What is Freedom? I always thought I knew: my right to swing my fist stops at the end of your nose. While it is difficult to know who originally formulated this thought, it is nevertheless a pithy expression of the concept of boundaries.
The problem with this statement is that it only easily applies to things whose ownership is clear and unambiguous: property, persons, patents, etc. When the boundaries between meum and tuum are less clear, that's when things get interesting. Let us take the case of vaccination as an example. Much has been written on this topic and so I will not attempt a detailed excursus of the various schools of thought. Indeed, for the purposes of this discussion, it doesn't matter so much who is right or wrong.
The question exercising me is how individual liberty relates to the public weal. The mathematician John Nash showed how our self interest depends not only on our own choices, but also in interesting ways on the choices of other people. The question "should I vaccinate my child" is one that every parent probably asks herself at some point. What are the risks? What are the benefits? What happens when the costs are personal and immediate and the benefits are diffused over a larger group or delayed? Or, vice versa, when the benefits of an action are immediate and clear to me, but the costs are not obvious or paid by somebody else who is not known to me?
Near and far
I think the tendency of most people is to be very biased with regard to distance and time. Things close by are more important than things farther away. Things tomorrow are more important than things next week or next month. I'm sure everybody can relate to thoughts like these:
- I really want to buy this thing now. I know I need the money to pay the rent, but that's not for three more weeks.
- I shouldn't eat this cake. I will regret it later. But it looks so good and I'm hungry now and I want it!
- I can imagine that a neighbor who I'm pretty good friends with asks me for a favor and I gladly and smilingly help out. But another person I know who I don't like so much, who is kind of whiny and needy, or has an unpleasant demeanor asks me for the same favor. Do I grant it? Do I do it as willingly or as smilingly as for my neighbor? If the effort required on my part is exactly the same for each person, do I nevertheless respond differently to the less-pleasant acquaintance than I did to the neighbor?
- I can imagine I see two children drowning, one of whom is my own and the other unknown to me. There is no one else around to ask for help. The children are equally far away from me and far enough from each other that I can only just barely save one of them. How do I choose?
- I find a way to fake a problem and get a large check from the insurance company with absolutely no risk that I'll get caught. What factors do I take into consideration? What if I reason that the insurance company has 2,000,000 other customers and the check I will get for $20,000 only works out to one penny per customer?
All these hypothetical questions are moral quandaries where some form of distance might play a role in our decision making process.
Risks and benefits
Now we circle back to the vaccination question. I have a little child and the doctor wants to stick a needle in her arm and inject a substance that will hurt and make her a little sick for a day. She will cry now, but it will save her from ever contracting a certain terrible, disfiguring disease later on. Do I let the doctor proceed? Of course. A little short-lived pain now to spare a lot of long-lasting misery later on is a very good trade-off -- a "no-brainer."
But now I hear that there is a tiny chance that this shot could cause brain damage. My colleague at work even knows somebody whose cousin's girl friend's brother-in-law's kid was a normal happy toddler and became a permanent vegetable within 30 seconds after having this exact same shot. Sure, the Doctor assures me that there is only a 1-in-a-gazillion chance that this could happen, but hey, this is my kid and I'm not taking any chances. Now how do I weigh the costs and benefits?
And the pharmaceutical company that produces this vaccine made over a billion dollars last year selling it! And here's this doctor obviously funding his lavish lifestyle from kickbacks he gets from Big Pharma, smarmily trying to pawn off some risky drug that's going to turn my kid into a vegetable, all so the CEO can get a bigger bonus this year? Only a crazy person would fall for that! And you tell me that if my kid doesn't get this vaccine, some other kid might get smallpox or measles or mumps or rubella or polio or tuberculosis or the bubonic plague? Well too bad! Better that some other kid who I don't know should get sick than my own kid!
This all-too-real scenario plays itself out every day in the minds of many people. It doesn't matter that we have done many, expensive, high quality, double blind randomized studies that have completely and utterly ruled out the link between vaccines and brain damage. It doesn't matter that this is the best and most reliable kind of scientific study with a track record that is proven solid seven ways to Sunday. People still think there's funny business going on and there could be a risk to their kid. It's very difficult to combat this kind of thinking.
My freedom and your freedom
And so now we circle back to the main question of this little essay. At what point do we as citizens say "enough is enough"? At what point do we decide that some peoples' irrational fears are putting the whole population at risk for the recrudescence of some terrible disease? At what point do we instruct our government to curtail those peoples' freedom of choice in this area and vaccinate their kids, willingly or not, for the public good?
And what about religious objections? Some people strongly feel that God does not want people to get vaccinations and that those who do will go to hell. They say their freedom to follow their religious convictions is guaranteed by the constitution. But what if by following those convictions they put other people at risk? At what point can we say "religious freedom is all well and good, but not at the expense of the public safety"?
And when we do reach that point of curtailing individuals' freedoms for the public good, where do we stop? It's one thing to talk about fists and noses when your fist is one inch from my nose. One inch and a quarter closer and you have crossed the line from exercising your personal liberty into violating mine and rendering yourself amenable to the law which protects us both. But what if your 'fist' is your failure to vaccinate your child and my 'nose' is my own kid with a case of the measles? And worse, your 'fist' is in California and my 'nose' is in Vermont. What then? Now we have conflicting laws in play: one that guarantees your freedom to choose whether to vaccinate and one that says you are liable for harm you incur on other people. One is easy to adjudicate: you exercised your choice not to vaccinate. The other is impossible: there is literally no way to prove that your failure to vaccinate your kid caused mine to get the measles. And yet, though indirect, that really was the cause and now, the eventual result of your negligence means that I have a very sick kid.
Here is where the distance question comes in: is it only for legal convenience that we give total priority to the law that can be adjudicated? Is it only because there is no way to prove the chain of cause and effect between your failure to vaccinate and my kid's case of the measles? You made a decision that you thought was the best one based on the risks and benefits as you perceived them for your kid. But in doing so, not only did you poorly evaluate that risk, but you actually put other people in danger, though that was not your intent.
As a society how do we manage to balance your freedom to chose with my freedom to not to be impacted by your decision when the train of cause and effect is real but invisible? We already limit your freedom for your own good by making you wear a seatbelt and fining you if you don't. How can we fail to recognize that vaccines are 1000 times more necessary than seatbelts for everyone's good, yours and mine included?
These are not easy questions and there are no pat answers. But the same type of discussion is relevant to many topics: pollution, climate change, school prayer, separation of church and state, religious freedom. We spend a lot of time hurling sound bites at each other on these topics, and place a great deal of emphasis on our Freedoms and protecting them at all costs. What we don't discuss nearly as much, even though John Nash gave us some tools to do so, is how the exercise of our freedoms and the effects of our decisions ripple out through others, but are reflected and come back to us sooner or later. Failing to vaccinate a child weakening herd immunity, having other kids get sick as a result, and eventually having your own unvaccinated kid catch the disease from one of those kids would be an example of this reflection.
So how to sum this up? We are all connected in obvious and non-obvious ways. Many philosophical traditions talk about the effects of our actions on others and on ourselves. Cast thy bread upon the waters and after many days thou shalt find it again; karma and the wheel of samsara; yin and yang. But the puzzle for us to solve and re-solve in every generation is this: we all are born and live together on our pale blue dot, the only home we have; we all have an equal claim on the earth's resources to obtain the wherewithal to live our lives; how do we order our actions and our society to ensure we give ourselves and our progeny the best chance of succeeding now and into the misty future? And what is the boundary of our concern? Our person, our family, our tribe, city, state or nation? No! It is the human race and that vast and intricate network of life that we depend on for our every breath, our ecosystem. It is in this context that we must judge what constitutes our fists and our noses.
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