Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem (...) committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges. (shrink)

In On Immunity: An Inoculation, Eula Biss, a writer and then-new mother, explores vaccination ethics through moving prose. She probes questions of autonomy, community, and power and exposes how vaccination provokes deep-seated fears about being alive and vulnerable in an uncontrollable world. She uses literature, science, and philosophy to create a multidisciplinary account of why vaccination continues to be a difficult choice for many despite widespread evidence that it is safe and overwhelmingly effective. She ultimately urges others to embrace a (...) collectivist ethic that stresses human interconnectedness, reminding us that immunity is a shared responsibility that we cannot accomplish on... (shrink)