HPV vaccine controversy: Autonomy versus beneficence, and the erosion and promotion of social justice

Debates over the human papilloma virus (HPV) vaccine mandates represent conflicts between competing ethical values. These debates typically involve arguments between the ethical principle of autonomy, which argues against government intrusion in favor of individual preferences, and ethical principles such as beneficence, utilitarianism, justice and nonmaleficence, which argue against individual preferences in favor of compulsory and widespread vaccination to promote the health and common good of the greater population. The controversy over whether or not the HPV vaccine should be compulsory for the young also reflects an historical trend of increasing emphasis on science, technology, medicine and changing individual behaviors to solve public health problems. This emphasis parallels a decreasing emphasis on mandating public health interventions and the use of social reform actions to improve the public's health. However, individual and voluntary methods such as electing to become vaccinated against the HPV are less effective than mandatory methods especially among certain racial and socioeconomic groups that carry a disproportionate burden of health problems associated with HPV and other diseases. Related to this theme, this paper argues that an increase emphasis on autonomy can lead to the erosion of social justice. This paper also describes how an emphasis on beneficene, the welfare of children, and population groups in greatest need can justifies the use of public health and political authority to promote social reform and improve the common good and health of a population. Public health examples and ethical arguments are provided to support this claim.