Bored Panda, a website that publishes “lightweight and inoffensive topics”, reports an allegedly true case from the US of a woman who refused to have her child vaccinated. The woman, who is described as a “conspiracy theory magnet”, provided 15 reasons why vaccines are more harmful than the disease they protect against.
When the doctor realised that he wouldn’t be able to dissuade her of her beliefs, he decided to present her with another one:
Have you considered the possibility that anti-vaccine propaganda could be an attempt by the Russians or the Chinese to weaken the health of the United States population?
The doctor deliberately deceived the woman and probably reinforced her belief in conspiracy theories by pretending to find them plausible himself. But the tactic worked. The mother consented to have her child vaccinated.
Right now, vaccination is key to overcoming the COVID-19 pandemic and regaining safe individual freedom. Yet a minority of people, like the woman in our example, still refuse vaccination on mistaken beliefs. But how far can we go to change their minds?
Would the doctor be justified in using similar tactics to make the woman consent to her own COVID-19 vaccination?
The best-interests view
Support for the doctor’s unconventional approach might come from a view recently developed by philosopher Moti Gorin and colleagues. They argue that a patient’s best interests should be a doctor’s primary guide in influencing medical decision-making, at least in situations where the doctor cannot mitigate severe biases through an open conversation.
Gorin and colleagues think about best interests objectively: such interests should be understood according to professional standards, not just in terms of what happens to be a person’s preference. And they emphasise that respect for a patient’s autonomy doesn’t “require that all patient preferences be honored, regardless of how informed or competent they are”. Sometimes, we are allowed or even required to override them.
If we apply this view to our case, we seem to get a clear result: assuming that vaccination is in the woman’s best interests and that the doctor cannot change the mother’s mind through an open conversation, the manipulative counter-question was permissible and completely justified.
But we might still feel uneasy. After all, the doctor deliberately induced a false belief in the woman and deceived her about his intentions. For this reason, we should look for another perspective on this case.
The disqualification view
The early modern legal theorist Samuel Pufendorf can help here. In his work on contracts, Pufendorf claimed that consent is invalid and obtained impermissibly if the consent-receiver – in our case, the doctor – “disqualified” himself by violating the norms of his role.
A doctor is bound by professional norms, which include, at a minimum, the obligation not to deceive patients. But our doctor engaged in deception and thereby disqualified himself.
This “disqualification view” gives us a verdict directly in opposition to the best interest view of Gorin and colleagues. And it is this disqualification view that we ought to adopt.
The disqualification view, unlike the best interests view, remains faithful to central medical norms. Particularly during a pandemic where public trust in the medical profession is key, allegiance to such a norm must be secured.
It is simply not worth sacrificing central medical norms to change the minds of the few “conspiracy theory magnets” out there and thereby risking the erosion of public trust in the medical profession.
From the perspective of public health, the few people who strongly adhere to conspiracy theories do not pose a real threat. And from the perspective of their individual health, people’s adherence to conspiracy theories, which are immune to rational circumspection, could justifiably be seen as their own responsibility rather than something doctors have to overcome by deception.
So, how far can we go to convince people who believe in conspiracy theories that their views are wrong? Well, rational persuasion should be a doctor’s first choice. If this remains unsuccessful, there are still various other types of influence consistent with professional norms. For instance, a doctor could still nudge a person into deciding at a later point to cool down, frame information in a certain way, or make certain pieces of information very salient, for example, by using pictures and videos, at least as long as doing so assists balanced decision-making.
All of these influences can make a difference and be consistent with professional norms. Sometimes, however, they might not make a difference at all. If so, we should simply accept that.
Maximilian Kiener receives funding from European Research Council, under the European Union’s Horizon 2020 research and innovation programme (project ID: 789270).