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........

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