Compulsory vaccination law upheld the View that individual freedom is subject to the police power of the state and can be subordinated to the public welfare

SYNOPSIS The 1905 Supreme Court case of Jacobson v. Massachusetts over compulsory vaccination law upheld the View that individual freedom is subject to the police power of the state and can be subordinated to the public welfare in situations where public safety demands it. This ruling provides a general mandate for public health to restrict individual liberty, but also establishes a condition for it, namely, protecting the public good. Many ethical issues arise in public health around the tension between individual and community interests. Resolving them often involves weighing liberty restrictions against potential harms or threats to public health and safety. CASE Smoke—Free Policies in Outdoor Public Spaces An outdoor smoke-free policy has recently been proposed by your County’s Department of Public Health. The policy would apply to all public parks, outdoor stadiums, and play areas. The Board has called you, the local health department director, to testify at the upcoming hearing on the potential policy. How would you, as the local health department director, evaluate whether and how the policy should be enacted? FURTHER INFORMATION Possible Case References 1. Centers for Disease Control and Prevention. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000—2004. Morbidity and Mortality Weekly Report 2008;57(45):1226—8. 2. The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta: US. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006 3. Bloch M, Shopland, DR. Outdoor smoking bans: More than meets the eye. Tobacco Control, 2000;9:99. 4. Bayer R, Stuber J. Tobacco control, stigma, and public health: Rethinking the relations. American Journal of Public Health 2006;96(l):47-50. 5. Hopkins DP, Razi S, Leeks, KD, et al. Smokefree Policies to Reduce Tobacco Use: A Systematic Review. American Journal of Preventive Medicine 2010;38(ZS):SZ75-89. 6. Centers for Disease Control and Prevention. Quitting smoking among adults—United States, 2001—2010. Morbidity and Mortality Weekly Report 201 l;60(44):1513-19.

Adapted fi’om Morain,S. (2012). Good Decision Making in Real T ime: Practical Public Health Ethics for Local Health Officials. Centers for Disease Control and Prevention. Atlanta, GA. CASE 3: BALANCING THE RIGHTS OF INDIVIDUALS 7. Chapman S. Should smoking in outdoor spaces be banned? BMJ 2008;337:a2804. KEY QUESTIONS 1. What are the types of harms that this policy aims to address? What is the appropriate role for the health department in addressing these harms? 2. Who are the stakeholders that should be considered in deciding if this policy should be enacted? What are the possible values, norms, and perspectives that each of these stakeholders bring to this issue? 3. What ethical issues/challenges might arise (make sure to consider ethical principles and theories for this question)? What are the major factual issues raised by this case? Previous health policies? In analyzing this issue, how would you justify such a policy? PM”

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