have set expensive precedents for doctors who perform a procedure with professional skill but who have omitted to explain that, even in the best hands, rare and disabling effects may ensue. (2)

The fact that present vaccination arrangements may not be conducive to the lengthy dialogue that informed consent sometimes requires, will not have escaped the notice of observers.
That may seem not to matter, in these unusual times.
The courts might decide otherwise, and enthusiasts for rapid clinical turnover need to be aware of that uncertainty.

1 https://blogs.bmj.com/bmj/2021/01/04/peter-doshi-pfizer-and-modernas-95-...

2 https://www.casemine.com/judgement/uk/5b2897ad2c94e06b9e1983ff

Gary Ogden

My dictionary defines ethics as, 1. "conforming to moral standards," and 2. "conforming to the standards of conduct of a given profession." Seems we got medical ethics straightened out at the Nuremberg Trial. Perhaps Dorit Reiss and Art Caplan have never heard of this historical event? The informed, free and voluntary consent for all medical procedures. No wiggle room there, no weasel words. Astonishing that our tax money pays the salaries of these two!

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