2015 年 33 巻 p. 41-51
The objective of this paper is to discuss the reasons that some individuals in the United States refuse to be vaccinated, focusing on those reasons usually described as "conscientious." This paper discusses current compulsory vaccination practices and the most common categories of reasons objectors in the United States give for refusing vaccinations (on medical, religious, or philosophical grounds, the latter two of which are often described as conscientious reasons). Possible ways to handle refusals are examined from the perspectives of the three categories of refusals mentioned above, the particularities of vaccination within biomedical ethics, and public health ethics discussions. Although refusals based on divergent perceptions of risk are commonly classified as refusals for philosophical (personal) reasons, objectors in this category are trying to present medical reasons, which do not convince experts. Even if experts try to persuade the public by presenting scientific evidence, there remain fundamental difficulties in convincing objectors. Refusals for religious reasons are to a certain extent established historically, but few major religious groups nowadays explicitly refuse vaccinations per se. Refusals in this category are not necessarily plainly "religious." Certain refusals on religious grounds, including those based on repugnance for the use of components derived from aborted fetuses, can be avoided by technological advances in the medical field. Refusals based on philosophical reasons should be handled in more sensitive, individualized ways than they are now. The inquiry ventured in this paper is important for Japanese society in that it deals with general questions surrounding the contradictions between the autonomy principle, which is paramount in biomedical ethics, and the compulsory schema of public health policy, and asks whether and how the different qualities or characters of decisions regarding health care and public health should be translated into practice.