Human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is a leading cause of cervical cancer in women but the virus is increasingly being linked to several other cancers in men and women alike. Since the introduction of safe and effective but also expensive vaccines, many developed countries have implemented selective vaccination programs for girls. Some however argue that these programs should be expanded to include boys, since (1) HPV constitutes non-negligible health risks for boys as well and (2) protected boys will indirectly also protect girls. In this paper we approach this discussion from an ethical perspective. First, on which moral grounds can one justify not reimbursing vaccination for the male sex? We develop an ethical framework to evaluate selective vaccination programs and conclude that, in the case of HPV, efficiency needs to be balanced against non-stigmatization, non-discrimination and justice. Second, if vaccination programs were to be expanded to boys as well, do the latter then also have a moral duty to become immunized? Two arguments in favor of such a moral duty are well known in vaccination ethics: the duty not to harm others and to contribute to the public good of public health. However, we argue that these are not particularly convincing in the context of HPV. In contrast, we believe a third, more powerful but also more controversial argument is possible. In our view, the sexual mode of transmission of HPV constitutes an additional reason to believe that boys in fact may have a moral obligation to accept vaccination.
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The term ‘discrimination’ appears to have two different uses. Although it is sometimes used to denote any form of differentiation between individuals, we want to focus only on illegitimate, unjust or prejudiced forms of discrimination, which arise when individuals are given differential treatment on the basis of characteristics that are not relevant to the case at hand.
In the remainder of the paper we will speak of boys’ moral duty to become vaccinated against HPV, even though their parents are to accept vaccination given that the vaccine would be offered in their early teens. We thus speak of boys’ duty to accept vaccination as shorthand for the parents’ duty to accept vaccination for their sons on behalf of their sons.
Given the fact that HPV vaccination is most effective before one’s sexual debut and is thus best administered in children’s early teens, this concern for health is to be framed in terms of the parents’ moral duties towards their children. In fact, arguing that individuals have the moral duty to promote their own health may be more controversial than arguing that parents have the moral duty to take care of their children’s health (Archard and Benatar 2010).
Whereas the usefulness of sex for the continuation of humanity is obvious, this is in itself no judgment regarding the desirability of humanity and societies continuing to exist. A case against the latter can be found in Benatar (2006).
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Luyten, J., Engelen, B. & Beutels, P. The Sexual Ethics of HPV Vaccination for Boys. HEC Forum 26, 27–42 (2014). https://doi.org/10.1007/s10730-013-9219-z
- Infectious disease
- Public health
- Sexually transmitted infection