Are Vaccines Ordinary or Extraordinary Care? (1/2)

In recent discussions about vaccines, it is clear that in general Catholics should take COVID vaccines despite the astronomically-remote connection to abortion. In fact, it is encouraging to see Catholics are the religious group with the highest COVID vaccination rate, and weekly Mass attendees are even more likely to be vaccinated than non-practicing Catholics.

Two related follow-up questions have arisen about vaccines. Are they ordinary or extraordinary care according to Catholic bioethics? Is vaccinating or not the default for Catholics? This two-part piece will explore these from various perspectives.

Once the claim of remote cooperation with abortion falls apart, some Catholics argue against vaccines for other reasons. Many of these rely on inaccurate assumptions. They either assume that there is no default between vaccination and non-vaccination, or they assume the Catholic default is not to vaccinate unless there is the most extreme reason. This piece will show the default for Catholics should be to get all medically recommended vaccines as ordinary care. This is not an absolute requirement to vaccinate but not vaccinating when medically recommended does require a very substantial reason.

This first part will cover arguments I see in moral theology as I know it. The second part will cover an article by a Catholic doctor and philosopher, and then have a conclusion covering both. Today’s part can be outlined: moral theology principles in basics, social doctrine, and bioethics.

EDIT: part 2, The Duty to Vaccinate in Catholic Social Teaching.

Basis in Fundamental Moral Theology

The first principle of practical reason is the first thing you learn studying Catholic moral theology. Thomas Aquinas expresses it “Good is to be done & sought after, evil is to be avoided.” Others vary it by having only one verb about good or having two about evil. But all these are all similar.

Disease is a natural evil for man. Thus, it should be avoided. The magisterium has been consistent on the goodness of immunization, which is the object of the act of vaccination. Thus, in general vaccination is a good to be done (immunization), a good to be pursued (disease prevention), and an evil to be avoided (disease). This is general, as allergies or immune issues exist.

Obviously, there can be a question of pursuing this good versus possible negative effects. There are three possibilities that exist in vaccines not widely recommended in the USA. First, some diseases are not present and not likely to be present without vaccines. For example, we generally don’t vaccinate against yellow fever. Second, the risk from the vaccine can be in the same range as the risk from the disease so the risk-reward benefit is not clear. This is why they are tested and not every vaccine is approved. This is a reasonable argument about participating in clinical trials for new vaccines. Third, certain populations have allergies or other very rare medical contraindications. For example, some vaccines are grown on eggs so those with egg allergies should avoid them. But, any approved or widely recommended vaccines have many hundreds or thousands of times more reward than risk.

Basis in Social Doctrine

Catholics don’t just have a duty to protect ourselves, we have a duty to others. If we don’t get infected with a disease, we won’t infect others with it. The principle of solidary, especially with those closest to us, further supports vaccinating. This will be taken up much more in-depth in part two.

Basis for Ordinary Care in Bioethics

In Catholic bioethics, certain things are considered ordinary and extraordinary care. (Some bioethics sources will use other terms like proportionate and disproportionate but the distinction seems similar or the same.) These types of care are not immoral and a Catholic can choose all of them. However, refusal of ordinary care either by a patient or by medical staff is not usually allowed. For example, in general, it would be unethical for me to refuse to stop eating, or for medical staff looking after me for some reason to refuse to give me food. This does not mean a hunger strike is directly and always immoral. It does mean that if one is going on a hunger strike it must be for the gravest reasons.

Defining Ordinary Care

How do we distinguish the two? I want to provide three sources that sound almost identical to show a consistent view over decades.

• The head of the NCBC notes in 2020: “Ordinary medical care is largely an intervention that is generally accepted as effective and not terribly burdensome or expensive.” He contrasts this: “Extraordinary means would involve severe burdens, physical or psychological or financial. Extraordinary means such as experimental treatments would not have a very high chance of effectively helping the patient.”
• Pius XII declared: “One is held to use only ordinary means—according to circumstances of persons, places, times, and culture—that is to say, means that do not involve any grave burden for oneself or another. A more strict obligation would be too burdensome for most men and would render the attainment of the higher, more important good too difficult.”
• Fr. Gerard Kelly, SJ, wrote in 1958: “Ordinary means of preserving life are all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or other inconvenience. […] In contradistinction to ordinary are extraordinary means of preserving life. By these we mean all medicines, treatments, and operations, which cannot be obtained or used without excessive expense, pain, or other inconvenience, or which, if used, would not offer a reasonable hope of benefit.”

Applying Ordinary Care to Vaccines

Given what we know about standard vaccines, they would seem to fall clearly in ordinary care. They have a reasonably good chance of success and are of the most minor burden. We have strong evidence that vaccines work. This ordinary vs extraordinary seems to match fairly closely to recommended vaccines vs vaccines that are experimental or only recommended in very specific circumstances. Those not recommended in normal circumstances would not have much chance of success here. Those rejected for too high of risk of reactions would be extraordinary as the risk-reward calculus is not so obvious.

There is obviously a difference in acute and preventative care. There is likely a slightly less serious moral obligation regarding ordinary preventative care vs acute care, but that does not mean we can ignore ordinary preventative care as we please or without serious reasons. If one has high blood pressure, for example, one can’t just reject both high blood pressure medication and lifestyle changes without a serious reason.

We have strong evidence that vaccines work. The reactions from approved vaccines are rare and usually minor, such that they are clearly a reasonable risk to take for disease prevention. Now, the Catholic Church does not make claims about scientific facts, but it does support both science and logic. John Paul II famous said, “Faith and reason are like two wings on which the human spirit rises to the contemplation of truth.” It is hard to argue using reason against the mountain of scientific evidence in support of vaccines and maintain that sense of reason.

Conclusion

By standards that have been consistent for decades, Vaccines are ordinary means. Disease is a physical evil to be avoided, so the most fundamental principle of do good and avoid evil can apply. Social doctrine points to us having obligation others near us and society more broadly. One can skip ordinary means in exceptional circumstances, but they have a general obligation.

EDIT: part 2, The Duty to Vaccinate in Catholic Social Teaching.