In his essay “The Medical Profession as a Moral Community,” Pellegrino addresses the characteristics of a moral community:
- Members of the group share a covenantal relationship both with each other and with society.
- The community has certain standards that remain constant regardless of contemporary leaders or members.
- The community is more than the sum of all its members.
By this definition, the field of medicine can be considered a moral community. The medical profession is more than each physician treating his or her respective patients. The moral nature of the medical profession can actually be seen as completely necessary for the continued ethical function of the profession, given the vulnerability of patients.
Pellegrino describes the vulnerability of patients, and how this imposes even more of a need for doctors to remain moral as individuals and as a community. In the not infrequent event of illness or disease, Pellegrino argues that the patient, no matter how self-sufficient they may be in other situations, becomes vulnerable in the medical setting. This inescapable vulnerability then creates a moral obligation for the physician.
This balance between beneficence and patient autonomy in a complex medical situation brings us back to what we discussed at the beginning of this semester. While the physician has the obligation to “First, do no harm,” they must also, Pellegrino says, protect their patients against exploitation, which may include protection from the patient themselves or the physicians themselves. One aspect of protecting the patient from themselves may be in the case of routine vaccination.
If physicians belong to a moral community that share a covenantal relationship with both each other and with society at large, then it would follow that they should support public health policies that protect the population majority. One of these policies is mandatory vaccination.
While vaccinations are considered mandatory for children to attend public school, the majority of the states in the US allow both religious and philosophical exemptions, which allow parents to refuse vaccination on any terms. If the medical profession is a moral community, then they have the obligation to protect their patients from the exploitation of the media with regards to anti-vaccination campaigns.
If physicians were to truly take a stand as moral agents in the medical profession, vaccination rates could possibly increase, which would decrease the number of outbreaks in communities, like the measles outbreaks which have gained attention recently. If physicians were to make their case for vaccination instead of deferring to the opinions of uninformed parents, they might be able to make a difference.
Pellegrino, Edmund (1990). The Medical Profession as a Moral Community. Bulletin of the New York Academy of Medicine. 66/3 221-232.