The strange ethics of vaccination, male contraception in comparison to cancer screening

We are facing a global crisis with an absurd amount of people refusing vaccination. I have nearly hourly conversations with patients about the importance of vaccination and largely my professional advice falls on deaf ears. To be honest, I’ve probably overly entertained the ethics and decision challenges regarding vaccination and find some similarities between that and male contraception in comparison to cancer screening.

Discussing specifically the medical ethics of immunization for rare diseases, it is kind of a strange practice. In the context of covid-19 vaccination this is moot given the absurd prevalence and declining the vaccine is really just an inability to make adult decisions. Nothing else. However, in the case of rare diseases, when we choose vaccination we choose to take a therapy that may potentially in even more rare circumstances cause us harm in order to protect those around us. It is an individually and medically absurd decision, but socially is absolutely vital. It does not make sense for doctors to encourage individual patients to expose themselves to potential harm to protect others if we consider the patient in front of us of utmost importance. This is why vaccination should be completely mandated and in the hands of the health department, not the responsibility of individual physicians. As I mentioned before, covid-19 prevalence is so ridiculously high that it’s absolutely a total and incomplete inability to reason to choose to not get it. I cannot imagine any unvaccinated individual will not get infected at some point, likely soon, and the risks infection are so ridiculously higher than vaccination. As a new physician, I have watched far too many people die from this largely preventable disease. This is moronic.

Tangentially but equally a medically interesting medically ethically but socially completely obvious is male contraception. It is absolutely no doubt that heterosexual men need to bear more of the burden of reproductive health. Medically, it is somewhat similar to vaccination in that those who will suffer the rare and likely minor harm are not the ones who benefit from the therapy. If we consider pregnancy a pathology, a parasite, men never have to worry about contracting the disease. Medically, to take contraception to protect one’s partner is a small risk, but is still a risk. In typical medicine, the patient receiving the intervention is also the one who will assume potential benefit and potential risk. While maybe a strange medical situation, it is absolutely a social obligation of men to advocate for better, more accessible male contraception and adopt it to protect female partners.

I thought about these two cases in comparison to screening such as breast cancer, colon cancer, or cervical cancer screening. There is an almost pathological cultural obligation to perform these screenings and they’re often expected of our populations. Clinics even have national measures that we target and report to the federal government to get as many patients as we can to get these screening tests. However, in the case of a declined colonoscopy, the only person that suffers from that decision is the patient themselves. We have unfortunately viewed the public health of these cancers as community diseases and they simply are not. We need to start decreasing the shame and burden on patients to engage in our screenings, especially in the setting of a global pandemic.

A crazy case related to this is that my clinic where I work, a federally qualified health center, a county clinic that receives funds from the federal government to provide quality care to underserved patients can give someone a tool to complete colon cancer screening or a pap smear immediately and we have not had the covid vaccine in our clinic in weeks. Completely insane. This single most important thing for our patients, for our population, is not available at our massive clinic. Meanwhile we’re putting out online marketing campaigns to encourage community vaccination but not offering it. Major facepalm.

The reason I bring these analogies up is because I doubt any dude will say they are unwilling to take a minor and small chance of risk for the potential that their partner gets pregnant. And hardly anyone questions a way riskier thing to get colon, cervical, or breast cancer screening with vastly lower chance of benefit when their doctor recommends it. However, when it comes to covid-19 vaccination (which let me reiterate should be a completely obvious decision and is totally irresponsible and shows a complete lack of ability to critically think to decline it), I have seen many partners, parents, grandparents, children unwilling to get vaccinated despite the huge, terrifying risk of spreading their contagious disease to their partners, grandchildren, parents and potentially killing their loved ones.

This is insane. It is such a clear, obvious decision that I cannot believe I am even giving it any thought. But I wanted to try to understand what the absolute hell is going on in the world. Ignoring the moronic conspiracy theories, I generally understand vaccine hesitancy in normal times from an individual perspective. It is because people think of it often as a personal medical decision and it is not. It is a social decision, which is why it should be obligated, a part of the contract for living in society, like paying taxes and driving the speed limit. We live in a community of other human beings, very few of which want to die such a painful death, so people should start looking around and think about how they would feel if they were responsible for someone’s death. But also, people, stop being dumb, get vaccinated for yourselves too. This is insane.

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