Good reasons to vaccinate: mandatory or payment for risk?

Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived risk of a novel vaccination, a system of payment for risk in vaccination may be superior. I defend a payment model against various objections, including that it constitutes coercion and undermines solidarity. I argue that payment can be in cash or in kind, and opportunity for altruistic vaccinations can be preserved by offering people who have been vaccinated the opportunity to donate any cash payment back to the health service.

Revolution in abortion care? Perspectives of key informants on the importance of abortion method choice in the era of telemedicine.

Patient choice of medical or surgical abortion is a standard of quality abortion care, but the choice of surgical abortion is constrained in England and Wales, particularly since the COVID-19 pandemic and introduction of telemedicine. This qualitative study explored the perspectives of abortion service providers, managers, and funders on the need to offer a choice of methods within early gestation abortion services in England and Wales. Twenty-seven key informant interviews were conducted between August and November 2021, and framework analysis methods were used. Participants presented arguments both for and against offering method choice. Most participants felt that it was important to maintain choice, although they recognised that medical abortion suits most patients, that both methods are very safe and acceptable, and that the priority for abortion services is to maintain timely access to respectful care. Their arguments related to practicalities around patient needs, the risk of reinforcing inequalities in access to patient-centred care, potential impacts on patients and providers, comparisons to other services, costs, and moral issues. Participants argued that constraining choice has a greater impact on those who are less able to advocate for themselves and there were concerns that patients may feel stigmatised or isolated when unable to choose their preferred method. In conclusion, although medical abortion suits most patients, this study highlights arguments for maintaining the option of surgical abortion in the era of telemedicine. More nuanced discussion of the potential benefits and impacts of self-management of medical abortion is needed.

A Millian Case for Censoring Vaccine Misinformation.

The spread of vaccine misinformation may contribute to vaccine refusal/hesitancy and consequent harms. Nonetheless, censorship is often rejected on the grounds of free expression. This article examines John Stuart Mill's influential defence of free expression but finds that his arguments for freedom apply only to normal, reasonably favourable circumstances. In other cases, it may be permissible to restrict freedom, including freedom of speech. Thus, while Mill would ordinarily defend the right to express false views, such as that vaccines cause autism, he might have accepted restrictions on anti-vaccine misinformation during the present pandemic. This illustrates that even the staunchest defenders of free speech can permit temporary restrictions in exceptional circumstances.

Management of the Medico-Legal Dispute of Healthcare-Related SARS-CoV-2 Infections: Evaluation Criteria and Case Study in a Large University Hospital in Northwest Italy from 2020 to 2021.

Healthcare-related SARS-CoV-2 infection is an issue of particular concern during the pandemic. It has important repercussions on the National Health System, which represents a source of medical-legal health disputes. In the healthcare context, there are reports of negative screening at hospital admission (via nasopharyngeal swabs) and subsequent diagnosis of SARS-CoV-2 infection during hospitalization. Such cases cannot be considered a priori of healthcare-related infections but require extensive in-depth evaluation. In this study, we propose an empirical classification to frame cases of SARS-CoV-2 infection diagnosed in the hospital (first negative admission swab, with subsequent positive test during hospitalization). The classification is based on five categories: nosocomial, probably nosocomial, indeterminate, probably community, and community cases. We analyzed patients who died after testing positive for SARS-CoV-2 during hospitalization (with initial negative screening) in the largest hospital in Northwest Italy from February 2020 to 31 December 2021. A total of 383 cases were tracked and are listed as follows: 41 cases (11%) were classified as nosocomial (i.e., 3.2% of COVID-19 deaths). In contrast, 71 cases (19%) were classified as probably nosocomial, 69 (18%) were indeterminate (i.e., the clinical, radiological, and laboratory characteristics did not provide information on the genesis of the infection), 166 (43%) were classified as probably community cases, and 36 (9%) were defined as community cases. Deceased patients with nosocomial SARS-CoV-2 infection constituted the following: 3.23% (41/1266) with respect to the total number of COVID-19 deaths, 1.1% (41/3789) with respect to those who entered the hospital with a negative swab and 0.82% (41/4672) with respect to the total of deaths from any cause of death. In this paper we discuss the topic and issues of nosocomial COVID-19 in hospitalized patients and address the medicolegal implications.

The influence factors of medical disputes in Shanghai and implications - from the perspective of doctor, patient and disease.

OBJECTIVE: This study aimed to explore the causes and factors behind medical disputes that occurred across eight hospitals in Shanghai over a three-year period (January 2018 to December 2020), thus providing targeted suggestions for amelioration. METHODS: Stratified sampling was employed to collect 561 cases in which medical disputes occurred at two tertiary hospitals, two secondary hospitals, and four primary hospitals in Shanghai. The causes were analyzed using descriptive statistics, while the factors affecting the dispute level (i.e., 1 through 4, with 1 being most severe) were analyzed via one-way ANOVA and logistic regression analyses.  RESULTS: Doctors and patients variously contributed to the medical disputes; 86.1% were related to doctors, while 13.9% were related to patients. For doctors, there are seventeen factors that influenced medical disputes. In particular, the insufficient communication (28.82%) is the most prominent factor in the doctors' factors. For patients, there are seven factors that influenced medical disputes. In particular, the misunderstanding of medical behavior (43.48%) is the most prominent factor in the patients' factors. Of all investigated medical disputes, 406 were level 4 (78%), 95 were level 3 (18%), and 19 were level 2 (4%); there were no level 1 disputes. The reasons for different level placements included the disease classification, treatment effect, diagnosis and treatment regulation violations by doctors, and low technical levels. CONCLUSIONS: In addition to strengthening training about clinical and communication skills, the hospitals should establish quality control mechanisms for case records and construct rapid, standardized referral mechanisms. The doctors should attach great importance to the quality and urgency of treatment given to critically ill patients, who must be informed about their prognoses in a timely manner to avoid medical disputes and physical deterioration. The patients should actively cooperate with their doctors in the treatment process, moderate any unrealistic expectations that patients may have about the outcomes. During the COVID-19 pandemic particularly, doctors and patients should strengthen empathy and mutual trust more, then defeat disease together.

People's perceptions of, willingness-to-take preventive remedies and their willingness-to-vaccinate during times of heightened health threats.

Pandemics, such as the current SARS-CoV-2 pandemic, represents a health threat to humans worldwide. During times of heightened health risks, the public's perceptions, and acceptance of evidence-based preventive measures, such as vaccines, is of high relevance. Moreover, people might seek other preventive remedies to protect themselves from getting infected (e.g., herbal remedies, nutritional supplements). A recent study on consumers' preference for naturalness showed that people put more weight on perceived naturalness of a preventive remedy compared to a curative one. This result was attributed to the increased focus on perceived effectiveness as opposed to perceived risk. This raises the question whether the current pandemic would shift people's perceptions from prevention to curing and thus, exhibit a preference for synthetic remedies because they are seen as more effective. The present online experiment (conducted in April 2021) investigated people's perceptions of vaccines and remedies within the context of the current SARS-CoV-2 pandemic. A 2x2 between-subject design with type of remedy (natural vs. synthetic) and salience of SARS-CoV-2 pandemic (high vs. low) was conducted in Switzerland in spring 2021 (N = 452). The data did not provide evidence of a curative mindset for preventive remedies, as the participants exhibited a clear preference for the natural remedy compared to the synthetic remedy. Our study stresses the importance of understanding people's mindsets on how to protect themselves from infection with a virus during an ongoing pandemic to tackle misinformation and vaccine hesitancy.

Opposition to voluntary and mandated COVID-19 vaccination as a dynamic process: Evidence and policy implications of changing beliefs.

SignificanceThe challenge of securing adherence to public health policies is compounded when an emerging threat and a set of unprecedented remedies are not fully understood among the general public. The evolution of citizens' attitudes toward vaccination during the COVID-19 pandemic offers psychologically and sociologically grounded insights that enrich the conventional incentives- and constraints-based approach to policy design. We thus contribute to a behavioral science of policy compliance during public health emergencies of the kind that we may increasingly face in the future. From early in the pandemic, we have tracked the same individuals, providing a lens into the conditions under which people's attitudes toward voluntary and mandated vaccinations change, providing essential information for COVID-19 policy not available from cross-section data.

Deliberation, Dissent, and Distrust: Understanding Distinct Drivers of Coronavirus Disease 2019 Vaccine Hesitancy in the United States.

BACKGROUND: Despite the availability of safe and efficacious coronavirus disease 2019 vaccines, a significant proportion of the American public remains unvaccinated and does not appear to be immediately interested in receiving the vaccine. METHODS: In this study, we analyzed data from the US Census Bureau's Household Pulse Survey, a biweekly cross-sectional survey of US households. We estimated the prevalence of vaccine hesitancy across states and nationally and assessed the predictors of vaccine hesitancy and vaccine rejection. In addition, we examined the underlying reasons for vaccine hesitancy, grouped into thematic categories. RESULTS: A total of 459 235 participants were surveyed from 6 January to 29 March 2021. While vaccine uptake increased from 7.7% to 47%, vaccine hesitancy rates remained relatively fixed: overall, 10.2% reported that they would probably not get a vaccine and 8.2% that they would definitely not get a vaccine. Income, education, and state political leaning strongly predicted vaccine hesitancy. However, while both female sex and black race were factors predicting hesitancy, among those who were hesitant, these same characteristics predicted vaccine reluctance rather than rejection. Those who expressed reluctance invoked mostly "deliberative" reasons, while those who rejected the vaccine were also likely to invoke reasons of "dissent" or "distrust." CONCLUSIONS: Vaccine hesitancy comprises a sizable proportion of the population and is large enough to threaten achieving herd immunity. Distinct subgroups of hesitancy have distinctive sociodemographic associations as well as cognitive and affective predilections. Segmented public health solutions are needed to target interventions and optimize vaccine uptake.

Psychological underpinnings of pandemic denial - patterns of disagreement with scientific experts in the German public during the COVID-19 pandemic.

We investigated pandemic denial in the general public in Germany after the first wave of COVID-19 in May 2020. Using latent class analysis, we compared patterns of disagreement with claims about (a) the origin, spread, or infectiousness of the SARS-CoV-2 virus and (b) the personal risk from COVID-19 between scientific laypersons (N = 1,575) and scientific experts (N = 128). Two groups in the general public differed distinctively from expert evaluations. The Dismissive (8%) are characterized by low-risk assessment, low compliance with containment measures, and mistrust in politicians. The Doubtful (19%) are characterized by low cognitive reflection, high uncertainty in the distinction between true and false claims, and high social media intake. Our research indicates that pandemic denial cannot be linked to a single and distinct pattern of psychological dispositions but involves different subgroups within the general population that share high COVID-19 conspiracy beliefs and low beliefs in epistemic complexity.

Say No to This: Unilateral Do-Not-Resuscitate Orders for Patients with COVID-19.

In this article, we comment on Ciaffa's article 'The Ethics of Unilateral Do-Not-Resuscitate Orders for COVID-19 Patients.' We summarize his argument criticizing futility and utilitarianism as the key ethical justifications for unilateral do-not-resuscitate orders for patients with COVID-19.

The Epistemic Duties of Philosophers: An Addendum.

In "Were Lockdowns Justified? A Return to the Facts and Evidence", we argue that Eric Winsberg, Jason Brennan and Chris Surprenant fail to make their case that initial COVID-19 lockdowns were unjustified, due to the fact their argument rests on erroneous factual claims. As is made clear by a response in this volume, the authors mistakenly take us to have been defending the imposition of lockdowns. Here, we clarify the aims of our original paper, and emphasise the importance of getting the facts right when making philosophical arguments in such a contentious domain.