By Kwame Anthony Appiah
May 14, 2019
I am the primary caregiver for my elderly mother, who has lupus and thus a compromised immune system. My sister has four young children, none of whom she has had vaccinated out of fear that vaccines cause autism.
My mother and I watch all four children regularly but have become increasingly uneasy in the face of outbreaks of measles and other communicable diseases. My mother and other relatives have implored my sister to reconsider her anti-vaccination stance. We have told her that if she doesn’t, we will have to stop watching her children, which would be a significant hardship for her. (My two older nephews were both denied entrance to a great local public school because my sister refuses to vaccinate, leading to even more babysitting time at my mother’s house.)
The health center where my mother receives regular care hosts a biannual, reduced-cost vaccination clinic. Would it be unethical for me to get the children inoculated there the next time such an event is held? I don’t want to alienate my sister, but at what point does the common good outweigh individual choice? Name Withheld
People with lupus are indeed more susceptible to infection, especially if they’re taking immunosuppressive drugs. So are older people, whose immune systems are less able to combat pathogens. Your mother is vulnerable for both reasons. Children who are not vaccinated are more likely to get diseases like measles, mumps and rubella and so more likely to transmit them to others. (The recent measles outbreak in an Orthodox Jewish community in Brooklyn began in part with an unvaccinated child who acquired the disease in Israel, and most, though not all, of those who then contracted it were unvaccinated.) The fact that your mother spends so much time with four unvaccinated nephews and nieces is a further source of risk.
And let’s repeat what shouldn’t need repeating. Despite the vociferations of anti-vaccination activists, the overwhelming scientific consensus strongly supports M.M.R. vaccination.
So I understand your wish to protect all these members of your family. I’m glad you’ve spent time trying to change your sister’s mind. Still, medical decisions for minor children are the responsibility of their custodial parents, and vaccinating her children behind her back would violate her right to make these decisions. If you can’t persuade her, you can’t overrule her.
I suppose there’s a chance that your sister would reconsider if you and your mother decided that you would no longer look after her kids otherwise. But given the nature of her convictions (and the fact that she wasn’t deterred by her kids’ being excluded from public education), she isn’t likely to respond to that pressure. Her problem isn’t what she’s doing, given what she believes; it’s what she believes. Many years of careful analysis show that the evidence for an autism link is simply nonexistent; nor can older children suddenly develop the disorder. Unfortunately, anti-vaxxers have the epistemological equivalent of a drug-resistant infection; the condition is stubbornly unresponsive to treatment.
The C.D.C. says that in the decade before a vaccine became available, in 1963, most children got measles by age 15; each year between three and four million people were infected, 48,000 were hospitalized, 1,000 came down with encephalitis and as many as 500 died. Unvaccinated children are free-riding on the responsible majority, without whom we would be headed back to that distressing situation. We have every reason to hope the anti-vaxxers don’t win the argument. So do what you can — but be mindful of what you can’t.
In my freshman year at college, I crossed paths with an upperclassman at a school club. We became Facebook friends sometime afterward but didn’t stay in touch. I never saw her again after that and over time, stopped seeing anything of hers on Facebook, too.
Recently, new posts of hers started popping up. She appears to have relocated to South America and is presenting herself as a self-healing mystic. Her posts feature lots of platitudes about “cosmic balance.” More recently, however, she has been asking for positive vibes because of an onslaught of C.I.A. brain attacks aimed at her. Lately, she implored her friends for donations.
Disturbing as it is to see this person suffering a mental breakdown in near-real time, I’ve felt conflicted about whether and how to act. I have no relationship with her; if not for social media, I wouldn’t even remember her. At the same time, her rants never seem to attract the help she needs — just more people affirming her preposterous claims. Do I have an obligation to help this person help themselves, and if so, what form should that help take? Name Withheld
A responsible estimate for psychotic disorders suggests a 3 percent lifetime prevalence. Which means you could probably find more people you’ve known over the years with these difficulties if you looked. This person is just one you happen to have learned about. And your connection to her is pretty remote. Of all the people who know her and her situation, you’re surely one of the least likely to be able to help her at reasonable cost in time and expense; an online message from someone she hasn’t seen in years isn’t likely to break through and persuade her to go see a doctor. In sum: No, you’re not obliged to act.
Even though you don’t have an obligation to act, however, it would be a good thing to try to do something. For one thing, these disorders are often highly treatable; there’s a good chance she would benefit from medical help. Trying to find and alert members of her family could benefit her more than anything you can do directly. It would probably be best for her to be brought back home, where there are people who can manage her care. But my bet is that her family already knows and hasn’t been able to make any headway with her. One symptom of certain psychoses is a specific inability — sometimes called anosognosia — to recognize that you’ve got a problem.
You might also consider alerting her online community to your interpretation of her situation and suggesting that someone who is in contact with her try to help. Given what you say about the responses to her posts, however, this may not produce results. And in her current mental condition, she’s quite likely to block you. A valuable thing about the internet is that if you’re someone who is marginalized and isolated in your community, it can connect you to an international network of people like you and assure you that you’re not alone. But that same ability to link people up to the like-minded can sustain tin-foil-hat beliefs — about how the C.I.A. is directing brain attacks, about how the Sandy Hook shooting was a hoax and, yes, about how vaccines cause autism. In the era of QAnon and Infowars, one person’s delusion can swiftly become everyone’s problem.
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Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)
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