I have cared for patients who refused crucial life-saving medical treatments and just wanted to leave the hospital. I told them that if they left, they would die. They didn’t believe me and insisted they would be fine. I tried to educate them about the risks and benefits of treatment. If they then fully understood, I would let them go. For those who still didn’t understand, I enlisted family members who realized that the treatment was in the patient’s best interests. Usually, they persuaded the patient to stay and get well, but these efforts often took several days.

I have recently been thinking about such patients in light of rising rates of measles, mumps, and whooping cough, and anti-vaxxers' arguments that parents should decide about vaccinations on their own, rather than relying on public health mandates. Many patients don’t understand the risks and benefits of various medical interventions, including vaccines.

Arguments about vaccine choice misapply key bioethical principles. The rhetoric reveals significant misunderstandings of public health and bioethics.

Kirk Milhoan, the new chair of the Federal Advisory Committee on Immunization Practices, for instance, asserts that vaccination against polio and measles should be optional since “if there is no choice, then informed consent is an illusion. Without consent it is medical battery.”

He says that requiring shots for entry to school is “authoritarian,” and that he is "returning individual autonomy to the first order—not public health but individual autonomy to the first order."

Yet as Supreme Court Justice Oliver Wendell Holmes once wrote, “The most stringent protection of free speech would not protect a man in falsely shouting fire in a theatre and causing a panic.” We each possess freedom—until we start to endanger others. This principle extends to public health.

Many people, for instance, would like to smoke in public places, but governments ban individuals from doing so because of the resultant harm to others. Likewise, millions of drivers would like to ignore red lights and stop signs yet are constrained by law. Our society requires everyone to pay taxes, rather than letting individuals choose whether to do so.

Similarly, we require patients with syphilis to divulge the names and contact information of their sexual partners so public health workers can contact these individuals to alert them that they’ve been exposed to a serious but treatable disease and should get tested to avoid spreading the infection.

As health care providers, we must often weigh the principles of bioethics—among them, avoiding harm, respecting and helping people, and pursuing justice—against each other. We always seek to follow patients’ wishes as much as we can, but at times, we cannot, because the patient doesn’t understand the risks and benefits involved, or because other people will be harmed. And this weighing of principles applies to all of us: At times, our society stipulates that we pursue the greater good over our own preferences.

While a few vaccines, such as that for tetanus, help the patient alone, most other vaccines, such as those for polio, measles, COVID, and the flu, aid not just whoever gets the shot, but others with whom the individual is in contact. Some people can’t take a vaccine for medical reasons. But if you don’t get immunized, you can infect them and countless others, including family members, friends, and neighbors. What’s more, if you’re unvaccinated, the virus can mutate in your body, creating new strains that can harm people who have gotten shots.

Informed consent is an essential component of health care, requiring that the patient is informed and, importantly, understands the pros and cons of procedures. To make an informed choice, patients need to comprehend the relevant facts about the risks and benefits entailed.

Yet many parents do not grasp that a major reason to take most vaccines is to benefit not only their child’s health, but also their family’s and neighbors’, establishing so-called herd immunity. Unfortunately, one study found that about 37 percent of Americans are not aware of this notion. While 78.9 percent of those who know about herd immunity plan to get vaccinated, only 67.8 percent of those who are not knowledgeable about it plan to do so. However, after those who were previously unaware of herd immunity receive a three-sentence explanation of it, they become significantly more likely to plan to get vaccinated.

The Centers for Disease Control and Prevention now also advocates “shared decision-making” for childhood immunizations, suggesting the decision be made by parents in consultation with their doctor. But physicians generally use this approach only when the pros and cons of a procedure clash and, based on the evidence, it is not clear which decision is necessarily better. That is not the case with these immunizations, and to suggest otherwise distorts decades of scientific findings.

Anti-vaxxers are creating a false distinction: that either parents choose on their own or authoritarianism ensues. But the reality is far more complex. We don’t see mandates to obey stop signs and red traffic lights as “authoritarian,” but rather as necessary protections that keep us all safe.

We must all be aware of how anti-vaxxers are misusing terms such as “shared decision making” and “informed consent” to impede health care, science, and public health. We need to respond to these arguments, understanding and addressing concerns while also explaining reasons for vaccine mandates and the potential harms of vaccine refusals, as well as pointing out how key ethical terms are getting skewed.

Alas, health care providers are already stressed and lack extra time for lengthy conversations. But they’re not the only ones who can help by having these conversations.

Most of us know people who are wary of vaccines. Just as I had to try to persuade hospitalized patients to understand the risks and benefits of their treatment plan, we can help others unpack the rhetoric around immunizations to see that the administration is misusing these terms and distorting key principles underlying both our individual and our nation’s health.

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