Eubios Journal of Asian andInternational Bioethics
EJAIB Vol. 32 (1) January 2022
www.eubios.info

ISSN 1173-2571 (Print) ISSN 2350-3106 (Online)

Official Journal of the Asian Bioethics Association (ABA)

Copyright ©2022 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

Contents

page

Editorial: Risks, wars and pandemics
1- Darryl Macer
Warrior’s Bravery
2- Humitake Seki, Gestur Bjorn Christianson, Mikko
Vilenius
Ethics of Freedom: Comparing Locke, Sartre and Gandhi- Ravichandran Moorthy, S. Panneerselvam,
3
Saji Varghese, Piyali Mitra
Euthanasia in Japan as portrayed by Shichiri Nakayama’s
novel, The Legacy of Dr. Death
6- Atsushi Asai
Ethical Issues of COVID-19 Vaccination Requirement for
On-Site Employees in Philippines
10- Laika Mae E.Timon and Rogelio P. Bayod
The Perpetuating Global Online Propaganda of theAnti-Vaccination Philosophy in the midst of the
COVID-19 Pandemic
16- Dianne E. Loyola and Rogelio P. Bayod
Challenge of Legitimacy in the Implementation of
COVID-19 vaccination requirements for on-site workers- Reyjane Mae P. Mercado and Rogelio P. Bayod 20
Utilitarianism and Compulsory Covid-19
Vaccination in Nigeria
25- Ikechukwu Monday Osebor and Marta Luciane
Fischer Allocation of Healthcare Resources During Public
Health Emergencies Should Not Perpetuate Ageism 27- Czeazar Ianne E. Lupo and Rogelio P. Bayod

Editorial: Risks, war and pandemics

f

f

f

f

One of the critical pillars of bioethics as the love of life
is the preservation of life. It is already dif icult for livingorganisms including human beings to prosper without
adding in gross human irresponsibility. As we start 2022
war has shattered the presumption of state sovereignty
that is one of the bedrocks of modern human rights. At
times there are demands of human rights to intervene
across national borders to protect against cross humanrights abuses, but the war in Ukraine is unethical.
Although many countries have fought wars and abused
human rights, there is no excuse for any of these kinds ofinterventions.
We start this issue with a reminder of some traits andexamples of an honourable warrior in a samurai tradition,

as explroed by one of my mentors, Professor Seki and twoof his colleagues from Kashima Shinryū. As we recently
met to discuss this article and life, we re lected on how
timely it was that this paper submitted in 2021 was being
published now. It was written prior to the war. There are
age-old lessons, that apparently some of the modern
generation have forgotten on the horrors of war.
The next paper is suitably entitled Ethics of Freedom:
Comparing Locke, Sartre and Gandhi, contributed by Prof.
Moorthy and colleagues. It is also timely to re lect on thephilosophical foundations of the basis of human rights
and how we should uphold the essence of nonviolenceand protect human rights. These concepts are found not
only in British, French and Indian traditions, but globallyu.
This is followed by a review of a novel of Shichiri
Nakayama on euthanasia by Prof. Asai. Himself the author
over the decades of a number of empirical studies of the
topic, he has taken the time to explore how literature on
this topic may also be shaping our perceptions of assisted
suicide and euthanasia. What roles should doctors play?
Certainly honorable ones, the same as samurai and all ofus, as we exercise our responsbilities.
The COVID-19 pandemic continues to challenge us all
and reform the way we consider development ethics. As
vaccines have become more available, the obvious
question that we can ask is at what stage should it become
our clear moral responsibility to get vaccinated in order toprotect others? There are four papers exploring this topic
in this issue, including three from Prof. Bayod andcolleagues in the Philippines and one from Nigeria. At
what stage do we move from vaccine skeptics toenthusiasts? While my personal; and professional advice
is to get vaccinated, it is up to each person. As discussed
in the WeCope Committee report on COVID-19
vaccination, there are existing mandatory vaccinations,found in many countries.
The inal paper explores ageism which is aninteresting issue for COVID-19, given that in general the
mortality associated with COVID-19 doubles every 6 yearsof age. EJAIB does not endorse any particular policy but
we welcome discussion of the science and associatedethical issues in these pages, and in the frequentInternational Public Health and Bioethics Ambassador
Conferences.
- Darryl Macer (darryl@eubios.info)

2Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

Warrior’s Bravery- Humitake Seki, Ph.D.
Emeritus Professor, University of Tsukuba and 19th
Headmaster of Kashima Shinryū, Japan
Email: hughseki@wd6.so-net.ne.jp- Gestur Bjorn Christianson, Ph.D.
Adjunct Acting Masters, Martial instruction bureau of theKashima-Shinryū Federation of Martial Sciences; UK
Email: bjorn@kashima-shinryu.uk- Mikko Vilenius, Ph.D.
Adjunct Acting Masters, Martial instruction bureau of theKashima-Shinryū Federation of Martial Sciences; UK
Email: mikko@kashima-shinryu.uk

f

f

f

f

f

f

f

f

f

In any great warrior, bravery is a de ining
characteristic.
Shimozawa Kan’s historical essays on the Shinsengumi(the Kyoto-based special police force established by the
Edo Shogunate from 1863 to 1869, constituted of irstrate warriors) record the story of Tani Sanjūrō, anillustrative example of the meaning of bravery andcowardice for warriors. Tani Sajūrō was one of theforemost warriors of the Bichū-Matsuyama domain, amaster of Taneda Hōzōin Ryū spear art, and the headteacher of spear technique for the Shinsengumi.
In this role, he was an outstanding teacher of warriors
in the dojo, which drew favourable comparisons withwarriors of an earlier age and so earned him a reputation
as a “Sengoku Spear.” However, during the famous Ikedaya
incident, when he was supposed to attack the antishogunate Shishi-warriors as a member of the Hijikata
corps, no witnesses could attest to his having achieved
any victories or captured any prisoners during the battle.
He was further disgraced as he failed to keep propercomposure and properly assist in the seppuku (formal
suicide by disembowelment) for Tauchi Toshizō, injured
in a private ight, when ordered by Hijikata Toshizō to act
as kaishakunin (the second to the person committing
suicide, beheading them after the disembowelment so as
to preserve their dignity and that of the proceedings). As
a result, he became unpopular, and his nickname changed
from “Sengoku Spear” to “Dojo Spear.” Eventually he wasassassinated one month after the bungled kaishaku on thestone steps of Gion, most likely by Saitō Hajime under theorders of Kondō Isami .
As this example illustrates, when even a warrior like
Tani Sanjūrō can be considered a “coward” for risking hislife while serving under a poorly educated but determined
leader such as Kondō Isami, it is truly a tragedy. We cancontrast this with the example of Iwama Okurazaemon,
who was blessed by an excellent lord as a vassal of theTakeda Clan.
Iwama Okurazaemon was a good looking man, but hewas very timid, and repeatedly led from the battle ield as
he was unable to cope with stresses of combat. This
became public knowledge in the Takeda clan and Takeda
Shingen’s retainer Oyamada Shingen recommended that
Iwama should be exiled from the clan. But instead, when
Takeda Shingen witnessed this cowardly behaviour during
a battle, he decided to teach Iwama to be brave. His
method of “tough love” was as follows:

In the irst month of the 19th year of Tenbun (1550),
during the attack on the Toishi castle in Shinano, Iwama
was bound in a sitting position, facing the enemy. As thethunder of gunshots roared, he was terri ied nearly to thepoint of death yet luckily none of the shots hit. He thenrealized that “if you are lucky, even a storm of bullets
won’t hit you”. With this, he ceased to be frightened bydeath, and went on to become a heroic warrior.

Figure 1: ”Kintoki wanders between this world and thebeyond” Kawanabe Kyosai (1863-1866): Dream of Sakata
Kintoki, in Kyosaihyakuzu(the irst printing by
woodblockprint)
Citing this example, Prof. Kanō (1860-1938)
concluded: “If you expect the worst possible outcome andfully accept it, your tanden (a focus point within theabdomen for internal meditative techniques) will naturally
settle … cultivate your courage through training, and you
will not be disturbed even if the earth and the heavens
suddenly change places.”
In the same vein, there are countless examples of“cowardly” people that have been cultivated into
courageous warriors in favourable social environments.
There are, of course, also people who are brave by nature.
This is illustrated by the Japanese saying “Sandalwood isalready fragrant as sprout”, meaning that a great person
will display their potential even in childhood.
For example, there is the story of Sakata Kintoki(of icial name with military rank: Sakata Shume-no-jo
Kintoki: 956-1012), a mid-Heian period warrior (Fig. 1).
Serving under Minamoto no Yorimitsu, he achieved great
deeds and became one of the Four Heavenly Kings. He
made notable contributions in defeating both Shutendōji
and Tsuchigumo.

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)
When Sakata Kintoki was asked how to become abrave warrior, he instantly replied “You must know
cowardice”. One should bear this in mind always.
References
Kanō Jigorō (1929): Tanryoku, Shūyō Z|enshū Daikyūkan(pp. 61-63), Dai Nippon Yūbenkai Kodansha, (Editor
and Publisher: Noma Seiji). 804 pages.
Shimozawa Kan (1977): Shinsengumi Monogatari (pp.
55-63), Chūōkōronshinsha. 376 pages.

Ethics of Freedom: Comparing
Locke, Sartre and Gandhi- Ravichandran Moorthy, Ph.D.
Universiti Kebangsaan Malaysia
Email: drravi5774@gmail.com- S. Panneerselvam, Ph.D.
Chennai Philosophical Forum, India- Saji Varghese, Ph.D.
Lady Keane College, India- Piyali Mitra, Ph.D.
University of Calcutta, India

f

f

f

Introduction
What is freedom? The contemporary history of humanity
is a quest for enduring human freedom over oppression,
subjugation and tyranny of many forms. In that pursuit,many wars have been fought, and millions of lives have
perished, and many ideologies were born. In simple
terms, freedom to the ability to act or change without
being constrained. Freedom manifests when obstacles toinitiate change or to express free will are removed. From aneeds perspective, freedom is when an individual canpursue his or her needs, wants and aspirations freely.
However, freedom may not be absolute; some constraints
or caveats can manifest from personal ethics and morality,
family, cultural, faith systems and governance structures.
It may also differ from one society to another. From areligious or philosophical perspective, freedom is often
associated with liberty and autonomy, and only exist in ahuman realm. This type of freedom is also known aspolitical freedom expressed in the forms of human rights
and civil liberties, which are often legislated and protectedby laws. Nonetheless, the limits and depths of political
freedoms such as freedom of choice, assembly,
association, and freedom of expression are often debatedand sometimes challenged through modern history.
As previously said, freedom is a regulation, and selfdetermination can be described as the human capacity toact (or not act) as we choose or like, without being
compelled or restrained by external forces (Cevizci,
1996:408). Further, it also refers to a presumption of
moral responsibility, in which actions have theconsequence of being favoured or desired and receive
praises, or it may be something which is undesirable ordisfavoured and receives disapproval and punishment.
Whatever the intentions and responses, those actions are
performed freely, as a rational human being. Individuals
are presumed to act morally and rationally based on their3

own choices and reasonable decisions. As such, human
freedom is considered as an inherent and inalienable
right, which exist within the framework of humanknowledge (Gokalp, 2012). Individuals are regarded as
moral agents, acting voluntarily in accordance with theirpersonal preferences and rational choices. As moral
agents, individuals take into account the Self and others inmaking decisions based on individuals' free will.
Individuals should be aware that their freedom to create afoundation for moral considerations is a fundamental
feature of human beings.
This paper seeks to compare the thoughts of freedom
from three imminent philosophers and social thinkers ofmodern human history: John Locke, Jean-Paul Sartre, andMahatma Gandhi. John Locke's theorizes based on
freedom of action and freedom of will that has had an
impact on the philosophy of action and moral psychology.
Locke provides unique explanations of action andforbearance, will and willing, voluntary (in contrast to
involuntary) acts and forbearances, and freedom (incontrast to necessity). Jean-Paul Sartre is a key igure in
the philosophy of existentialism and phenomenology. “For
Sartre, existence precedes essence, freedom is absolute, andexistence is freedom. It has been made clear that Sartre
does not believe that any essence or substance can be
attributed to individuals prior to their existence.
Individuals, irst of all, exist, and there is no ‘human nature’
which exists outside or inside beings. Freedom is therefore
limitless, but the physical limitations of the world are taken
into consideration” (Manzi, 2013). Mahatma Gandhi, thefather of the Indian independence struggle, is seen as aproponent of freedom from colonial oppression
throughout the world. According to Gandhi, freedomrefers to some total of self-respect, self-restraint andmaturity, which can alone be attained through nonviolence. He claims that "no society can be built on thedenial of individual freedom." It goes against man's very
nature. Deprivation of liberty is the equivalent of death.
True freedom is one that can be attained solely throughone's own efforts, with no outside assistance. Freedom isalways necessary because a nation or an individual cannot
fully develop without it (Bhardwaj & Basumatary, 2013).
The following sub-sections discuss the views of thesephilosophers.
John Locke on Freedom
John Locke (1632-1704) is celebrated as the founding
father of liberalism who proposed his ideas about
freedom in response to the 17th-century politicalenvironment in Europe and particularly in England. He
was a strong critique of the theories of absolute monarchy
as mainly advocated by Thomas Hobbes, R. Filmer, Tully
and many others. Scholars believe that Lockean freedom
is a single power, the power to do one's will (Locke,
1975:96). Locke describes freedom as a "two-way" power,
really a combination of two conditional powers belonging
to an agent, that is, to someone endowed with a will.
Human beings or agents are free with regard to a speci ic
action or forbearance inasmuch as if the individual wills
to do the action and then the individual has the power todo the action and if she wills to forbear doing an action.
Locke notes that agents who are unfree to take some4

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

action as acting under, or by, necessity. So freedom,
according to Locke conception, is a property of substances
meant as persons, human agents.
Locke does not ind "freedom of will" meaningful butallows that "freedom to will" could mean that, when any
action in a man's power is proposed to his thoughts as
something to be done by him, the man is free either to will
or not-will on the matter (Moulds, 1961). Lockean scholar,
LoLordo (2012) holds that Locke conceives of active
power not as the underlying source of the ability to makechanges, but has the capacity to make changes by one's
own power (rather than by the power of another); that
active power is not unique to the soul and should not be
identi ied with the will, which is merely one among many
active powers that Locke's conception of freedom ofaction is merely the ability to do as one's will. Freedom ofaction, properly conceived, includes neither avoluntariness condition nor a counterfactual condition;that although (non-human) animals have many active
powers, they do not possess wills or freedom of action,and hence animals provide no reason to think thatsomething in addition to freedom of action is required formoral agency; that there is indeed only one notion ofliberty, namely freedom of action. The capacity to suspend
is merely a species of this freedom. That what
differentiates moral agents from beings who are notmorally bound is freedom of action which includes thepower to suspend and that suspension of desire can andindeed must be voluntary. Locke may be agnostic about
the metaphysical grounds of moral agency, but he is not
thoroughly agnostic about all metaphysical aspects of his
theory of freedom.
It is to be noted that Locke's conception of freedom as
the power to perform what one's will is held to be only
incidental to the real problem of the freedom of the self.
His theory is criticized as minimizing man's rational andspiritual nature, and that they exclude freedom of thought
and choice, they make God responsible for all human's
acts even for the evil acts and thus smudge the differences
between good and evil, thus failing us to see that ideas
frequently determine desires. Locke's views pertaining toincoherent hedonism is inconsistent with his objective
altruism. He admitted that no man's knowledge could go
beyond experience, so the principle of necessity is notnecessary knowledge, and the adequate grounds of moral
judgment are destroyed. As a result of his narrowly
empiricistic interest in what men can know, his concept
was not successful enough in determining how and why
men can know. Despite the various inconsistencies, histheory of freedom supports an enlightened pursuit ofhappiness and moral responsibility for avoidable
ignorance and inadvertency for thinking and choices.

f

f

f

f

f

f

f

f

f

f

f

f

Sartre on Human Freedom
How to de ine freedom? Strictly speaking, a formal
de inition of it is not possible. It is because human reality,
being free, is continually making itself. The past can bede ined, but the present cannot be de ined but only bedescribed. Freedom though inde inable, is describable.
Man learns his freedom through his action; therefore,
freedom can be best understood by describing thestructure of human actions. Sartre says that freedom has

no essence and hence cannot be de ined. For Sartre,
nihilation, temporalization, freedom and choice are one
and the same. He further says that consciousness has
appeared to us as freedom. Freedom is not a property ofsubsisting in consciousness but rather the inner structureof consciousness. In Sartre's play, The Flies, when Orestes
realizes his position among his people of Argoes, hebecomes a “freedom-conscious consciousness”. To be free,
he does not mean to obtain what one has wished, butrather to project towards speci ic goals.
In other words, for Sartre, every human consciousness
is a free choice from which it acts to express itself. Man iscondemned at every moment of his life to create himself.
Sartre de ines consciousness as “a being such that in its
being, its being is in question insofar as this being implies abeing other than itself.” (Sartre, 1963:23) Sartre spoke
extensively on the doctrine of non-egology. For him,
consciousness is non-egological. Sartre rejects thedoctrine of the transcendental ego of Husserl. Sartre
claims that there is no permanent self or ego within or
behind the stream of consciousness. This means that
consciousness is egoless or not-self. For Husserl, thetranscendental ego is important for unifying the stream ofexperience. One can say that this is the subject-pole ofexperience. In other words, the ego here is nothing but theepistemological self. In the transcendental ego, there issomething permanent residing in the stream of everchanging conscious acts. This permanent thing in
consciousness is known as the “transcendental ego”,
which is rejected by Sartre.
Freedom is identi ied with the human consciousness.
For Sartre, human freedom is neither a quality gained byan individual through his experience; nor is freedom
something a man lacks within his human constitution.
Freedom is the human being itself. For Descartes,
consciousness is identical to thought, but for Sartre, it isidentical to freedom. For Sartre, it is not possible todistinguish between human reality and freedom because
freedom is a human reality. In The Flies, Sartre shows that
Orestes does not exist irst in order to be free later. Thereis no difference between his being and his being free. Thismeans that freedom constitutes the existential structureof man. Sartre argues that a man is ontologically free,which cannot be taken away from him. He is of the viewthat man is free even in the hands of the executioner(Sartre, 1963:25)
In Existentialism and Human Emotions, Sartre says thatto exist is not merely to determine the relationshipbetween my for-itself and my in-itself, but to determine
my existence with respect to others. He talks about theabstract possibility that there could be an isolated humanbeing for whom others would not exist, but such a
possibility is meaningless for us. He says: “It would
perhaps not be impossible to conceive of a For-itself
which would be wholly free from all For-others...But thisFor-itself simply would not be ‘man’” (Sartre, 1963:376)
Just as the for-itself stands in a relation of “internal
negation” to the in-itself, so it stands in a comparable
relation to the Other. Insofar as it discloses the existenceof another person, this second negation has a radicallyalienating effect on the for-itself. Sartre says that therelationship of the for-itself to the Other as one ofEubios Journal of Asian and International Bioethics 32(1) (January 2022)
irreducible con lict. This relation is con lictual in nature
because it is impossible for each of the two to recognize
the other as a for-itself at the same time.
Is there anything called "omnipresence of freedom"?
Sartre answers this by saying that irst of all, theomnipresence of freedom does not mean that it is always
possible to resist the red-hot pincers “but simply that thevery impossibility…must be freely constituted”. His
example of the torture victim points to the relationshipbetween facticity and freedom. His existentialism deals
with the constituting freedom of consciousness. In Searchfor Method, Sartre says that when the bare constituting
freedom of consciousness and real possibility coincide, a
new philosophy of freedom will emerge. “As soon as there
will exist for everyone a margin of real freedom beyond the
production of life, Marxism will have lived out of its span; aphilosophy of freedom will take its place. But we have nomeans, no intellectual instrument, no concrete experience
which allows us to conceive of this freedom or of thisphilosophy,” says Sartre (Sartre, 1944:34).

f

f

f

f

f

f

f

f

f

f

f

Gandhi on Freedom
Gandhian ecologism emphasizes the importance of livinga life of concern and care, applying ethical and spiritual
principles to all aspects of nature. The importance andfunctions of ecosystems are central to human ecology. It isa clearly value-laden topic. Life becomes much moremeaningful when lived from within, more self-consciously,
deliberately, in perfect harmony with spiritual values—
and the process of transformation is never exclusive, but
always inclusive. The Gandhian philosophy ofdevelopment should be studied alongside the philosophyof happiness. It arose as a critique of the dominantwestern-centric approach to development, with its
misplaced emphasis on promoting individual growth andself-advancement, harnessing nature, attaining
technological sophistication, accelerating urbanization,and increasing the use of marketplaces for the
distribution of economic goods and services. A humanecology viewpoint is comprehensive and holistic. Gandhi
did not advocate separate rules for different aspects ofhuman life, but rather treated all aspects as a whole,which best exempli ies the human ecological perspective.
Consumption and sustainability are intertwined. Whileneoliberals advocate a consumerist trend, ecologists
emphasize the type of development that allows future
generations to meet their basic needs. An ideal discourseon sustenance should cover a wide range of topics,
including the nature of human need, the social, cultural,and ethical in luences that shape consumption patterns,
and the most important question of 'suf iciency.' The
question of how much is enough, however, remains
relevant. The instrumental view of nature is frequently
contrasted in this debate with a "deep ecology"
perspective, which sees the preservation of ecologicalintegrity as an ultimate necessity. The preservation of
ecological integrity carries a sense of obligation. The
instrumental viewpoint can accommodate a view ofnature as serving many different purposes for humanity.
This re lects the anthropocentric aspect once more. Given
that we do not have a universally agreed-uponunderstanding of either the functioning of nature or the

5

dynamics of human society, uncertainty is a signi icant
complicating factor. There is considerable disagreement
about the risks involved in either disturbing nature or
foregoing economic development. Thus, the GandhianPhilosophy is concerned with the question of what value
pattern to follow for the sustenance of earth's resources.
Human ecology is associated with the ecologicalconsequences of everything humans do. We are alsointerested in resource generation, sustainable use, andhuman adaptive growth and development. All of thisoccurs in an environment in which the criticalinterconnections between humans and nature arerecognized and reinforced. This entails refraining fromdoing anything that may harm our fellow beings, nature,or future generations. At its heart is a profound sense of
responsibility for other humans and the environment, as
well as love for all living things. Gandhi's daily life
included conservation. He would be extremely frugal withwater. The same could be said about money and otherpersonal assets. He also discovered the need to save hissexual energy for bigger goals. They could be dismissed as
austere practices associated with him on a personal level.
Gandhi emphasized the importance of conserving
resources for future generations. In all of this, heembodied a true ecologist, whose practices were models
of ecological living worthy of imitation.
Gandhi's concept of swadeshi, or self-reliance, hasmany implications for the creation of a non-exploitative
society. According to Johan Galtung, the father of modern
peace research, self-reliance is inextricably linked withecological balance. "When ecological cycles contract theconsequences of production and consumption, in terms ofdepletion and pollution, will be not only more visible, butalso more direct. The farmer who by and large produces
what he consumes and consumes what he produces has thegut knowledge that pollution and depletion will be
detrimental to him and his off-spring, and this very
knowledge initiates the type of negative feedback that may
prevent ecological problems from surfacing at all. Depletioncannot be relegated to some far-off corner of the world,
because in that corner they are also practicing self-relianceand do not let raw materials out except to neighbours at
the same level” (Galtung 1976).
It reaf irms Gandhi's belief that everyone has equal
capabilities, while also emphasizing the importance of
having governance through elected representatives. In themodern era, Amartya Sen and Martha Nussbaum,
advocates of development ethics, emphasize on the goal ofdevelopment as the development of human capabilities. In
response to the question, "What is development?" Sen andNussbaum's response is – the improvement of certain
human functions and the expansion of human capabilities
to such functions. Freedom and capability expansion are
well-known de initions of development (Sen, 2008).
Nonetheless, there are a variety of ways to become free,and emphasizing economic freedom does not serve thepost-scienti ic conception of development well.
Conclusion
The notions of freedom developed by Locke, Sartre, andGandhi appear to converge at some points while diverging
in other areas of study. Nonetheless, all of them appear toEubios Journal of Asian and International Bioethics 32(1) (January 2022)

extrapolate the idea of freedom based on the philosophies,
trends, geography and experiences of their times. In
analyzing freedom, they seek to explain the fundamental
principles such as the nature of human existence, rights
and justice as human beings, and societal and governancestructures that in luence human actions. One of Locke's
most novel ideas was that all people are born equal andendowed with the same right to seek self-preservationand happiness. This is a widely held belief today, but it
was a revolutionary idea in Locke's time because it
contested the belief that there is a certain natural
hierarchy of individuals. Finally, Locke's perspectives on
freedom and rights set the groundwork for modern
societies with equal rights for all. Sartre had a different
take on the notion of freedom. He argues that existence
precedes essence, which means God did not have a grandplan when he created humans. As such, by just existing,humans have absolute freedom of choice and actions. In
fact, human is condemned to be free because he did not
create himself. The only option we do not have is not tohave options. Freedom is absolute, and existence is
freedom. It has been made clear that Sartre does notbelieve that any essence or substance can be attributed toindividuals prior to their existence. Individuals irst must
exist, and there is no 'human nature' outside or inside
beings. Freedom is therefore limitless, but the physicallimitations of the world are taken into consideration. On
the other hand, Gandhi broadened the concept of freedom
from intrinsic individual freedom of expression andchoice to a nationalistic and patriotic quest for self-rule in
the face of colonialism. According to Iyer (2000), freedom
is also the notion of obligation to others as well as tooneself while retaining the element of voluntariness thatis the very foundation of freedom.
References

f

f

f

f

f

f

f

f

f

f

f

Bhardwaj, B. and Basumatary, I. (2013). Gandhian Concept ofFreedom and Non-Violence and Its Viability in Today’s
Society. IOSR Journal of Humanities and Social Science (IOSRJHSS), 16(3), 42-44.
Cevizci, A. (1996). Felsefe sozlugu. Ankara: Ekin.
Galtung, J. 1976). Trade or Development: Some Re lections on
Self-Reliance. Economic and Political Weekly. 11, 207-215.
Gokalp, N. (2012). Philosophy Education and Human Freedom,
Procedia - Social and Behavioral Sciences. 47, 477-479.
https://doi.org/10.1016/j.sbspro.2012.06.683.
Iyer, R. (2000). The Moral and Political Thought of Mahatma
Gandhi. Oxford University Press.
Locke, D. (1975). Tree Concepts of Free Action, Part 1.
Proceedings of the Aristotelian Society (Supplemental Volume)
4, 5-112.
LoLordo, A. (2012). Locke’s Moral Man. Oxford: Oxford
University Press
Manzi, Y. (2013). ‘Jean-Paul Sartre: Existential “Freedom” and thePolitical’. Available at https://www.e-ir.info/2013/01/23/
jean-paul-sartre-existential-freedom-and-the-political/
Moulds, H. (1961). John Locke’s Four Freedom Seen in a New
Light. Ethics. 71(2), 121-126.
Sartre, J. P. (1963). Search for a Method. Trans. Hazel E. Barnes.
New York: Vintage Books.
Sartre, J.P. (1944). Being and Nothingness. Trans. Hazel E. Barnes.
New York: Washington Square Press.

f

f

6

Sen, A. (2008). ‘The Economics of Happiness and Capability’. In
Bruni, L., Comin, F. and Pugno M. (Eds.) Capabilities andHappiness. OUP Oxford.

Euthanasia in Japan as portrayedby Shichiri Nakayama’s novel, The
Legacy of Dr. Death- Atsushi Asai, M.D., Ph.D., M.Bioeth
Department of Medical Ethics, Tohoku University Graduate
School of Medicine 2-1 Seiryo, Aoba-ku, Sendai, Miyagi,
980-8575, Japan
E-mail: aasai@med.tohoku.ac.jp
Abstract
Over the past several years in Japan, cases of voluntary
euthanasia or assisted suicide, rarely disclosed until
recently, have occurred in close succession. The purposeof this short essay is to examine euthanasia-related issues
considered important in modern-day Japan by presenting
and analyzing a novel by Japanese novelist Shichiri
Nakayama, The Legacy of Dr. Death. This novel was madeinto a commercial ilm by director Yoshihiro Fukagawa,entitled The Legacy of Dr. Death: Black File, which was
released in 2020 (5). I also compare the novel with theilm and discuss the ethical signi icance of some of thedifferences between the two works. Euthanasia-related
issues to discuss include
perception of oneself as aburden on others as a primary reason for requesting
euthanasia; relationship between law and ethics; andethical implications of differences in Dr. Death’s depictionin the two works. Fiction works such as novels and ilms
can mirror real social situations from which they are
produced. I feel that this novel teaches us that we need tokeep thinking about euthanasia issues, dif icult as theyare.
Keywords: Japan, Euthanasia, Fiction, Burden, Law,
Ethics, Jack Kevorkian, Medical assistance in dying
1 Introduction
Over the past several years in Japan, cases of voluntary
euthanasia or assisted suicide, rarely disclosed until
recently, have occurred in close succession (1-3). Inspiredby these events, ethical, legal, and social debates about apatient’s right to self-determination of death—in otherwords, their right to die—have arisen in Japan, as has
happened in many other countries. The purpose of thisshort essay is to examine euthanasia-related issues
considered important in modern-day Japan by presenting
and analyzing a novel by Japanese novelist Shichiri
Nakayama, The Legacy of Dr. Death (4). This novel was
made into a commercial ilm by director Yoshihiro
Fukagawa, entitled The Legacy of Dr. Death: Black File,which was released in 2020 (5). I also compare the novelwith the ilm and discuss the ethical signi icance of someof the differences between the two works. Below, I present
a spoiler-free essay that will not reveal to the reader theidentity of Dr. Death in either the novel or the ilm. For the
purposes of this paper, euthanasia is de ined as the act ofkilling an individual who is suffering severely in a peacefuland painless manner, in compliance with the individual’s
own or someone else’s request.

f

f

f

f

f

f

f

f

f

f

f

f

f

f

2 The Legacy of Dr. Death: A summary
In this detective novel, detectives in a police murder
investigation department try to arrest a mysterious
person, self-named “Dr. Death,” for murder. Dr. Death
receives requests from people who want to die due tosevere illness-related suffering (requester: patient) or
those who want to end the painful dying process of theirfamily member (requester: a member of the patient’s
family) through a euthanasia request site made by Dr.
Death; the patient in question is euthanized directly by Dr.
Death. Dr. Death states on the euthanasia request site that
this mission and cause was inspired by a US doctor, Jack
Kevorkian, who performed 129 assisted suicides and one
active euthanasia during the decade between 1989 and
1998, earning him the title of “Dr. Death.” Accordingly, Dr.
Death in Japan also inherited Dr. Kevorkian’s nickname (4,6, 7).
Believing in an individual’s right to die and theimportance of self-determination of death, Dr. Death has
euthanized many people suffering from an illness or
disability in order to end their agony. Dr. Death has also
attempted to transform Japanese society (where
euthanasia remains illegal) and build a society where apatient’s right to die would be respected through medical
assistance in dying. Dr. Death has no intentions to earnmoney through the practice of euthanasia, offering these
services at a very low price.
The police investigation inds at least three end-stage
cancer patients and an end-stage dilated cardiomyopathy
patient who have been euthanized by Dr. Death. There isalso an elderly patient with heart failure and severe
dementia, and her death is strongly suspected to havebeen due to euthanasia at the request of her son, her only
family member. In a case of attempted euthanasia, apatient with severe collagen disease died a natural deathat the hospital; plans for euthanasia at her own home by
Dr. Death had been made for after her discharge. Patientages varied from the early twenties to 90 years old, as did
their medical conditions, prognoses, and inancial
statuses. In some cases, the suffering patients made theirown requests for euthanasia to Dr. Death, while in othercases, the patient’s family member did so on their behalf.
Some patients consulted with their families and were inagreement about the euthanasia, while others made theirrequests to Dr. Death without their families’ knowledge.
The team of detectives, Hayato Inukai and Asuka
Takachiho, follow Dr. Death. During this process, most of
the bereaved family members express their deep
gratitude toward Dr. Death, as their loved one’s
intolerable suffering was ended peacefully andcomfortably through the practice of euthanasia. The two
detectives are shocked by the families’ appreciation of Dr.
Death. Inukai has a daughter in her early teens who has
been hospitalized for persistent renal failure; she has
been undergoing chronic dialysis and is in considerable
suffering. Inukai is con licted by the desire to end the painof his daughter, feeling that there may be somejusti ication of euthanasia, and the strong sense of his
professional calling to catch this serial killer. While the

f

f

f

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

7

detective team eventually succeeds in arresting Dr. Death,
Inukai and Takachiho are still confronted by theremaining ethical dilemma about the ethicality ofeuthanasia.
3 Main issues regarding euthanasia in modern Japanas depicted in the novel
1: Perception of oneself as a burden on others as a primaryreason for requesting euthanasia
The wording on Dr. Death’s euthanasia request site differs
between the novel and the ilm. In the novel, it reads, “Areyou worried about end-of-life treatments for your loved
one? Do you not lead a hard life because your loved one wasgiven a hopeless diagnosis from his or her doctor and you
have serious inancial problems and mental distress? Dr.
Death promises to give your loved one a peaceful andpainless death.” In the ilm, however, the sentences
depicted on the site are as follows: “It is very noble andprecious that a patient wants a peaceful death for the sakeof their beloved family. Every patient suffers from theknowledge that he or she has put a heavy burden on thefamily, sometimes more than his or her own sufferingfrom the illness.”
It seems that the euthanasia site depicted in the novel
caters more to patient families, recommending that theyrelieve the patient’s pain, while also emphasizing theinancial and mental burden of the patient on their family.
In the ilm, however, Dr. Death’s site speaks more directly
to the patients to end the inconvenience or trouble totheir families, emphasizing the heavy burden that thepatient has created on their families. In any case, both
works emphasize the burden on others caused by thepatient’s treatment and care.
The novel suggests that an increasing number ofpatients in Japan require long-term care due to thedeclining birthrate and aging population, and that it is
dif icult to utilize existing end-of-life decision-making
guidelines due to the lack of a clear de inition of ‘end-oflife’ and a stark absence of end-of-life related laws. It alsosuggests that patient families are left without hope oralternative options with regard to handling their dif icult
predicaments and increasing medical expenses, and thatthe endless practice of high-cost life-prolonging treatment
just contributes to the physician’s income. Thus, aside
from the patient’s desire to end their intolerable suffering,the inancial burden on both the family and the nation
often appears as a primary reason for requesting
euthanasia.
One mother, interrogated in the novel by a detective
about the death of her son who had suffered from dilated
cardiomyopathy but was euthanized by Dr. Death at theage of 24, explains that their family experienced serious
inancial dif iculties and were unable to pay the hospitalbills, leaving them no other choice than to switch thepatient from inpatient care to home care. Clearly, quick
elimination of the inancial burden on both the patientand his family had become one main reason forrequesting euthanasia in this case. Japan has had auniversal health insurance system since 1961, but thenovel reveals that medical care for critically ill patients
can impose a heavy inancial burden on families. In thenovel, the wife of another euthanized patient told

8

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

detective Inukai that she and her husband both felt
"abandoned" by the Japanese healthcare system because
she couldn't afford inancially to continue withhospitalization.
If a family of a patient with a serious and incurable
disease cannot pay the hospital bills and the hospitaldemands that the patient leaves and switches from highquality inpatient care to unsatisfactory home care, then it
is certainly fathomable that the physical and mental
burden on the family would become unacceptably greaterthan that when the patient was hospitalized. This isespecially true when mental illnesses such as dementia
complicate any devastating physical illnesses the patient
already has. One son, suspected of asking Dr. Death toeuthanize his elderly mother with heart failure anddementia, said accusingly to Inukai, “Dr. Death is much
more competent than the police—at least Dr. Death could
resolve the problem of long-term care in society.”
The novel also notes, “euthanasia is a sweet temptation
for those with a sick family member.” Euthanasia may
liberate the patient from intolerable pain and endless
distress, while also relieving the patient’s family fromphysical, psychological, and inancial burdens caused bynursing and long-term care of the patient. That said, I
would argue that the burden on others must not be theprimary reason for one’s choice of death, as many social
interventions are available to shoulder this burden. I would
also agree with the view presented in the novel, which was“Don't threaten a patient's right to life in order to reduce
national medical costs.”

f

f

f

f

f

f

f

f

f

f

f

2: The relationship between law and ethics
The relationship between law and ethics is also depicted
as one of the major issues related to euthanasia in thestory. The law comprises rules and the enforcement ofsuch (8). The law is a required order that allows many
people to lead a happy social life together in a community
in a manner such that the community itself can besustained. To some extent, the law limits each person's
freedom in order to achieve its purpose. The law is fair inthat it treats everyone the same (8). In 2017, when The
Legacy of Dr. Death was published, and in 2020 when thecorresponding ilm was released, both assisted suicideand commissioned murder were illegal under the criminal
law in Japan (2); this remains true as of today in 2022,
and no laws or of icial guidelines exist in Japan withregard to medical assistance for dying. In other words,
implementation of euthanasia by Dr. Death would still beconsidered murder in modern-day Japan. In all past casesof euthanasia brought to the courts, Japanese doctors that
performed them have been convicted of murder. It is safe
to assume, therefore, that euthanasia violates social
justice norms in Japan.
Interestingly, while many of the characters in the novel
are fully aware of the illegality of euthanasia, they do notnecessarily think that the act is ethically wrong. Many
characters seem to believe that there is something more
important than the legality of the act when it comes tohuman lives, and views on the ethical permissiveness ofeuthanasia differed depending on the character’s position
or role. Dr. Death is, of course, a convicted criminal, withno doubt about the ethicality of euthanasia. Dr. Deathargues that the practice of euthanasia may violate
Japanese law, but that the act is humane. Speaking about
Dr. Death, one of the characters in the novel says to Inukai,“No one holds any grudge against the doctor. Will they still
be considered guilty?” Detectives Inukai and Takachiho
become increasingly more uncertain about the moral
impermissibility of Dr. Death’s actions as the story
progresses. Inukai asks himself, “If my daughter’s
condition worsens and Sayaka (his daughter) wanted todie herself, would I have the courage to let her choose
euthanasia as an option?” There are many voices of
sympathy toward patient family members who arearrested for assisted suicide in the novel.
During police interrogation, the wife of the patient
who died in the irst case in the novel remarks to thedetectives, “It's certainly illegal because the law in Japansays it is, but so what?" For the spouse whose husband
endlessly suffered from terminal cancer and who had ayoung child to rear, given her situation in which her family
income had been cut off, she was inancially distressedand physically and mentally exhausted from caring for her
husband. Her husband’s comfort and the survival of her
family were more important than the legality of heractions. Placed in the same situation, I would imagine thatmany people would feel the same way. The law exists toallow community members to survive safely and securely,
and not the other way around. We must not harm others,
but complying with the law is not our main objective inlife. I believe that the issues of law and ethics ineuthanasia require more attention in Japan and feel thatthe popular claim that legalizing medical assistance indying in Japan would inevitably cause signi icant harm tosocially vulnerable individuals must be re-examined. The
meaning and signi icance of an individual’s right to live
must be considered, along with Dr. Death’s statement in
the novel about deliberating the importance of anindividual’s right to die.
3: Ethical implications of differences in Dr. Death’s
depiction in the two works
The representation in the novel of Dr. Death’s motive forpracticing illegal euthanasia for those who want to die inJapan is quite different from that of the ilm; given thesedifferences, the image of Dr. Death portrayed to eachaudience would also vary between the two works. In thenovel, the reader learns about Dr. Death’s experience
working with Doctors Without Borders in several war-tornareas. During this time, Dr. Death often witnessed scenes
where doctors working there had euthanized soldiers
who were suffering from extreme pain because they wereunlikely to be saved in battle ield hospitals. In addition,
when another doctor, highly respected by Dr. Death,suffers a fatal serious injury, this doctor begs Dr. Death tokill him, saying, “grant me the right to die.” Dr. Deathreluctantly euthanizes the respected doctor.
Since then, Dr. Death has euthanized many soldiers inbattle ields who were in severe suffering. Readers would
understand that these experiences built in Dr. Death astrong belief that euthanasia, as a way to relieve thesuffering of a dying patient, is a kind of salvation, and that
it is important to respect the patient's right to die. After
returning to Japan, Dr. Death continues to believe in theEubios Journal of Asian and International Bioethics 32(1) (January 2022)

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

legitimacy of euthanasia as a salvation and decides toperform euthanasia upon request from suffering patients
and/or their families. While some ambiguity remains in
the con irmation of the patient's voluntary intention todie, I think that Dr. Death’s motive is understandable.
In contrast, the ilm does not mention Dr. Death’s
experience with Doctors Without Borders in war-tornareas. In fact, the original experience and understandable
motive of Dr. Death are not depicted at all. Rather, Dr.
Death of the ilm says that the moment a person ends hisor her life in peace is “truly beautiful.” In addition, there isa scene in which Dr. Death declares, “I am a savior” in aself-adulating manner. The ilm shows Dr. Death’s
collection and decoration of pictures of the many faces of
euthanized people at the time of their death; this highly
disturbing scene seems to suggest that Dr. Death is amurderer obsessed with the moment of an individual’s
death and the beauty of their dead face. The ilm
essentially portrays Dr. Death as a psychopathic serial
killer.
In one scene in the novel, Inukai writes a fakeeuthanasia request on Dr. Death’s site under the guise of afather who desires active euthanasia for his daughter
suffering from a chronic and devastating illness. Dr. Deathsees right through this act. Despite being in the position of
being able to kill Inukai’s daughter quite easily, Dr. Deathdoes no harm to her, saying, “Of course, euthanizing apatient against their will is against my rule, so I didn't doit.” In the novel, Dr. Death and Inukai see in one another amutual commonality in their perspective on life, and in
one sense, the two maintain a respectful relationship tothe end. Inukai seems to perceive Dr. Death as aprofessional in a sense.
Meanwhile, the ilm contains one scene in which
Inukai harshly abuses Dr. Death, calling the latter a “dirty
serial killer.” Dr. Death, unable to forgive Inukai for this,approaches Inukai’s teenage daughter hospitalized for
dialysis treatment, saying “You’re putting a lot of strain on
your father.” Dr. Death’s brainwashing of Inukai’s daughter
causes the latter to desire her own euthanasia by Dr.
Death. After leaving the hospital without permission, she
is kidnapped by Dr. Death, who intends to kill her.
The novel also describes how a homeless person who
assisted Dr. Death did so simply for money, completely
unaware that Dr. Death had euthanized so many people.
The ilm, however, suggests that this person was
fascinated by Dr. Death's ideology on the right to die andthe skill of killing a person without any pain. The assistantrecognized that euthanasia took place and said, “I don’tcare about money.” The depiction of this person’s attitudeand behaviors in the ilm is quite eccentric and highlysuggestive of a psychological abnormality.
I am afraid that the audience of the ilm will be
unknowingly imprinted that both those who practiceeuthanasia and those who agree with and accept thelegitimacy of the practice have abnormal personalities,
and that they are interested in human death. Anotherconcern is that free and open debate about medical
assistance for dying in Japan in the future would behindered by images created by this ilm suggesting that
euthanasia is something very weird and those involved in
the practice are abnormal. Incidentally, this ilm was a hit

9in 2020.
At the end of November 2019, two doctors euthanizeda female patient in Japan with amyotrophic lateralsclerosis (ALS) at the patient’s request. The doctors werearrested in July 2020 on charges of commissioned murder(3). The doctors were strongly criticized by many inJapanese society, and it is possible that this incident
affected the production of the ilm, creating very negative
images of Dr. Death. The ilm’s depiction of Dr. Death may
have also been affected by the mass murder incident of
2016, in which a former care worker U at the Tsukui
Yamayuri Garden killed 19 residents with disabilities in
Sagamihara City, Kanagawa Prefecture. U was sentenced
to death on March 31, 2020, but consistently attests that
euthanasia was his motive for murder; theseincomprehensible and unusual beliefs as well as
fanaticism displayed in interviews with U were widely
conveyed to Japanese society (9). However, as Dr. Deathstates in the novel, “If the patient does not die in comfort,
it is not euthanasia; it is just slaughter.” what happened at
Yamayuri Garden was undoubtedly an unforgivable act of
genocide. Confusion of an act that is permissible undercertain conditions with unforgivable acts such as the Nazi
genocide is unacceptable.
4 Conclusion
In addition to the above, this novel also includes a case ofabuse of the term “euthanasia”, in which a murder was
disguised as euthanasia, speci ically related to inheritanceissues. As mentioned in the synopsis of the story, thepractice of euthanasia as depicted in the novel was often
ambiguous in terms of whether or not the patient’s
deliberate request for euthanasia was made when they
were fully competent; this is, I believe, the essentialcondition required for acceptance and allowance of thisact. Overall, euthanasia 1) with unclear patient intentions
to die, 2) primarily due to inancial troubles, 3) without
proper palliative care, and 4) with no safeguard or thirdparty oversight are all problematic. Accordingly, Dr.
Death’s practice of euthanasia would be neither ethicallyjusti ied nor acceptable in my opinion.
However, due to the lack of clear legislation on end-oflife care and patient rights regarding medical care in
Japan, Dr. Death, an “unlicensed” euthanasia contractor,
may well emerge in Japanese society. The current
domestic situation may be regarded as similar to thatduring the decade between 1989-1998 in the UnitedStates, when Jack Kevorkian actively performed assisted
suicides (6,7). Multiple US states have now establishedlegal medically assisted suicide systems and havemaintained these.
In the last scene of the novel, Inukai's daughter,referring to euthanasia, says to her father, “It is the same
compassion that makes us think that we don't want to let
family members die, or that we don’t want to let themsuffer. The root is the same: compassion. It's notunconditionally happy for us to live for a very long time.
The motivation is the same, but the approach is different.”
I would agree with this statement. Some people wish to let
a loved one die out of compassion, while others wish tosustain their lives as long as possible, out of the very same
compassion. Which approach is most ethical? No easy

10

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

answer or consensus will be reached. However, I feel that
this novel teaches us that we need to keep thinking about
euthanasia issues, dif icult as they are.
Fiction works such as novels and ilms can mirror realsocial situations from which they are produced. Japanesenovelist Shinya Tanaka once wrote in an essay, “It is often
said that a writer is a canary in a coal mine ... they used toregard a writer as a person who senses danger earlier
than others. A writer plays the role of quickly snif ing out
any changes and putting them into words (10).” Forexample, Sugako Hashida, a well-known Japanese
screenwriter, announced in her essay compilation,
entitled “Please let me die by euthanasia,” that she wanted
exactly this: to die by euthanasia (11). Attitudes andperspectives concerning medical assistance in dying may
be starting to change in present-day Japan. I advocate thatit may be time to begin serious and practical discussions
about the domestic applicability of an established system
for medical assistance in dying, as is available overseas inplaces such as the US, Canada, and Australia.

f

f

f

f

f

References
1. Yoichi Miyashita A Japanese who accomplishedeuthanasia. Shogakkan, Tokyo, 2019. (In Japanese)
2. Yoichiro Murakami A philosophy of the era we cannot
die. Bunshun Shinsho, Tokyo, 2020. (In Japanese)
3. Jeanette A. Taudin Chabot Euthanasia to live. The
Netherland: Current status of “good death.” Nippon
Hyoronsha, Tokyo, 2021. (In Japanese)
4.
Shichiri Nakayama The Legacy of Dr. Death.
Kadokawa Bubko, Tokyo, 2017. (In Japanese)
5. The Legacy of Dr. Death: Black File. Yoshihiro
Fukagawa Director, Japan, 2020. (In Japanese)
6. Hengameh M. Hosseini. Ethics, the illegality ofphysician assisted suicide in the United States, andthe role and ordeal of Dr. Kevorkian before his death.
Review of European Studies 2012; 4: 203-209.
7. M. Sara Rosenthal Healthcare Ethics on Film A guidefor medical educators. Springer, Switzerland, 2020.
The Kevorkian Chapter: Physician-Assisted Death in
You Don’t Know Jack (2010). P143-182.
8. Daisaburo Hashizume Law and society. PHP
Institute, Inc., Tokyo, 2003. (In Japanese)
9. Karin Amamiya A trail hearing record of the
Sagamihara case: In between "I want to be useful"and "Hate for the disabled." Ohta Publishing, Tokyo,
2020. (In Japanese)
10. Shinya Tanaka. The theory of solitude. Run away andsurvive. Tokuma Shoten, Tokyo, 2017. (In Japanese)
11. Sugako Hashida. Please let me die by euthanasia.
Bungeishunshu, Tokyo, 2017. (In Japanese)

Ethical Issues of COVID-19
Vaccination Requirement for OnSite Employees in Philippines- Laika Mae E.Timon
laikamaetimon@g.cjc.edu.ph- Rogelio P. Bayodroger.bayod@gmail.com
Cor Jesu College, the Philippines
Abstract
The global health crisis brought by the COVID-19
pandemic calls for immediate vaccination, particularly ofthe vulnerable and most exposed members of the
population, for increased protection from infection andmitigate severe effects of the virus. With the permission
granted by the Philippine government to businessestablishments to resume operations, employers andemployees have been required to undergo vaccination tostabilize the threat of increased infections due to direct
exposure to potential carriers and create jobs for laid off
workers during business closures as businesses will needmanpower when it will resume operations. Conversely,some people rejected the mandatory vaccination due toreligious beliefs, fear of side effects, doubts, and otherpersonal reasons. This paper presents a discussion on
both stands concerning the vaccination requirement withthe concepts of utilitarianism and Kant’s philosophy onhuman rights. These concepts weigh the bene its andcosts when individual rights will be upheld at the expenseof the general welfare and vice versa. This paper will thenargue the necessity for suspending individual rights
regarding vaccination as this is a case of global healthemergency, where governments should prioritize thegreater bene it for all.
Introduction
The outbreak of COVID-19 has brought drastic global
damages in health, employment, education, and business.
It had halted all operations in business sectors andprohibited the traditional conduct of transactions andeducation due to the high transmissibility of the virus. In
response to the pandemic, advanced pharmaceuticalcompanies immediately developed vaccines to mitigate
the damages on the global health and economy. Such
responsiveness enabled mass vaccination all over the
globe, including the Philippines. Concerning this, thepaper intends to explore and assess the issues on
vaccination requirement for on-site employees imposedby the government in the Philippine setting. The paper
starts with a thorough discussion regarding the humanrights advisory on COVID-19 vaccination issued by theCommission on Human Rights. It features the hesitancy ofthe employees to be vaccinated because of doubt, fear, andignorance.
The paper then presents the vaccination requirement
implemented by the government and its aim. Immanuel
Kant’s philosophy on human rights and utilitarian ethics
by John Stuart Mill will scrutinize this requirement inconsideration of employee and employer perspectives.
The paper then argues that the action taken by theEubios Journal of Asian and International Bioethics 32(1) (January 2022)

f

f

f

f

f

f

f

f

f

f

f

government is ethically justi ied, as it is its responsibility
to the governed to attain the common good. Mass
immunization needs to be pushed through as the virus
poses a great threat to human health. This was evident inmassive increases in infection and death cases on a global
scale. While vaccines may not cure the sickness, thesehelp in boosting the immunity of the person to the virus.
Thus, immediate vaccination of all eligible people is animperative if we want to preserve life and resume our
economic and social activities. For instance, vaccination isimportant to enable companies and other establishments
to resume operations with higher security on health forboth employees and employers. The paper further argues
that it is necessary and justi iable to focus on the wellbeing of the people even if in the process, some individual
rights might be suspended. After evaluation, the paper
offers a recommendation that the government may opt to
do to encourage the public effectively to be vaccinated.
Amid the pandemic, President Rodrigo Roa Duterte
had promised on July 31, 2020 that things will be back tonormal by December 2020. However, it took almost two
years before face-to-face transactions were gradually
implemented up to date because of the hightransmissibility of the virus. This was made worse byvarious mutations recorded as the virus spread from one
host to another, as well as its exposure to varying
environmental conditions. The increasing cases ofinfections and deaths pushed the government to takemeasures in securing a suf icient supply of vaccines for all
Filipinos. However, with insuf iciency of budget, price, andproduction of vaccines, the Philippine government had
dif iculties in acquiring vaccines, which led to theestablishment of prioritization program given the limited
supply of vaccines in the earlier period of the pandemic.
Nevertheless, with the exerted effort of the Philippine
government, it was able to obtain a consistent in low ofsupply of vaccines that enabled the implementation of
vaccination programs nationwide.
However, a portion of the population is not supportiveof the programs and still refuses the vaccination. Some arestill in doubt of the actual existence of the virus despite its
visible damage to society. They believe that it was aconspiracy to instill fear to the public and claimed that themassive infections and death cases recorded and declared
as caused by the virus is not true (Fact check: The
coronavirus pandemic is not a hoax or a conspiracy tocontrol the general public, 2020). People like Roland
Dicdican, a resident in Buenavista, Bansalan Davao delSur, believed that hospitals opt to declare such numbers inorder to receive the allotted budget by the Philippine
government for the treatment of Covid-19 positive
patients as covered by Philippine Health Insurance
Corporation (Personal Interview)
Another reason why others are reluctant towards
vaccination is due to the fact that the vaccine comes fromthe virus itself while some fear the future side effects ofthe vaccines to the human body. Mrs. Cuyag, a teacher inMetilla Daycare Center, narrated that she feared
vaccination due to this particular reason. Even though it
was explained to her explicitly that it cannot multiply andwas merely administered to boost her immune system,
the explanation fell on deaf ears. She believed that it could

11

destabilize one’s health condition based on experienceshe heard from colleagues and acquaintances (PersonalInterview). Furthermore, the public is not yet over thecontroversy surrounding Dengvaxia (Commission on
Human Rights, 2021, p. 7). All the aforementioned are theprimary reasons for the reluctance of some which arerooted from the lack of knowledge and research.
Advisory of the Commission on Human Rights
The Commission on Human Rights issued an advisory toensure that the citizens can continue to exercise their
human rights amid issues on COVID-19 vaccines andnational COVID-19 immunization programs (Commission
on Human Rights, 2021, p. 3). The advisory highlighted
the right of every Filipino to access safe and effective
vaccines without discrimination. This implies that thevaccines must have undergone “extensive and rigorous
testing to ensure their safety and ef icacy”. The clinicaltesting for COVID-19 vaccines was categorized under
different phases. It was tested on animals at irst to
determine the potential and side effects of the vaccine.
The promising results led to the testing of the vaccines onhuman volunteers under three different phases(Commission on Human Rights, 2021, p. 4). With theseseries of tests conducted, the data that were gathered andanalyzed became the basis of authorities in implementing
mass vaccination. This proves that the emergency use
authorization (EUA) granted by the Food and Drug
Administration (FDA) guarantees the safety of the vaccine
although it still requires monitoring in case of adverse
effects to people with special health conditions(Commission on Human Rights, 2021, p. 5).
Further, the advisory highlighted that prioritization
cannot be avoided due to the limited supply available
during the earlier period of the pandemic. As deemed
proper during the writing of the advisory, healthcare
workers who are openly exposed to the patients infectedwith COVID-19 are prioritized for vaccination. The
priority also included people with high chances of being
infected brought by old age and existing health conditions,and the disadvantaged population at large (Commission
on Human Rights, 2021, p. 6). Eventually, supply of
vaccines stockpiled but the citizens remain unwilling to be
vaccinated. There were even instances when healthworkers waited for several days yet very few individuals
visited the vaccination sites.
In addition, the advisory also addressed the right toaccess information regarding the COVID-19 vaccines to
impart knowledge to the public. Transparency is
considered by the Commission on Human Rights as means
to build trust and give assurance as to the safety andef icacy of the vaccines. Moreover, transparency can help
clear the doubts of the public that are rooted in thecontroversy of Dengvaxia, a vaccine created to counterdengue that was used in a widespread school vaccination
program and was linked to the deaths of children (Lo,2019). The Dengvaxia controversy had instilled fear to theparents and became worse when claims were spread on
standalone posts in Facebook stating that the COVID-19
vaccines were ifty times more likely to cause death ofchildren than the virus (Funke, 2021). However, this claim
was invalidated since no veri ied evidence can beEubios Journal of Asian and International Bioethics 32(1) (January 2022)

presented to support it. In order to counter thismisinformation spread on social media and otherplatforms, the Philippine government coordinated withvarious agencies to implement information campaigns
through accessible channels to permit the disseminationof legit and relevant information to the public andencourage many Filipinos to get vaccinated.
Despite these campaigns, there were still few who
irmly refuse vaccination and insist on exercising theirright to freedom of choice. This was addressed in theadvisory stating, “COVID-19 vaccination should not becompulsory and should only be administered under theconditions of informed consent” (Commission on Human
Rights, 2021, p. 8). This was asserted to emphasize thatthe vaccination should be carried out after securingconsent from people who were informed beforehand of
the relevant information regarding the vaccines such as
the risks and its side effects. Furthermore, thenoncompulsory provision in the advisory is a means ofrespecting religious or cultural beliefs that inhibit
members from receiving any form of vaccines. Although
this advisory was issued to protect the interest of the
public, the provision of noncompulsory vaccination
cannot be enforced without a condition as it compromises
the interest of other members in the society. This implies
that those who are not in favor of vaccination must bear
the restriction on certain freedoms deemed appropriate
and proportionate to the threat involved as a consequenceof their decision.

f

f

Vaccination Requirement Scope and Limitations
The economic damage brought by the pandemic pushednations to impose protocols that will enable the conductof operations without compromising the health of thepersonnel involved. In the Philippines, people wererequired to wear face masks and face shields on publicgrounds to protect themselves from the virus. Moreover, asocial distancing protocol was also implemented toprevent direct contact, which fosters fast transmission.
Despite the limited resources and availability of vaccines,
the government is making efforts to achieve herd
immunization for increased protection and stabilizing
national health security. However, many are hesitant toget vaccinated, which makes it hard for the government toachieve its goal of herd immunization. With the threat ofthe virus, and various requests from businessestablishments to lessen restrictions so they could
conduct operations more ef iciently, the government opt
to require vaccination for on-site employees.
On the 12th day of November 2021, Presidential
Spokesperson Harry Roque had announced thevaccination requirement for on-site employees of public
and private establishments in areas with a suf icient
supply of vaccines, which took effect on December 1, 2021
(Atienza, 2021). This statement implies that the
mandatory vaccination applies to all workers who
physically engage in the workplace and transact withcustomers like public transportation services, healthcare
workers, construction workers, staff of fast-food chains,and many others. Mandatory vaccination was speci icallytailored to on-site workers because they are directly
exposed to the threat of the virus. This direct exposure

f

f

12

increases the magnitude of risks, which calls for measuresof additional protection. However, mandating vaccination
violates the right of individuals in exercising one’s
freedom of choice. Moreover, such mandate failed toconsider the circumstance of employees with religious or
cultural beliefs that inhibits them in getting vaccination.
These issues were explicitly addressed in the advisory
issued by the Commission on Human Rights, which infers
that employees cannot be compelled to get vaccinated.
Even so, the reality is far from this picture.
During the announcement, Roque said, “Eligible
employees who remain unvaccinated may not beterminated but they shall be required to undergo regular
RT-PCR testing, or antigen tests, at their own expense”(Atienza, 2021). This implies that the government will nolonger shoulder the expenses for the tests. In such case,
employees are burdened to consider the expenses forregular testing while weighing the capacity of their salaryand expenses for basic needs. This strategy was employed
to provide incentives for employees who get themselves
vaccinated, while providing burden to those against it in
the form of compulsory regular antigen testing which
increases their expenses leaving a smaller net income.
This particular condition to retain employment urges thelabor force within the minimum wage threshold to opt for
COVID-19 vaccination instead. This illustrates the fact that
employees are being compelled to mandatory vaccination
despite the issuance of the advisory, which aims toprevent such compulsion. Moreover, a pending bill in theHouse of Representatives is seeking to legally impose
mandatory vaccination in the country, which can further
hinder an individual’s autonomy.
Immanuel Kant’s Philosophy on Human Rights
Human dignity is the center of Kant’s moral philosophy.
This pertains to an individual’s worth regardless of rankor status in a society that should be respected asrecognition for an individual’s autonomy (Hill, 2015). This
autonomous characteristic of humans makes themrational beings, who can decide and act on their decisions,which makes them an end in themselves. With rationality
and autonomous characteristic, people are endowed with
dignity, which ought not to be violated. This implies thattreating others as means for one's interest is wrong, as it
is an act of disrespect of the former's dignity. Meaning, as
individuals have the same intrinsic worth in society, one
does not have the right to compel and manipulate or use
another for his endeavors.
Through manipulation, a person restricts the otherfrom exercising judgment with full knowledge of thesituation, which technically means the manipulator leads
the decision-making of the other party. Thus, themanipulator himself most likely makes the decision rather
than the other individual thereby disrespecting the
dignity of the latter as a human person. On the other hand,treating a person as an end allows him/her to exercise thefreedom to decide for oneself, which shows how one
respects the rationality of this person (Velasquez et al.,2014). However, as rational beings, humans have thecapacity to weigh the gravity of one’s self interest as
against the common good. This posits that individuals
need not be manipulated nor compelled in order to act forEubios Journal of Asian and International Bioethics 32(1) (January 2022)
the bene it of the majority. Furthermore, in the case of
public emergency situations, such as the COVID-19
pandemic, suppression of some individual rights in favorof public good, can be justi iable as per the statement of
Dr. Ramon Lorenzo Luis R. Guinto (Atienza et al., 2021),
and as beings with logical reasoning, people need notquestion why this has to happen.
Hence, the rationality and autonomous characteristicof human beings are the grounds of human dignity andthe respect it demands founded the notion of humanrights. As individuals with equal intrinsic worth, we areentitled to protect such dignity by upholding our rights forrespect and doing the same to others. This concept was
further explained in an article by Velasquez et al. (2014)
stating, “Kant's principle is often used to justify both afundamental moral right, the right to freely choose foroneself, and also rights related to this fundamental right.”
According to them, the related rights to the fundamental
right come in two categories, negative and positive rights.
Negative rights refer to claims that impose a negative dutyor “duty of not doing” from others such as privacy and theright to live. On the contrary, positive rights allow theinterference of another party in an individual’s affairs forthe bene it of the latter, such as the assistance for healthand education, to help the needy attain the minimum
standard of well-being. Respecting these rights ofindividuals and interfering when needed, especially when
the circumstance demands so such as in the present when
the society is battling the pandemic, show that we value
their dignity and autonomy as a person whose worth isneither greater nor lesser than ours. Thus, the presence ofdignity in every human person brings forth equality andrespect for the worth of each.

f

f

f

f

f

f

f

f

f

f

f

f

f

K a n t ’ s P r i n c i p l e o n C OV I D - 1 9 Va c c i n a t i o n
Requirement for On-site Employees
Human rights is a concerning issue amid the COVID-19
pandemic, particularly in vaccination which was proposedin the House of Representatives to be mandated legally.
With the supply of vaccines that could last until irst halfof 2022, the government encourages the public to get
vaccination shots to increase protection against the virus
and prevent severe symptoms in case of infection(Kabagani, 2021). Subsequently, this urged employers to
uphold their right to health security and the conduct ofbusiness by pleading to be allowed to require vaccinationon their employees and to not accept unvaccinatedapplicants. Employers fear for their safety as well as theoperation of their business due to the great risk posed byunvaccinated employees.
Manpower plays a signi icant role in business. Thisfactor of production makes the business run as equipment
and raw materials cannot process themselves without theaid of humans. In service sectors, the absence of
manpower itself equates to the closure of the business.
The possibility of immobilization of the business due tocomplications in manpower is the primary reason why
employers running a business want to make vaccination arequirement. This reduces the risk of spreading the virus
and getting severe infection that could cause
hospitalization of employees reducing the manpower,
which could threaten the immobilization of the entire

13

business. Further, a case of infection of one employee cancause the business to cease operation for a few days todisinfect the vicinity, quarantine close contact employees,
and con irm their negative antigen tests. This duration
can cause foregone pro its of the business that would havebeen earned had the business's operations were notinterrupted. Further, the news of recorded infection of theestablishment could instill fear among customers andavoid the place for the meantime, which could further
increase forgone pro its as a result of a temporary
decrease in customer patronage.
On the other hand, employees can also insist on theirright to freedom of choice. They pled for respect of theirrefusal to vaccination due to personal reasons. Some fear
the fact that the vaccine is cultured from the virus itself.
Although vaccination campaigns meticulously explainedthat the virus in the vaccine cannot multiply and is simply
administered for the production of antibodies, the mereidea of injecting a virus into one's body caused theirrefusal. There were also some whose reasons for refusing
vaccination are rooted in the side effects of the vaccinethat is yet to be discovered. This was further fueled byspeculations of the people who linked the death andparalysis of some individuals to the COVID-19 vaccines asthese events occurred after a period passed since theindividuals were vaccinated. Due to this circumstance,
people were reminded of the Dengvaxia controversy,
which increased their fear of vaccination. That being thecase, their reasons are without basis except for obvious
lack of knowledge about vaccine development and thebene its of vaccines. Nevertheless, these reasons of
employees who irmly refuse COVID-19 vaccines are
merely defense mechanisms for the uncertainty of the
future. With this negative mindset plaguing the mind ofmany bothered citizens, information dissemination is a
crucial factor for neutralizing such fear and embracing thepositive mindset that the current situation demands.
With the con licting rights of employees andemployers, the government faces an ethical dilemma
whether to uphold the rights of employers against theemployees’ or to uphold the employees’ rights at theexpense of the employers. More than this, the government
is more concerned for the welfare of the country. The
recently announced limited vaccination requirement,
which pushes minimum wage earners to opt for
vaccination, as well as the bill pending in the House ofRepresentatives, implies that the government is taking
steps towards mandatory vaccination for the entire
population of the country. This makes us question
whether the action taken by the government will justify
the probable violation of the rights of the citizens.
Utilitarian Ethics of John Stuart Mill
Utilitarianism is a form of consequentialism whereby theend justi ies the means (Abumere, 2019). This theory isbased on the proposition that the moral rightness andwrongness of an action and inaction depends on theconsequences it derives. The classical utilitarianism ofBentham and Mill accounts for bene it and harm in termsof happiness/unhappiness and pleasure/pain (Abumere,2019). The principle of utility holds that an action or
inaction taken results in greater happiness and less harm

14

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

as compared to other alternatives, the action or inaction isdeemed morally right. However, if the action or inaction
results in less happiness and more harm as compared toother alternatives, the action is morally wrong. Thisimplies that the bene its enjoyed by an individual brings
the happiness that one desires, thereby making happinessas the only thing desirable as an end (Mill, 1863).
Utilitarianism aims to achieve the common desire of every
member in the society that is called happiness. With thefocus of attaining the desired end, it had failed to consider
the morality of the means taken thereby compromising
the rights and distinctness of individuals. For instance, themandatory vaccination drive of the government is a kindof utilitarian approach, which aims to provide a stable
health security to the public amid the pandemic. Even
though it was implemented to promote the common good,
the government compromised the right of individuals tochoose upon imposing the mandate which thereby
tarnished the goodness of the action taken by thegovernment. Nevertheless, the happiness enjoyed bymajority is presumed to have justi ied the sacri ice of a
few as proven by the increase in net utility.

f

f

f

f

f

f

f

f

Utilitarianism on COVID-19 Vaccination Requirement
The government was established to manage affairs on
local, national, and international levels that will bene it
the people within its jurisdiction. The public elected thecandidates they deemed responsible and worthy of theauthority that will be given by them. Consequentially, thegovernment must serve the people and act for the interest
and welfare of the latter. Amid the COVID-19 pandemic,
massive death and infection cases were recorded in thePhilippines. This pushed the government to do what it canto acquire a suf icient supply of vaccines for the citizens
up to the extent of incurring debt from other countries.
Further, they coordinated with other agencies toimplement vaccination campaigns as means of persuading
the public to get the shots. Despite these efforts, a portionof the population remains hesitant to accept vaccination
shots. With the gradual reopening of businessestablishments and resuming operations of otherindustries, employees are expected to report in theirrespective workplaces. In such case, the risk of infection
through close contact is increased brought by a greater
population transacting in public grounds. This risk is evengreater for unvaccinated employees as infection of one
poses a great threat to his/her health as he/she may
experience severe symptoms. Moreover, this also poses agreat threat to his/her co-workers and other unvaccinatedemployees as they tend to be infected faster thanvaccinated individuals brought by weak protection fromthe virus, and will suffer severe symptoms as compared tovaccinated individuals. Nevertheless, the government
perceived that infection in an unvaccinated population
could potentially balloon death cases in the future at an
alarming rate, which could then again cause theimplementation of enhanced community quarantine.
This threat left the government no other choice
but to propose mandatory vaccination to ful ill its duty ofproviding health security to the entire population.
However, individuals who cannot take the shots due torestrictions from religion, health conditions, and personal

choice are not compelled to comply but with the conditionof regularly undergoing antigen tests to monitor theircondition and help mitigate the outbreak of infections.
This condition provides additional burden to the poor
since antigen test is costly and being required to undergosuch test from time to time will compromise their budget
for basic needs.Hence, to compensate for the gap between
the poor and rich, the government offers the vaccines forfree to every Filipino regardless of status to provide
protection for all against the virus, even if it means
making vaccination mandatory.
Opposing Positions on COVID-19 Mandatory
Vaccination
The human rights advisory issued by the Commission on
Human Rights highlighted that COVID-19 vaccination
should not be compulsory (Commission on Human Rights,
2021, p. 8). This provision emphasized the right ofindividuals to choose whether to accept vaccination shots
or not. This view is practically anchored on Kant's
principle on human rights, which is rooted in humandignity. For him, humans have equal intrinsic worth due totheir autonomous characteristic and are thereby granted
to make their own decisions, as they are an end inthemselves. This enables individuals to weigh theiroptions and the corresponding consequences before
choosing the option they deemed as best. Consequently,
they are held accountable for their choice as they decideon such act freely. Therefore, unvaccinated on-site
employees should bear the consequence of paying for the
regular antigen testing if they opt to continue working
while remaining unvaccinated. While some employees
shoulder this condition as a consequence, the majority of
the labor force, particularly the minimum wage earners,
view this as a compulsion to accept vaccination. The
speculation was further strengthened when news of apending bill seeking mandatory vaccination came out.
While many may argue that individual rights should be
respected concerning this issue, some experts believe thatthe action taken by the government is necessary to attainthe common good. As per the statement of Ramon
Lorenzo Luis R. Guinto, a medical doctor and associate
professor, the right to choose is not absolute especially ifthere is a strong case of improving the overall publicwelfare (Atienza et al., 2021). In this pandemic, whereinnational health security is at stake, the government has
the authority of mandating vaccination so that the
majority (if not all) of the population will be protected.
This action is anchored on utilitarian ethics, which
upholds the bene it of many at the expense of the rights ofa few. Through mandatory vaccination, the country willachieve herd immunization. The increased protection ofindividuals against the virus prevents fast transmission
thereby mitigating the chances of increased infection anddeath cases in the future. Further, herd immunizationc o u l d l e s s e n re s t r i c t i o n s a n d a l l ow b u s i n e s s
establishments to operate, which is bene icial for both
employers and employees, as well as job applicants. With
the mobility that is gradually taking place brought bydecreasing infections and risks as a result of pushing
through vaccination programs, the Philippine economy isstarting to recover repairing the damages attained on theirst few months of the COVID-19 outbreak. The
aforementioned bene its prove that the positive
consequences of mandatory vaccination outweigh thenegatives.

f

f

f

f

f

Conclusion
This paper presents the opposing sides and the facts
considered in implementing mandatory vaccination for
on-site employees. On one hand, the government intends
to mandate vaccination to uphold the welfare of all as
anchored on utilitarianism. The government consideredpotential bene its that will be reaped upon its
implementation such as stabilization of health security,
availability of jobs, and conduct of business operations
among others that will enable mobility promoting
improvement in the economy of the country. On the other
hand, the Commission on Human Rights, an independent
government of ice, represents the right to choose ofindividuals whether to accept or refuse vaccination. Such
representation depicts the free and democratic Philippine
government that has no absolute power of enforcing
authority to the people at the expense of personal
freedom and choice. This was evident in its issuance of thehuman rights advisory to protect the interest of every
citizen and allow them to decide freely.
While the right to choose of every individual mattersin every affair, this paper argues that the government’s actof disregarding this right in the implementation of
mandatory vaccination may be ethical considering thesituation of the country. Despite the efforts of vaccination
campaigns, the country is still far from achieving herd
immunity. With almost two years of battling the
pandemic, the decreases in cases recorded daily imply theslow pace of improvement, which re lects the state of theeconomy. It was only recently when restrictions werelessened and businesses started to resume theiroperations, slowly regaining the losses they incurred
during the halt of operations. Subsequently, self-employedindividuals are back in the streets making a living throughoffering transportation services, street foods, eatery, etc.
However, this progress is being threatened by the greatrisk posed by unvaccinated individuals, particularly by onsite employees who are constantly on public grounds who
might cause another breakout that could disrupt thegradual mobilization of the Philippine economy.
More than this, the government’s utmost concern isthe survival of its people. Studies show the fact thatvaccination helps an individual’s body, particularly the
immune system, respond rapidly and effectively clear the
infection caused by the virus before it causes the disease.
This was made possible due to the immune memory
developed from effective vaccines (COVID-19 vaccines &immune response, 2020). Such immunization lessens theseverity of the symptoms an infected will experiencemaking the disease less deadly than before. Many areblinded by their fear from the fact that getting the shots
and achieving herd immunization would make COVID-19
not any different to in luenza, which also caused the deathof many decades ago but has now become just an ordinary
disease that could be treated with medication available inpharmacies. With the intention of the government topromote general welfare, it opts to make vaccinationff

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

15

mandatory as a way of achieving the aforementioned
goals. However, the government may also choose to
incentivize those who is fully vaccinated to further entice
the public to participate in the mass vaccination such as
discounts in purchases and fare. The government must
formulate other methods of persuading the public tomake the mandatory vaccination more voluntary and lessburdensome. Nevertheless, the goal is to achieve herd
immunization and stabilize health security to enablemobilization of the overall economy and provide
happiness that will be enjoyed by all.
References
Abumere, F.A. (2019). Introduction to Philosophy: Ethics. Rebus
Press. Retrievedfrom
h t t p s : / /press.rebus.community/intro-to-phil-ethics/chapter/
utilitarianism/
Atienza et al. (2021, November 07). Analysts warn against
compulsory vaccination. BusinessWorld. Retrieved fromhttps://www.bworldonline.com/analysts-warnagainstcompulsory-vaccination/
Atienza, K.A. (2021, November 12). Philippines to impose
COV I D - 1 9 v a cc i n e m a n d a t e f o r o n - s i t e w o r ke r s .
B u s i n e s s Wo r l d . Re t r i eve d f ro m h t t p s : / /www.bworldonline.com/philippines-to-impose-covid-19vaccine-mandate-for-on-site-workers/
Commission on Human Rights. (2021, January 26). Human
Rights Advisory on COVID-19
Dancel, R. (2020, July 31). Duterte says Philippines 'will be back tonormal' by December, pins hope on China vaccines. The Straits
Times. Retrieved from https://www.straitstimes.com/asia/
se-asia/philippines-extends-coronavirus-restrictions-inmanila-as-cases-surge
Fact check: The coronavirus pandemic is not a hoax or aconspiracy to control the general public (2020, August 21).
Reuters. Retrieved from https://www.reuters.com/article/
uk-factcheck-hoax-idUSKBN25G2KM
Funke, D. (2021, December 02). Fact check: COVID-19 vaccines
safe for children, notlinked to deaths. USA Today.
Retrieved from https://www.usatoday.com/story/news/
factcheck/2021/12/02/fact-check-more-children-not-dievaccine-than-covid-19/8740405002/
Hill, T.E. (2015, March 05). 22 - Kantian perspectives on therational basis of human dignity. Cambridge University Press.
Retrieved from https://www.cambridge.org/core/books/
abs/cambridge-handbook-of-human-dignity/kantianperspectives-on-the-rational-basis-of-human-dignity/
888A73505F167E52F149953CCFE74A20
Kabagani, L.D. (2021, December 14). PH vaccine stockpile enough
until irst half of2022. Philippine News Agency.
Retrieved from https://www.pna.gov.ph/articles/1162695
Lo, C. (2019, December 16). The dengue vaccine dilemma.
Pharmaceutical Technology. Retrieved from https://www.pharmaceutical- t e c h n o l o g y . c o m / f e a t u r e s /dangvaxia-philippines
Mill, J.S. (1863). Utilitarianism. Mc Master University. Retrieved
from https://socialsciences.mcmaster.ca/econ/ugcm/3ll3/
mill/utilitarianism.pdf
Update on COVID-19 vaccines & immune response (2020,
February 28). The World Health Organization. Retrieved
f ro m h t t p s : / / w w w. wh o . i n t / d o c s / d e fa u l t - s o u rc e /coronaviruse/risk-comms-updates/update52_vaccines.pdf?
sfvrsn=b11be994_4
Vaccination (Report No. CHR (V) A2021-001). Retrieved fromhttp://chr.gov.ph/wp-content/uploads/2021/02/HumanRights-Advisory-COVID- 19-Vaccination.pdf

16

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

Velasquez et al. (2014, August 08). Rights. Markkula Center for
Applied Ethics.
Retrieved from https://www.scu.edu/ethics/ethics-resources/ethical-decisionmaking/rights/

The Perpetuating Global Online
Propaganda of the AntiVaccination Philosophy in the
midst of the COVID-19 Pandemic- Dianne E. Loyola
Email: dianneloyola@g.cjc.edu.ph- Rogelio P. Bayod
Email: roger.bayod@gmail.com
Cor Jesu College, Inc., the Philippines
Abstract
In the context of pandemic-stricken modern societies, theinternet has allowed the circulation of all kinds of online
propaganda with the introduction of COVID-19 vaccines.
We argue that immoral deceptions perpetrated by antivaccination believers need to be stopped before in licting
more signi icant damage to humanity. To justify ourcontentions, we will use a discourse analysis approach torefute anti- vaccination arguments. Furthermore, living by
the morally valuable character traits of bene icence andbenevolence in rejecting the philosophy of antivaccination re lects the virtue of other-centeredness. In an
era that is continuously threatened by the COVID-19
pandemic, anti- vaccination movements primarily imperil
the lives of many. Perpetuating attitudes, beliefs, andbehavioral intentions grounded on anti-vaccination
philosophy is neither reasonable nor ethical.
Keywords: Online Anti-Vaccination Propaganda. AntiVaccination Philosophy. Covid-19 Pandemic.

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

Introduction
Over the centuries, humankind has been threatened byseveral endemics, epidemics, and pandemics, withsmallpox and measles being the earliest forms of diseases
to be recorded in history. Although the Chinese pioneered
the irst inoculations against smallpox (The College ofPhysicians of Philadelphia, 2021), Edward Jenner
successfully adopted a scienti ic approach in developing avaccine against smallpox in 1796 (Tafuri et al., 2011;Children’s Hospital of Philadelphia, 2021). Since then,other vaccines have undergone development throughclinical trials and were subsequently distributed acrosscountries to immunize both children and adults against
life-threatening diseases. Nonetheless, despite therespective success rates of various types of vaccines andthe fact that vaccine development has been considered
one of the most outstanding achievements in publichealth, instances of vaccine hesitancy are still prevalentand continue to be a threat to vaccination programs
spearheaded by the World Health Organization.
As a matter of fact, a growing number of individuals
have developed negative perceptions of vaccines andconsidered them to be both unsafe and unnecessary(Dubé et al., 2013). With this, cases of vaccine hesitancy

have increased the transmission risks of epidemics andpandemics that could have been prevented throughimmunization. Undeniably, the internet contributed to themass dissemination of misinformed opinions against
vaccines as the in luence of modernization spread acrossseveral countries worldwide (Kata, 2010). In an era that iscontinuously threatened by the COVID-19 pandemic, antivaccination movements imperil the lives of many. This
paper will argue that refusing to get vaccinated isunethical based on our moral duty and responsibility toprotect and preserve lives. To justify our contentions, wewill use a discourse analysis approach to refute antivaccination arguments. In this way, we will provide thereaders with a thorough understanding of the subject
matter by discussing the issue through an ethical lens,
supporting these arguments with research-based
evidence, and establishing a position regarding the
problem based on ethical principles and relevant studies
grounded on both ethics and science. Furthermore, thispaper may minimize vaccine hesitancy levels, increase
community cooperation and participation in vaccination
programs, and develop supplementary moral and ethicalgrounds for getting vaccinated, especially in thePhilippines, where the Department of Health has reported
sluggish vaccination rates among different age groups.
The Philosophy of Anti-Vaccination
Modern anti-vaccination movements accelerated in 1998
when Andrew Wake ield published an article claimingthat the vaccine against measles, mumps, and rubella(MMR) could put children at risk for regressive autism
and colitis. Such claims caused some parents in the United
Kingdom and the United States to refuse to vaccinate theirchildren (The National Academy of Sciences, 2017),
although the paper weas retracted as a false paper. The
contentions made by Wake ield were even morepatronized when news regarding the failure of Dengvaxia,
a dengue vaccine manufactured by Sano i Pasteur, in thePhilippines broke out. Since then, declines in vaccine
coverage have been recorded in different countries andhave put more people at risk of being infected by several
life-threatening yet vaccine-preventable diseases.
Wake ield’s philosophy’s cascading effects havebecome evident in the long run, especially during theonslaught of the COVID-19 pandemic. Despite the effortsof the World Health Organization (WHO) and private
vaccine developers to achieve herd immunity, many
people from all over the globe abide by the retracted
article written by Wake ield. Globally, vaccine hesitancy
levels were relatively high in the Middle East, Russia,
Africa, and most European countries (Sallam, 2021). In
the United States, people were hesitant towards receiving
the COVID-19 vaccine mainly because of the possible side
effects, the novelty of the vaccine, the odds of the vaccine’s
ef icacy, and infection risks (Momplaisir et al., 2021).
Meanwhile, vaccine hesitancy in Asia, particularly in India,
Pakistan, and Bangladesh, can be associated with thecirculation of false information, insuf iciency and nontransparency of vaccine information, lack of trust forgovernment and public agencies, and even religious
factors in addition to previously held knowledge about
Wake ield’s claims (Kanozia & Arya, 2021). In thePhilippines, where majority residents are hesitant about
getting vaccinated, De Leon et al. (2021) encouraged
religions to embrace values that promote vaccine
acceptance and even recommended that the government
mitigate conspiracy theories regarding the COVID-19
vaccine. With this, the Filipino were constantly reminded
about the dangers of being unvaccinated.
Since anti-vaccination movements and high levels ofvaccine hesitancy are commonly reported by several
countries nowadays, understanding the anti-vaccination
philosophy will be an avenue for refuting it throughprinciples anchored on ethics and morality aside frommedical sciences. As a prevailing problem encountered by
the public health practice in the aspect of vaccination,
there is an urgent need to end the characterization of antivaccination philosophy, attitudes, and behaviors.
Conventionally, rampant negative perceptions towards
vaccination can be resisted through justifying vaccination
programs based on the interrelated ethical principles ofbene icence and benevolence. To de ine with, bene icenceis manifested through courses of action with the purposeof bene iting others. Meanwhile, benevolence pertains tothe characterization or tendency to act for the bene it ofothers. In biomedical research ethics, both principles are
the grounds for developing a form of medication that will
not harm the recipients during the process and combat
risks with bene its (Stanford Encyclopedia of Philosophy,2019). Grounded on the ethical principles
aforementioned, it is understood that the government andprivate vaccine manufacturers should make public
disclosures about the ethical compliance to the protocols
and procedures in producing the vaccines.
Equally important is the fact that justifying thebene its of the COVID-19 vaccines can be done through an
ethical approach that highlights each person’s duty
towards promoting the common good. While it may betrue that rebuilding public trust and con idence for
vaccines is primarily be carried out by the government,each person is still responsible for exercising mindfulness
and thinking critically about the personal and social
bene its of getting vaccinated (Capulong,2021). Thus, as
rational beings, it is our moral responsibility andobligation to protect ourselves and the people
surrounding us. Furthermore, living by the morally
valuable character traits of bene icence and benevolencein rejecting the philosophy of anti-vaccination re lects thevirtue of other-centeredness. It promotes attitudes andbehaviors geared towards achieving herd immunity forthe bene it of all. Nonetheless, it is our right to demandt r a n s p a r e n c y a n d d i s c l o s u r e o n t h e va c c i n emanufacturing process and how the bene its of getting
vaccinated outweigh the risks associated with getting
infected by the virus. This the crucial task of governments
and medical scientists.

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

A Growing Multitude of Anti-Vaccination Believers in
Social Media
Undoubtedly, the internet has been deemed a potent andhelpful tool in providing information that could improvealmost every aspect of life over time. However, just likeanything that is used above moderate and acceptablelevels, it could also bring about adverse effects, especiallyff

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

17

in the dissemination of various types of information.
Although the internet has been used to raise awarenesson several advocacies and movements, it has also been the
primary tool for global online propaganda that constantly
challenges governments, public agencies, and even privateorganizations and consistently deepens the in luence of
globalization and consumer culture in almost all aspectsof our lives. Following the global online propaganda for
spreading misinformed judgments regarding vaccines, it
has been previously established that argumentss u p p o r t i n g a n d p o p u l a r i z i n g a n t i - va c c i n a t i o nphilosophies are circulated in different social media
platforms where anti-vaccination believers create online
spaces for discussing their perceived detrimental effectsof vaccines (Smith & Graham, 2019).
Commonly dubbed as “anti-vaxxers,” people who
refuse to get themselves and their families vaccinatedmake use of social media in spreading online false
information about the about the vaccines and thevaccination processes. As early as February 2020,
Facebook, one of the world’s biggest social media
platforms, allowed the publication of misinformed posts
and conspired concerns regarding the lack of trust andcon idence for vaccines against COVID-19 (Kalichman etal., 2021). Additionally, Yang et al. (2021) concluded thatvaccine misinformation spreaders had a remarkableability to effectively coordinate different communication
strategies across anti-vaccination discourses increasing
on Facebook. Meanwhile, anti-vaccination believers andsupporters on Twitter share and exchange conspiracy
theories using emotional language in successful andengaging online discussions, which are alarming due tothe strong sense of community among groups of antivaxxers (Germani & Biller-Andorno, 2021). Similarly,
YouTube has previously been a matter of concern for the
WHO since it was reported to allow a signi icant volume of
misinformation regarding vaccines (Machado et al., 2020)and even perpetuated tons of conspiracy theories
regarding the COVID-19 pandemic. All things considered,
the perpetuation of misinformation regarding vaccine
safety and the pandemic itself is an ethical issue thatneeds to be acted upon and resolved.
It has been previously established that a signi icant
number of parents belonging to the Boomer, Gen X, andMillennial generations were the ones who most likely
upheld anti-vaccination philosophies, displayed negative
attitudes towards vaccination programs, and developed
mistrust for vaccine safety and ef icacy. In fact, theindings of a study conducted by Jenkins and Moreno(2020) revealed that parents tend to have their own“research” and rely more on misinformed claims fromanti-vaccine communities established online thanscienti ically-based facts backed by medical experts.
Repeatedly encountering misleading news and article
headlines across different social platforms encouraged
people to believe that spreading misinformation is not as
unethical as it seems (Effron & Raj, 2019). The inclination
towards spreading misinformation can be considered anadverse moral consequence of misleading fake-news
headlines.
Currently, there exists a necessity to discuss theunethical premises of fake news and misleading article

18

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

headlines. Although resolving such tendencies can bechallenging, it can start with anchoring online
publications with the basic tenets of media ethics. In
addition, educators and policy makers should also look
into more feasible ways of combating the proliferation of
fake news in the social media. Basically, media ethics
appropriately addresses moral issues concerning theacquisition, disclosure, and dissemination of data andinformation in mass media. In line with this, social media
platforms should be held responsible for perpetuating
misinformation regarding vaccine safety and bene its
since its democratized access allowed anti-vaccine
believers and supports to take advantage of theopportunity to reach multitudes of audiences on a global
scale. This is where policy makers of governments shouldcome into the scene by crafting laws that would
discouraged and even penalized people who promote fakenews in the social media.
Additionally, it is a social networking site’s
responsibility to establish and implement standard andethical measures for ensuring that fake news andmisleading article headlines containing anti-vaccination
conspiracies and beliefs are not capable of reaching asigni icant number of readers, supporters, and sharers.
Being one of the main sources of information nowadays,
these sites should abide by the ethical principle ofimpartiality by prioritizing the realization of mechanisms
geared towards overcoming transmission risks andputting an end to the devastating effects of the COVID-19
pandemic. This where researchers and ethicists should
also be sought by these social networking sites to provide
them input and guidance in dealing with fabricatedinformation and fake news to be published in theirwebsite. Hence, immoral machinations and deceptions
perpetrated by anti-vaccination believers should be
stopped before in licting more signi icant damage tohumanity. Moreover, encouraging and facilitative, rather
than coercive, vaccination programs should be
implemented by different governments worldwide thatthe most prominent social medial platforms should help
the government in this campaign and advocacy.

f

f

f

f

f

f

f

f

f

f

f

Moral Implications of Anti-Vaccination
In Kant’s deontological ethics, the morality of an act isevaluated according to the motive or the intention of thedoer while in utilitarian ethics, it is assessed according to
its consequences rather than the intention. While we do
not know the intentions behind the attitudes andbehaviors of those who perpetuated anti-vaccination
philosophy in the social media, it is of no doubt that it had
resulted to vaccine hesitancy of many people. To further
elaborate the in luence of a person’s attitudes on their
behavioral intentions, we utilize Fishbein and Ajzen’s
Theory of Reasonable Action. In this paper, the “beliefs”
held by an anti-vaxxer refer to the link between antivaccination and some attributes that were perceived to be
the bene its of not getting vaccinated. Meanwhile, an antivaxxer’s “attitude” pertains to their negative evaluation of
COVID-19 vaccines. Based on the premises of the theory of
Reasonable Action, it can be inferred that an anti-vaxxer’s
belief in the immediate community’s attitudes towards a
subject matter is identi ied to be the determining factor ofthat individual’s behavioral intention. Since an anti-vaxxer
believes that there are positive outcomes of being
unvaccinated, they seek support from other people whoshare the same beliefs. Identifying themselves with acommunity of anti-vaxxers will most likely strengthen
their behavioral intentions to refuse getting vaccinated,hold adverse perceptions towards vaccination programsand drives, and instill their beliefs on other people,
including their families, friends, and colleagues.
Years of consistently abiding by the philosophy behind
anti-vaccination and intending to carry out courses ofaction in line with it can be evaluated ethically andmorally. It is a fact that intentions are the determinants ofthe morality of human acts according to Immanuel Kant’sDeontological Ethics. In fact, intentions are how an action
is willfully done by a person whose state of mind is in a
conscious state. Accordingly, the intention for doing an act
should align with our sense of duty that requires us tochoose to do the good because it is good. Relating thismoral principle to the subject matter of this paper, let us
imagine a man who voluntarily decids to get himself
vaccinated based on the virtues of bene icence andbenevolence. Strongly driven by this moral responsibility
to protect his life and the lives of others, he criticallyevaluates the bene its of getting vaccinated and thedangers of getting infected by COVID-19 and subsequently
comes to a generalization that educating himself withfacts and scienti ically-based evidence is part of his moral
obligation. In such a case, the acts of critically thinking
about his decision to get vaccinated and seeking
vaccination after that are considered moral and ethical.
His behavioral intention is well-aligned with the decision
to do the good because it is good. Hence, anti-vaccination
philosophies and movements perpetuating worldwide
cannot be held as either moral or ethical since thebehavioral intentions associated with it is not in itself
good, for it does not consider the well-being of otherpeople and do not, in any way, promote the common good.
We believe that neither the personal welfares nor
those of other people should be willfully neglected inperforming moral and ethical acts. This is mainly because
morality is anchored on our personal decision to choose
what is right, not just for the good of ourselves but also forthe bene it of other people. In addition, we agree withKant’s contention, explicitly mentioning that consistentmoral actions develop virtues. In his Deontological Ethics,
Kant also highlighted that it is correct to do and practicewhat is good because it is good. Conversely, voluntarilychoosing not to do what is good can equate to not doing
good deeds, just like in the case of anti-vaxxers’ intentions
and actions evident in embracing the precepts of the antivaccination philosophy, failing to educate themselvesproperly, and refusing to get vaccinated.
Most importantly, the impartiality of Kant’s ethicalprinciple on deontology reconciles justice and fairness
with a person’s intentions to act and the consequences ofcarrying out such a course of action. In such a case, Kant
explained that acts that were done with ill motives areunlikely to be considered morally right, even though theactions resulted to positive outcomes. For the utilitarians,
the acts are considered good even if the intention of doing
the action is bad so long as the outcomes of such action isEubios Journal of Asian and International Bioethics 32(1) (January 2022)
good. Remarkably, even if the philosophy behind antivaccination is to “protect” people from the perceived“dangers” of vaccines, the motive is not good enoughbecause it deprives people of the potential bene its ofminimizing the risks of transmission and increasing the
likelihood of achieving herd immunity which is the irst
towards inally putting an end to the most destructive
pandemic ever recorded in history.
Furthermore, Kant’s ethical inquiry promotes andgives importance to each person’s sense of duty, respectfor dignity, and autonomy. In fact, he emphasized letting
the good will be our guiding principle as we choose to dowhat is good is our moral duty, responsibility, andobligation as members of society. In addition, Immanuel
Kant’s ethical philosophy encourages us to exercise ourgifts of freedom and rationality. In light of the COVID-19
vaccination, our dignity as human persons is evident inacknowledging that our freedom is not absolute. This
generally means that being free on choosing what to doshould still be anchored on our ability to reason out andthe inclination to do what is good. Finally, theDeontological Ethics emphasizes that we can exercise
autonomy since we are in complete control of our destiny
based on our respective decision-making process,involvement of reason through thinking critically, andletting goodness prevail in everything that we intend andchoose to do. Our freedom and autonomy should lead us
to do good. Indeed, we are free because as a rational
being, we are able and capable of doing good.
Conclusion
Truth be told, beliefs and attitudes associated with antivaccination movements, whose roots can be traced to
Wake ield’s contentions, on a global scale have been
consistently perpetuating even before the occurrence of
the COVID-19 pandemic. In the context of pandemicstricken modern societies, the internet has allowed thecirculation of this global online propaganda with theintroduction of COVID-19 vaccines. Notwithstanding thefact that it is ultimately that this issue requires
government intervention, we should bear in mind that
deciding on what philosophies to abide by and believe inshould not hinder us from exercising our gift of freedom
and reason. This generally means that as rational beings,
it is our moral obligation to conduct a fact check withinformation that we encounter online, correct
misinformed judgments regarding vaccine safety, and let
the good prevail under any circumstance. To reiterate,
perpetuating attitudes, beliefs, and behavioral intentions
grounded on anti-vaccination philosophy is neither
reasonable nor ethical. For this reason, it is safe to say thatchoosing to get unvaccinated increases the risk oftransmission, decreases the probability of creating safe
spaces for everyone, and is not in line with our moral
obligation to do what is good and necessary for thebene it of the people around us.
References

f

f

f

f

f

f

f

f

Capulong, H. G. M. (2021). Mindfulness as key in easing
COVID-19 vaccine hesitancy. Journal of Public Health, 43(2),e338-e339. https://doi.org/10.1093/pubmed/fdab050

19Children’s Hospital of Philadelphia. (2021). Vaccine History:
Developments by Year. Retrieved December 6, 2021, fromhttps://www.chop.edu/centers-programs/vaccine-educationcenter/vaccine-history/developments-by-year
De Leon, N. D., Garcia, L. M. G., Hilado, C. A. T., & Sanchez Jr, P. T.
(2021). Vaccine hesitancy of Filipinos during the COVID-19
pandemic. https://animorepository.dlsu.edu.ph/etdb_psych/
7/
Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R., & Bettinger, J.
A. (2013). Vaccine hesitancy: an overview. Human vaccines &immunotherapeutics, 9(8), 1763-1773. https://doi.org/
10.4161/hv.24657
Effron, D. A., & Raj, M. (2020). Misinformation and morality:
Encountering fake-news headlines makes them seem lessunethical to publish and share. Psychological Science, 31(1),75-87. https://doi.org/10.1177%2F0956797619887896
Germani, F., & Biller-Andorno, N. (2021). The anti-vaccination
infodemic on social media: A behavioral analysis. PloS one,16(3), e0247642.https://doi.org/10.1371/
journal.pone.0247642
Jenkins, M. C., & Moreno, M. A. (2020). Vaccination discussion
among parents on social media: a content analysis ofc o m m e n t s o n p a re n t i n g b l o g s . J o u r n a l o f h e a l th
co m m u n i ca t i o n , 2 5 ( 3 ) , 2 3 2 - 2 4 2 . h t t p s : / / d o i . o r g /10.1080/10810730.2020.1737761
Kalichman, S. C., Eaton, L. A., Earnshaw, V. A., & Brousseau, N.
(2021). Faster than warp speed: early attention to COVD-19 byanti-vaccine groups on Facebook. Journal of Public Health(Oxford, England).https://dx.doi.org/
10.1093%2Fpubmed%2Ffdab093
Kanozia, R., & Arya, R. (2021). “Fake news”, religion, and
COVID-19 vaccine hesitancy in India, Pakistan, andBangladesh. Media Asia, 1-9. https://doi.org/
10.1080/01296612.2021.1921963
Kata, A. (2010). A postmodern Pandora's box: anti-vaccination
misinformation on the Internet. Vaccine, 28(7), 1709-1716.
https://doi.org/10.1016/j.vaccine.2009.12.022
Machado, D. F. T., de Siqueira, A. F., & Gitahy, L. (2020). Naturalstings: alternative health services selling distrust about
vaccines on YouTube. https://doi.org/10.31235/osf.io/vtf5r
Momplaisir, F. M., Kuter, B. J., Ghadimi, F., Browne, S., Nkwihoreze,
H., Feemster, K. A., ... & Green-McKenzie, J. (2021). Racial/
Ethnic Differences in COVID-19 Vaccine Hesitancy Among
Health Care Workers in 2 Large Academic Hospitals. JAMA
Network Open, 4(8), e2121931-e2121931. https://doi.org/
10.1001/jamanetworkopen.2021.21931
Sallam, M. (2021). COVID-19 vaccine hesitancy worldwide: aconcise systematic review of vaccine acceptance rates.
Va c c i n e s , 9 ( 2 ) , 1 6 0 . h t t p s : / / d o i . o r g / 1 0 . 3 3 9 0 /vaccines9020160
Smith, N., & Graham, T. (2019). Mapping the anti-vaccination
movement on Facebook. Information, Communication &Society, 22(9), 1310-1327. https://doi.org/
10.1080/1369118X.2017.1418406
Stanford Encyclopedia of Philosophy. (2019, February 11). The
Principle of Bene icence in Applied Ethics. Retrieved December
6, 2021, from https://plato.stanford.edu/entries/principlebene icence/#BeneBiomEthi
Tafuri, S., Martinelli, D., Prato, R., & Germinario, C. (2011). Fromthe struggle for freedom to the denial of evidence: history of
the anti-vaccination movements in Europe. Annali di igiene:
medicina preventiva e di comunita, 23(2), 93-99. https://
europepmc.org/article/med/21770225
The College of Physicians of Philadelphia. (2021). The History of
Vaccines. Retrieved December 6, 2021, from https://www.historyofvaccines.org/timeline/all#EVT_1
The National Academy of Sciences. (2017). The Wake ield MMRAutism Case. The National Academies Press. Retrieved20

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

December 6, 2021, from https://www.nap.edu/read/21896/
chapter/21
Yang, A., Shin, J., Zhou, A., Huang-Isherwood, K. M., Lee, E., Dong,
C., ... & Liu, W. (2021). The battleground of COVID-19 vaccine
misinformation on Facebook: Fact checkers vs. misinformation
spreaders. Harvard Kennedy School Misinformation Review.
https://doi.org/10.37016/mr-2020-78

Challenge of Legitimacy in the
Implementation of COVID-19
vaccination requirements for onsite workers- Reyjane Mae P. Mercado
Email: reyjanemercado@g.cjc.edu.ph- Rogelio P. Bayod
Email: roger.bayod@gmail.com
Cor Jesu College, the Philippines
Abstract
The Philippines is currently implementing the mandatory
vaccination for eligible on-site employees in areas withplenty of COVID-19 vaccine supplies as per IATF
resolutions 148-B and 149. Accordingly, these workers
may still choose not to get vaccinated provided that they
undertake regular RT-PCR or antigen testing at their own
expense. This new directive draws disparate views fromthe affected labor sector, with some workers seeing it asnecessary to combat the COVID-19 pandemic, whileothers remain skeptical of the effects of vaccination onhuman health following the Dengvaxia controversy in2017. With such contrasting viewpoints among its
citizens, this paper will seek to answer the question, "Canthe government legitimately use its coercive politicalpower to impose the vaccine or test rules for on-site
workers despite the different opinions?" This paper will
incorporate John Rawls’ Political Liberalism, primarily thenotion of a political conception of justice, into solving the
problem of legitimacy brought on by obligatory
immunization. This paper will then argue that the
government cannot enforce mandatory vaccination
legitimately as it obstructs workers' ability to exercise
their rights, liberties, and freedom of choice. However, thegovernment may continue to encourage citizens to getthemselves vaccinated through different forms of
incentives, impose minimal health protocols such as social
distancing, mandatory use of face mask and following
health and safety standards to all the citizens.
Keywords: Covid-19 Vaccination, Legitimacy, Individual
Rights, Public Good. Government Intervention.

f

f

f

f

f

f

f

f

Introduction
The Philippines is currently implementing a nationwide
vaccination program to combat the damage brought by
the COVID-19 pandemic. This initiative provides citizens
with free immunizations against COVID-19. Vaccination is
not legally mandated among the citizens, except for the
speci ied workers in the labor sector. In connection with
this, the Inter-Agency Task Force for the Management ofEmerging Infectious Diseases (IATF-EID) issued

resolution 148-B, approving the mandatory vaccinationfor eligible on-site workers in locations with plenty of
COVID-19 vaccines supply starting December 1, 2021.
These on-site workers include employees who need to beat their working site like construction workers, foodservers, and among others. The said resolution states thatthose ineligible workers may present medical clearance
issued by a Municipal Health Of ice, City Health Of ice,
and/or Provincial Health Of ice or birth certi icate toprove such ineligibility for vaccination. In addition,
employees who refuse to get vaccinated can still work,
provided that they will undertake regular RT-PCR or antigen testing at their own expense (Valente & Mendoza,2021). Regarding the frequency of testing, IAFT resolution
149 (2021) clari ied that it shall be construed as that
determined by the employer but which should be at least
once in every two weeks.
However, the vaccine-or-test rules for on-site workers
draw opposition from different agencies. The House ofRepresentatives Committee on Labor and Employment,
under its chairman Pacman Partylist Rep. Enrico
Pineda, has recommended the suspension of the said
policies introduced by IATF (Sarangay, 2021). Trade
Union Congress Party (TUCP) party-list Representative
Raymond Mendoza also criticized the resolutions, citingthat they were confusing and lacked consultation(Mercado, 2021). According to Makabayan bloc (analliance of leftist legislators in the lower house of thePhilippine government) which is the coalition of twelve
party-list in the House of Representatives, the regulartesting requirement poses an additional burden to theworkers. In addition, Senator Risa Hontiveros has called
for the IATF's decision requiring mandatory vaccination in
the workplace to be recalled, claiming that these workers
should instead be encouraged to get vaccinated rather
than imposing a punishment (Tilo, 2021).
Filipinos are divided regarding this issue. Some agreewith the said policy as it will ensure the safety of these
employees, who are also frontliners during this pandemic.
Others are still hesitant about the vaccine and are now
protesting against the new directive. Accordingly, a study
revealed that 90% of the respondents worry about
possible side-effects of the vaccines, 87% were concerned
about their effectiveness, and 78% were hesitant about
the safety of such vaccination against COVID-19.
One of the causes of their hesitancy can be traced backin 2017 during the Dengvaxia controversy when concerns
about the vaccine's health effects were raised, with someeven claiming in the media that the vaccine was directly
responsible for children's deaths (Mendoza et al., 2020).
Furthermore, disinformation propagated by the media,
the society, and the health-care system has a signi icant
role in in luencing the perceptions of Filipinos,
p a r t i c u l a r ly g ive n t h e q u i c k s p r e a d o f s u c hmisconceptions through social media. Similarly, vaccine
refusal is further exacerbated by structural barriers suchas political issues and poor implementation (Amit et al.,2022). Finally, resistance to receive vaccinations issometimes linked to philosophical or moral attitudes
about health and immunity, such as a preference for"natural" over "manufactured" medications. Refusal of
vaccines has also been linked with strong religious

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)
convictions citing the belief that vaccination contradicts
religious beliefs about the “origin of illness, the need forpreventive action and the search for a cure” (Dubé, 2013).
The aim of this paper is to address the challenge oflegitimacy in the implementation of COVID-19 vaccination
requirement for on-site workers using Rawls’ Political
Liberalism Theory. More speci ically, this paper answers
the question, “Can the government legitimately use its
coercive political power to impose the vax or test rules foron-site workers despite the different opinions?” Thepaper then argues that, based on the notion of a politicalconception of justice, the said vaccination requirement
cannot be enforced against on-site workers. Finally, thispaper recommends for vaccination to remain voluntary
while continuing on strictly imposing minimal healthprotocols as measures to combat the COVID-19 pandemic
without violating workers’ rights. To entice citizens to get
vaccinated, the government should grant incentives tofully vaccinated individuals instead of forcing them to doso.
Political Liberalism: A Political Turn of John Rawls
John Rawls' (1999) A Theory of Justice introduces the ideaof a well-ordered society. In this kind of society, theprimary institutions are regulated by the principle ofjustice that everyone accepts wholeheartedly. However, anideal society that adhered to authority seems impossible
in the liberal society we live in. In a democratic society,citizens are entitled to rights and freedom, including thefreedom of thought, speech, and conscience. These
entitlements would lead people to have contrasting
viewpoints of what justice is. Such con licting opinions
would lead society to chaos if people only followed theirrespective beliefs. Thus, there should be laws and policies
to attain order and peace in society. However, Rawls'
discussion about congruence and stability in "A Theory ofJustice" seemed to be at odds with the assumption ofpluralism because he plotted his ideas about justice andhow to attain it using the assumption of a well-orderedsociety.
In response to this problem, John Rawls' (1993)
Political Liberalism will account for a pluralistic society. It
recommends concepts and principles to resolve
disagreements of citizens and to come up with rules thateveryone should abide by despite their respective beliefs.
Political liberalism attempts to address the challenges oflegitimacy and stability in a diverse citizenry. This paper
only caters to the issue of legitimacy in connection to thevaccination requirement for on-site workers.

f

f

f

f

Plurality of Conceptions regarding the Vaccination
Requirement
In a liberal society, people will have diverse worldviews.
We have different views about religion and how the world
works. Our diverse culture also contributed to ourperspectives about right or wrong, good or bad, and otheraspects of our lives. Even in a communitarian state likethe Philippines, we cannot deny the fact that each of us
have our own viewpoints evidenced by how Filipinos
debate on certain issues on social networking sites like
Twitter or Facebook. In connection to this, the issue on
the mandatory COVID-19 vaccination also stirred diverse

21

responses from the citizens. According to a survey
conducted in May 2021 by Statista Research Department(2022), majority of individuals who are willing to receive
vaccinations against the coronavirus (COVID-19) citedtheir safety and protection against the virus as theprimary reason for vaccination. Safety and protection
against COVID-19 is vital for on-site workers because thenature of their work requires them to interact with people
frequently. Getting vaccinated will protect them against
the virus for them to serve their customers well.
However, some people are against the new directive.
They are hesitant about the vaccines for a variety ofreasons. First, they are concerned about the side effects ofthe vaccines following Dengavaxia issue, where deaths ofchildren were reported after getting vaccinated (Fatima &Syed, 2018). They also have their individual perceptionsa b o u t t h e va c c i n e s w h i c h a re i n l u e n c e d bymisinformation spread through social media (Amit et al.,2022). It was also found out that the problem of vaccine
hesitancy is strongly related with a lack of trust in
government, wherein some people still doubting theexistence of the virus (CUNY Graduate School of Public
Health and Health Policy, 2020). Aside from that, theseries of calamities in 2020, like the earthquakes in someparts of Mindanao, Taal Volcano eruption, typhoons, andthe COVID-19 outbreak, heightened their religious belief
that these are punishment of God.
Despite differing people’s views, there is only one
policy for every aspect of our lives that must be followed.
The purpose of this is to attain order and peace in thecommunity. Moreover, this is where the lawmakers dotheir job to make laws that will be implemented
throughout the nation. Nevertheless, how can thegovernment impose its political power to enforce citizens
to follow the rules like the resolutions mentioned earlier
in a pluralistic society?
The Liberal Principle of Legitimacy
In a democratic society with diverse citizens, enforcing
political power is challenging. It is dif icult to impose one
policy or law with different interpretations from thepeople. Rawls’ Liberal Principle of Legitimacy permits theuse of a democratic state’s coercive political power within
the bounds of the law, where subjects will presumablyobey. Rawls’ (1993) Liberal Principle of Legitimacy states
that: “Our exercise of political power is fully proper only
when it is exercised in accordance with a constitution theessentials of which all citizens as free and equal may
reasonably be expected to endorse in the light of principles
and ideals acceptable to their common human reason “ (p.
137)
This principle implies that political power can bewielded over the citizens if they can be reasonably
expected to support it. Though the directive imposed on
on-site workers gained opposition from different groups
and agencies, most workers already got their shots. They
were forced to do so because they were afraid of losing
their jobs, which they hoped would help them survive thispandemic. As the new rules were implemented, anotherset of workers were being coerced to receive vaccines as
they will get punished by the burden of paying for tests ifthey will do otherwise. According to Bernardo Wabe, 46, aEubios Journal of Asian and International Bioethics 32(1) (January 2022)

security guard at a state-owned bank in Manila, thevaccination requirement compelled him to get vaccinatedbecause he feared he might end up using his earnings justto pay for his swab tests. He added that he was hesitant
about the vaccines stating, “I was afraid I’d get even more
sick if I get vaccinated, but this time I really had no choice”(Lopez & Calonzo, 2021).
Nevertheless, as the COVID-19 cases rose, theyrealized the necessity of the vaccines to protect
themselves and their family. According to the Department
of Health, 86% of hospitalized COVID-19 cases were notfully vaccinated between March and November. In data
recently shared by DOH, unvaccinated Filipinos are twice
as likely to develop severe COVID-19 and nearly threetimes likely to die from the disease (Tomacruz, 2021).
Over time, the mandatory COVID-19 vaccination gained
endorsement from the majority of the public but the way
these workers are being forced to get vaccinated implies
that such policy cannot be legitimately enforced.
Reasonable Citizens
According to Rawls (1993), reasonable citizens are
citizens living in a society where they are willing to obey
rules provided that others will do the same. Even if such a
policy contradicts his views and interest, he is still willingto follow them. Rawls says that these citizens have theircomprehensive doctrine, their personal views about how
the world works. For instance, the Philippines is divided,in terms of religion and various sects. Majority of the
population embraced Catholic as their religion, while
there are other Christian denominations like Evangelical
Christians, Baptists and other protestant groups. There
are also members of the local sect which is the Iglesia ni
Kristo.
The remaining members of the populationembraced Islam as their religion. Though they strongly
believe in their respective religions, they are unwilling toimpose such religions as the standard. They are unwillingto force other reasonable citizens to live according to theirown religious beliefs.
This notion is true, especially when we think ofworkers' reactions after the imposition of the mandatory
vaccination. Though some of them think that vaccination
should be legally mandated, they do not disregard theperceptions of other workers. Other workers who were
hesitant about the vaccine did not insist to pro-vaccine
workers their beliefs. Both parties allow each other to dowhat they think is right for them, whether to get
vaccinated or not. They both accepted their counterparts'
explanations for their contrasting views.

f

f

f

Reasonable Pluralism
Rawls’ idea of reasonable citizens highlights his view ofhumans as not irredeemably self-centered and dogmatic.
This primary concept of citizens gives cause to aspire forreasonable pluralism. Accordingly, the concept ofreasonable pluralism suggests that citizens' different
doctrines will motivate them to support a speci ic rule insociety. Rawls anticipates that people' accepted religious,
moral, and philosophical views will embrace toleration
and accept the principles of a democratic regime.
In the case of the vaccination requirement, both
perspectives of the anti and pro-vaccine workers are

f

f

22

reasonable because of their respective motives. First, theviewpoint of the irst group of workers to be vaccinatedfor their own and for the general population's sake, forexample, is reasonable because it will protect them and it
will aid the entire population in combating the same
enemy. If the entire community is vaccinated, thelikelihood of getting infected by the virus will be minimal.
On the other hand, other workers may also choose not tobe vaccinated to avoid adverse health consequences.
Despite the FDA's approval, hesitancy is understandable
considering that the Dengvaxia vaccine has also been
approved by the European Commission and the US Foodand Drug Administration (Lo, 2019). Thus, such differing
decisions and viewpoints are not merely pluralism, but
are reasonable pluralism.
However, the notion of reasonable pluralism does notaddress the issue of legitimacy, that is, what law can belegitimately enforced on diverse citizens. For example, it
was previously stated the Philippines is divided into
different religions and because of citizens’
reasonableness, no religion was enforced as the basis ofreligious beliefs and practices in the country. Thoughmajority of Filipinos are Catholics, it is unreasonable toexpect everyone to endorse Catholicism as the only
religion that must be followed in the country. It is also
unreasonable to force Catholics to follow Islam or
atheism. Similarly, even if there is reasonable pluralism ina society, it would be unreasonable to impose amandatory vaccination, given that citizens are hesitant
about it. It will also be unreasonable to insist that the provaccine workers refuse vaccinations because they havethe freedom to do so. Therefore, reasonable pluralism
only softens the legitimacy problem that obligatory
vaccination currently faces.
Political Conception of JusticeWith the goal of addressing the problem of legitimacy inimposing policies in a democratic society, Rawls
introduced the concept of a political conception of justice.
According to Rawls, a policy can be legitimately enforced
on its citizens if a state’s political power is exercised inaccordance with a political conception of justice. In theirst section of his book Political Liberalism, he de ined
this term by presenting the three characteristics of apolitical conception of justice. Accordingly, a politicalconception of justice is a moral conception that applies tothe basic structure of a society, which includes its primarypolitical, social, and economic institutions, and how theyinteract to form a cohesive system of social cooperationfrom generation to generation. A political conception ofjustice is presented as a freestanding view whose content
is established independently of the comprehensive
doctrines af irmed by citizens. Finally, the content ofpolitical conception of justice is expressed in terms ofcertain fundamental ideas seen as implicit in the publicpolitical culture of a democratic society. This publicpolitical culture, according to Rawls, “comprises thepolitical institutions of a constitutional regime and the
public traditions of their interpretation (including thoseof the judiciary), as well as historic texts and documentsthat are common knowledge” (Rawls, 1993, p. 13–14).

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

f

f

f

f

f

f

f

As mentioned earlier, each reasonable citizen has theirrespective comprehensive doctrine. In instances where
reasonable pluralism is not applicable, thesecomprehensive doctrines should not be employed aspolitical conception of justice must be establishedindependent from such individual doctrines. For Rawls,
the society's public political culture can be used as aforeground to make such laws. In connection with this,Rawls proposes a solution to the problem of legitimacy. To
remedy this dilemma, he believes that political powershould be used in line with a political conception of justicethat can be derived from fundamental beliefs in a society's
public political culture.
According to Rawls, the three most fundamental ideas
from a democratic society's public political culture are thenotions of free and equal citizens plus a fair system ofsociety. These ideas prompted Wenar (2021) to conclude
that political conceptions of justice will have three key
basic features. Accordingly, a political conception ofjustice will: ascribe to individual rights and liberties ofcitizens; prioritize these entitlements over other generalinterests, and ensure that citizens' freedom is usedeffectively.
Given these basic features, we will then examine
IAFT's resolutions if they are implemented according to apolitical conception of justice. The irst aspect emphasizes
the importance of safeguarding individual rights andliberties.
The resolutions speci ied that COVID-19
vaccination should be mandated for all eligible personnel.
If they refuse to get vaccinated, they will be asked toundergo regular RT-PCR or antigen testing at their own
expense. These rules continue to value workers' rights tochoose whether or not to receive immunizations.
However, the requirement to pay for their RT-PCR or
antigen testing is unacceptably harsh. Employees' salaries
are barely adequate, and most of the time, insuf icient tocover their living needs. Will they be able to support theirfamily if they have to pay for the testing as well? Of course,
people would prefer to be vaccinated rather than incur
additional costs. This demonstrates that these workers
continue to be without a choice and cannot fully exercise
their rights.
The second feature states that a political conception ofjustice will prioritize citizens' rights and liberties overdemands of the general public good. The primary goal of
the IATF's new guidelines is to increase the number ofvaccinated Filipinos at the same time decrease the casesof COVID-19. During this pandemic, on-site employees are
one of the irst responders. Since they are exposed to avariety of people on a daily basis, they might get infectedor if they are already infected, they might pass the virus totheir customers. This means that mandatory vaccination
is aimed at the greater public good than each workers'
welfare.
The third feature states that a political conception ofjustice will ensure suf icient means to use their freedoms
effectively. IATF's resolutions 148-B and 149 implicitly
obstruct workers' ability to exercise their freedom of
choice. Though it was explicitly stated that they can stillchoose to get vaccinated or not, the provision about thetesting rules is just a pretense. The government sought todemonstrate that workers have freedom, but such rules

23

are simply propaganda that will bene it them in the longrun, preventing people from successfully exercising theirrights. Thus, based on the examination, the requirementsfor on-site workers seems to be at odds with workers’
rights and freedom.
The Idea of Overlapping Consensus
COVID-19 vaccination is viewed as a means ofcontaining the pandemic by preventing everyone fromgetting infected by the virus. However, based on thenotion of political conception of justice, mandatory
vaccination for on-site workers cannot be legitimately
enforced. Thus, what measures should the government
impose to help combat the COVID-19 pandemic?
As previously stated, each citizen has their own
comprehensive doctrines, which includes their ideology
regarding mandatory vaccination, with which somecitizens agree and others disagree. In addition, it was
mentioned earlier that political conception of justice is
freestanding, that is, it is independent from any of thecomprehensive doctrines of each citizen. In an
overlapping consensus, each citizen will end up endorsing
the same political conception of justice for a variety ofreasons, allowing the country to impose a policy thateveryone is willing to abide.
In this instance, both the anti and pro-vaccine
advocates will agree on vaccination remaining voluntary
while still imposing minimal health protocols on all
residents, such as social distancing, mandatory use of facemask and adherence to health and safety standards. Antivaccine workers will agree on such policy since they will
not be obligated to get vaccinated and will still beprotected against COVID-19 due to health protocols.
Meanwhile, pro-vaccine workers will support the policy
given their primary motivation for advocating forobligatory vaccination is their own safety. Thus, bothparties will agree for reasons internal to their own
comprehensive doctrine.
Furthermore, if such health protocols will beconsistently implemented and strictly followed,
vaccination does not need to be mandatory. The rationale
behind imposing mandatory vaccination is to compel thecommunity to get vaccinated to attain herd immunity.
Instead of imposing such punitive policies that are against
the rights of workers, the government should instead
grant incentives to fully vaccinated individuals to
encourage them to receive the vaccines. It is also
important to address misinformation that heightens
hesitancy among Filipinos by continuing on educating
Filipinos about the vaccine and its bene its.
Conclusion
In a democratic society with pluralism in the people's
worldviews, legitimately enforcing coercive politicalpower over its citizens poses a big challenge. This is theissue that the mandated vaccination for worksite
employees is attempting to address. John Rawls' liberalprinciple of legitimacy states that laws or policies can only
be enforced if citizens endorse them despite theircontrasting viewpoints. He introduces the idea of
reasonable citizens who want to live in a society where
they may work with their fellow citizens on terms that are24

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

f

f

f

f

f

acceptable to all. In the case of on-site workers, they havedifferent perspectives on the guidelines. Some of themthink that it will be best for everyone to get vaccinated,while others' hesitancy drove them away from the idea ofgetting vaccinated. Since both parties have reasonable
justi ications, requiring mandatory vaccination for antivaccine workers while forbidding pro-vaccine workers
from receiving the vaccine is just unreasonable.
Following the failure of Rawl's "reasonable pluralism"
approach, we shift to the political conception of justice.
Accordingly, policies must be applied in accordance with apolitical conception of justice, which has three essential
features. Upon examining IATF's regulations on on-site
workers, we found out that these rules do not coincidewith the three key features and, therefore, cannot be
imposed legitimately. First, these workers' need to pay for
their testing forces them to get the shot because it will be
added to their long list of bills to pay. Second, thegovernment's primary purpose is to serve the common
good because fully vaccinated on-site workers mean
protecting the entire population. Finally, the overall
impact to the employees is the obstruction of theircapacity to use their freedoms in a suf icient manner.
Because the vaccine or test rules for on-site workers
cannot be legitimately enforced on its citizen, we shift tothe idea of overlapping consensus in determining what
measure should instead be imposed to help the ight
against COVID-19. According to the notion of overlapping
consensus, citizens with contrasting opinions about the
mandatory vaccination will still agree on the same policy,
which is to continue making vaccination voluntary while
strictly imposing minimal health protocols on all
residents, such as social distancing, mandatory use of facemask and adherence to health and safety standards.
Though they have different viewpoints regarding theimposition of compulsory vaccination, they will adhere to
the new policy for different reasons. Anti-vaccine
advocates will agree to prevent them from getting
vaccinated as they are concerned for the adverse effects ofthe vaccines, whereas pro-vaccine workers will do sosince strict adherence to health protocols and theircapacity to choose to get vaccinated will protect themfrom getting the virus, without forcing others to do thesame.
We argued that for citizens to be enticed to get
vaccinated, the government must refrain from utilizing
measures that are punitive in nature. They should instead
formulate incentive plans to persuade people to get theirjabs such discount in the purchase of medicines and evenfuel. There are gasoline stations and pharmacies that
implement this. If you have vaccination card, you will get
10% discount. McDonalds and other food establishments
also did this. However, it is not yet institutionalized.
Maybe, the government can look into this scheme andimplement a nationwide incentive program to enticepeople to be get themselves vaccinated. Aside from that,they should start addressing the problems with the
spread of misleading information that promotes
misconceptions and hesitancy among Filipinos.
We also found out that even though Rawls'
Political Liberalism is coming from a liberal perspective,
the sense of community can still be observed given thefact that both parties affected by the mandatory
vaccination, who are considered reasonable citizens, still
think of others welfare by not enforcing their respective
comprehensive doctrines. This notion is particularly
relevant to a communitarian society like the Philippines
where the importance of community is emphasized evenin the political aspect of our lives.
References
Amit AML, Pepito VCF, Sumpaico-Tanchanco L, Dayrit MM(2022) COVID-19 vaccine brand hesitancy and other challenges
to vaccination in the Philippines. PLOS Global Public H e a l t h2(1): e0000165. https://doi.org/10.1371/
journal.pgph.0000165
Caple, A., Dimaano, A., Sagolili, M. M., Uy, A. A., Aguirre, P. M.,
Alano, D. L., ... & Austriaco,
N. (2021). Interrogating
COVID-19 vaccine hesitancy in the Philippines with anationwide
open-access online survey. medRxiv.
CUNY Graduate School of Public Health and Health Policy. (2020,
October 20). Coronavirus vaccines stir doubts among many
people worldwide, new study shows: Nature Medicine
publishes indings of a 13,400-person survey in 19 countries
hit hard by COVID19. ScienceDaily. Retrieved March
14, 2022 from w w w . s c i e n c e d a i l y . c o m / r e l e a s e s /2020/10/201020131340.htm
Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R., & Bettinger, J.
(2013). Vaccine hesitancy:a n o v e r v i e w. H u m a n
vaccines & immunotherapeutics, 9(8), 1763–1773. https://doi.org/10.4161/hv.24657
Fatima, K., & Syed, N. I. (2018). Dengvaxia controversy: impact
on vaccine hesitancy. Journal of
global health, 8(2),010312. https://doi.org/10.7189/jogh.08-020312
Lo, C. (2019, Dec. 16). The dengue vaccine dilemma.
Pharmaceutical Technology.
h t t p s : / /www.pharmaceutical-technology.com/features/dangvaxiaphilippines/
Lopez, D. & Calonzo, A. (2021, Dec 1). Philippine Covid Shot
Mandate Sees Millions Facing
Test Fees. Bloomberg.
https://www.bloomberg.com/news/articles/2021-1130/philippines-vaccine-mandate-sees-millions-facing-covidtest-fees
Mendoza, R. U., Valenzuela, S., & Dayrit, M. (2020). A crisis of
con idence: the case of Dengvaxia
in the Philippines. Available
at SSRN 3519736.
Mercado, N. A. (2021, Dec. 1). Suspension of resolutions on
mandatory vaccination for on-site w o r k e r ssought.
Inquirer.net. https://newsinfo.inquirer.net/1522472/
suspension-of- resolutions-on-mandatory-vaccination-foron-site-workers-sought
Rawls, J. (1993). Political Liberalism. New York: Columbia
University Press.
Rawls, J. (1999). A theory of justice: Revised edition. Harvard
University Press.
Sarangay, M. (2021, Dec. 1). House panel recommends
suspension of 'No Vaccine, No Work','No Vaccine, No Pay' policies. Manila Bulletin. https://mb.com.ph/2021/12/01/house- p a n e l - r e c o m m e n d s suspension-of-no-vaccine-no-work-no-vaccine-no-paypolicies/
Statista Research Department. (2022). Reasons for willingness
to receive vaccination against
coronavirus (COVID-19) inthe Philippines as of May 2021. Statistica.https://www.statista.com/statistics/1238243/philippines-reasons-tobe-vaccinated-versuscoronavirus/
Tilo, D. (2021, Dec. 4). Vaccine mandate for on-site workers draws
o p p o s i t i o n . H u m a n R e s o u r c e D i r e c t o r. h t t p s : / /www.hcamag.com/asia/specialisation/employment-law/vaccine-mandatefor-on-site-workers-drawsopposition/318823
Tomacruz, S. (2021, Nov. 24). Unvaccinated nearly 3 times more
likely to die from COVID-19 −DOH. Rappler.com. https://www.rappler.com/nation/doh-says-unvaccinated-peoplemore-likely-die-from-covid-19/

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)
Valente, C & Mendoza, R. (2021, Nov. 13). Vaccination requiredfor onsite workers. The Manila Times.https://www.manilatimes.net/2021/11/12/news/palace-covid-19vaccination-nowmandatory-for-eligible-on-siteworkers/1821949
Wenar, L. (2021). John Rawls. In Zalta, E. (Ed.), The Stanford
Encyclopedia of Philosophy (Summer 2021 Edition). https://
plato.stanford.edu/entries/rawls/?
mc_cid=795d9a7f9b&mc_eid=(UNIQID)

Utilitarianism and Compulsory
Covid-19 Vaccination in Nigeria- Ikechukwu Monday Osebor
Department of Arts and Humanities, Delta State Polytechnic
Ogwashi-Uku PMB 1030, Nigeria
https://orcid.org/0000-0002-2642-662X
Email: osebordarry @yahoo.com- Marta Luciane Fischer
Pos graduate Master Course in Bioethics,
Ponti ice Catholic University of Parana pucpr, Brazil
Abstract
The COVID-19 pandemic is one of the health challenges
facing humanity. Covid-19 evolved into a serious global
emergency, leading to its declaration as a pandemic by theWorld Health Organization (WHO). Covid-19 has affected
all members of society, no matter their status or positionof power. Equally, anyone who is irresponsible or refuses
to protect oneself would put others at risk. To avoid
worsening the health crisis; the Edo state government
proposed compulsory vaccination of all residents in thestate to prevent the further spread of the Covid-19 virus.
The ethical-legal implications of compulsory vaccination
include human rights violation. The moral justi ication ofcompulsory vaccination entails debates. From theconsequentiality standpoint, compulsory vaccination
turns out to be good for the greatest number of persons,and then it should be permitted to avoid worsening thehealth crisis. Although some may argue that Covid-19
virus would not stop spreading irrespective of themandated choice. Nevertheless, adherence to COVID-19
protocols is essential for the common good of humanity.
This paper concludes that sensitization instead ofcompulsory vaccination to curtailing the spread of theCovid-19 pandemic.
Keywords:
legal, Compulsory vaccination, ethics,
COVID-19, social distance, facemask and lockdown

f

f

f

f

f

f

f

f

Introduction
Coronavirus was irst reported in Wuhan, China, in
December 2019. It evolved into a serious global
emergency leading to its declaration as a pandemic by theWorld Health Organization (WHO) (Monday, 2020).
Corona virus is a RNA-virus found in animals including
birds, camels, cattle, cats, pigs, and bats. “Among theseanimals, the rhinolophid bats are the most dangerous
carriers and they do not exhibit clinical signs of infection. In
other animals, the virus develops severe illness such as
infectious bronchitis (IB) disease in chicken, which could

25

lead to serious economic losses to the poultry
industry" (Heshu et al., 2020).
COVID-19 has led to over 3 million deaths globally(ECDPC, 2022). The COVID-19 pandemic has also led toincreased post traumatic disorders. While someindividuals may cope well with posttraumatic disorder,some develop further psychological distress including
depressive symptoms, anxiety, or stress (Noemi et al.,2021; Ravi, 2020).
The mode of virus transmission occurs via direct(deposited on persons) or indirect (deposited on objects)
contact and airborne (droplets and aerosols) routes(Renyi et al., 2020). "Previous experimental andobservational studies on inter-human transmission haveindicated a signi icant role of aerosols in the transmissionof many respiratory viruses, including in luenza virus,
SARS-CoV-1, and the Middle East Respiratory Syndrome
coronavirus (MERS-CoV)" (Renyi et al., 2020). For thisreason, governments and researchers are investing
millions of dollars in increasing human understandingaround vaccine production or preventative drugs to avert
further health crises due to Covid-19 (Monday, 2020).
Many measures have been speci ied to stop the spreadof the coronavirus. The measures include physicaldistancing, wearing of facemasks publicly, ventilation andair- iltering, hand washing, covering one's mouth whensneezing or coughing, disinfecting surfaces, andmonitoring and self-isolation for people exposed or
symptomatic (Heshu et al., 2020) (WHO,2020) (Monday,2020).
Physical distancing is the reduction in personal
contacts between people in or outside a community. It isa non-medical intervention, which helps to curtail the
spread of Coronavirus (Ben, 2020),(Eric,2020). To
implement social distancing, governments have closed
down churches, mosques, markets, airports, schools andhave the established quarantined centres, which helps todelay the rise in the number of infections in a pandemic(Monday, 2020).
Physical distancing has affected relationships andinvaded the privacy of all citizens. It negates the
traditional assertion that man by nature is a social being.
Human beings are social creatures. Fisher et al., (2021)
maintain that personal and daily decisions about how topromote self-care place them in a chain of global
responsibilities and interdependencies. We rely on eachother not only for the goods and services, also for theemotional basics we need, such as compassion,understanding, friendship and love (Human Right Watch,
2020). Physical distancing reshapes social experience andeconomic losses. It also decreases the African sense ofcommunalism and increases impersonality andindividualism among the African community.
Socialdistance seem plausible, it helps to latten the curve of apandemic.
The use of facemasks is one of the strategies to
stopping the spread of covid-19. The prevalence ofevidence suggests, "Mask wearing reduces thetransmissibility per contact by reducing transmission of
infected droplets in both laboratory and clinical contexts.
Public mask-wearing is most effective at reducing the
spread of the virus when compliance is high. The

26

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

decreased transmissibility could substantially reduce thedeath toll and economic impact while the cost of theintervention is low" (WHO, 2020). The effects of facemask
can include making the individual uncomfortable, skinrashes, headaches, it reduces air low, and this canadversely affect children or others who are incapacitated(Howard, 2020).
Indiscriminate disposal of facemasks is discouraged,
to avoid contamination of the environment. We contend
facemasks are used only in public places to improve
hydration and skincare, and citizens should use only
medically designed facemasks to avoid a decline in health.
However, the aforementioned strategies for combating
the Covid-19 virus are not suf icient to stop the spread of
the plague but "vaccination" would be an effective
strategy to combat the Covid-19 pandemic. This researchis concerned with the ethical implications of compulsory
vaccination in Nigeria.
Compulsory vaccination
Governor Godwin Obaseki of Edo state Nigeria hasannounced plans to make vaccination of Covid-19
compulsory for residents to stop the spread of theCovid-19 virus. The Edo state government announced that
residents must present proof of Covid-19 vaccination
before accessing public places from the second week of
September (Vanguard, 2021).
Compulsory vaccination "compels direct or indirect
threats of imposing restrictions in cases of noncompliance. It is a policy, which limits the individual
choice in non-trivial ways by making vaccination a
condition of, for example, attending school or working inparticular industries or settings, like health care in
Nigeria. Vaccines administration reduces the risk ofinfection. It builds body mechanism for natural defences(WHO Vaccine, n-d). "Vaccines work by training andpreparing the body's natural defences – the immune
system – to recognize and ight off the viruses andbacteria they target. After vaccination, if the body is later
exposed to those disease-causing germs, the body isimmediately ready to destroy them, preventing illness.
(WHO Vaccine, n-d). However, the COVID-19 vaccine will
help to prevent serious illness and death. "We still don't
know the extent to which it keeps you from being infected
and passing the virus on to others" (WHO Vaccine, n-d).
We maintain that citizens should continue to take actions
to stop the spread of the virus through adherence to
Covid-19 protocols.

f

f

f

f

f

f

f

f

f

f

f

Ethical-legal Issues
Ethics deals with distinctions between the right andwrong of human actions. Ethics is the study of "moral
principles and why people make moral and immoral
decisions. It focuses on how people ought to behave basedon their moral compass or values, and society's sharedvalues, laws, and traditions" (Mondayc, 2020). Ethics
focuses on fundamental issues of practical decisionmaking, which enhances the safety of citizens during andafter a pandemic (Mondayc, 2020) (Peter, 2019).
The ethical issues surrounding compulsory
vaccination of Covid-19 requires a philosophical analysis
to identify the right approach to address them. Some may

argue that compulsory vaccination is a rule utility. Ruleutility is an effective strategy to preventing the spread of
infectious diseases such as Covid-19.
However,compulsory vaccination repudiates human dignity(Michael, n-d).
It is a policy option, which interferes with individual
liberty and autonomy. It could be considered only if itwould be of bene it to the greatest number of person and/or promote signi icant and unequivocal public healthbene its (WHO, 2021). For the utilitarian's, compulsory
vaccination would help to increase the happiness or
welfare of many persons for the common good of thepeople.
On the other hand, vaccination should be informed
consent. The principles of bioethics should follow
diagnostics, testing of drugs or vaccines.
Research
participants have the right to make choices on
vaccination. The individual choice must not infringe on
the rights of others. We maintain that governments;
health care providers must assist research participants inmaking informed choices. Communicating relevant
information openly and truthfully in a language clearly
understood by participants, and that vaccine are
distributed based on the principle of justice.
International Human Rights law guarantees everyone
the best attainable standard of health. It is an unethicalthreat to public health and is to supply medical aids tothose who need it (Human Right Watch, 2020).
Emergency restrictions such as compulsory vaccinations
would be justi ied, to stopping the spread of infectious
diseases such as COVID-19.
WHO recently issued aposition statement that national authorities andconveyance operators should not require COVID-19
vaccination as a condition of international travel oraccessing public of ices (Human Right Watch, 2020).
Vaccination is value rooted and goal-directed to solving
health crises confronting humankind.
Mandatory
vaccination when considered from the utilitarian
standpoint, it is a proportionate attempt to address publichealth emergency and to legitimate public healthauthority (WHO, 2021).
Utilitarian Standpoint on Compulsory Covid-19
vaccination
Jeremy Bentham irst formulated the concept of
Utilitarianism and was developed by John Stuart Mill
(Mondayb, 2020). Utilitarianism holds that the "morally
best action is that which brings about the greatest amountof pleasure or happiness to the greatest amount ofpeople" (Mondayb, 2020). This view says that the mostimportant feature of an action is the consequences, rather
than the intention or motivation behind it. Utilitarianism
is a moral theory of rightness, what is good, is thewellbeing of all or utility. Moral action is that which
results in the highest overall "wellbeing" for all
stakeholders. Here, Compulsory vaccination should bepermitted and morally justi ied, provided it will bebene icial to humankind who acted upon the interest oflarge numbers of persons (Mondayb, 2020) (Dave, 2020).
Vaccination robustly improves their lives rather thanworsening the health crisis ravaging the worldSome argue
that compulsory vaccination is to maximize utility. For

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)
this reason, utilitarianism cannot be overruled in solving
the health crisis ravaging the world.
It is a common good geared for the greatest good of
the greatest number of people. Vaccination is a plausible
clinical practice, geared for the good of the greatest
number of persons. We argue that Covid-19 vaccines be
distributed based on the principle of justice for thehappiness of all (WHO Vaccine, 2020).
Conclusion
These re lections upon the ethical implications ofcompulsory vaccination, show that personal disposition,
beliefs and libertarianism in luence the choice ofvaccination against Covid-19. Nevertheless, the collective
efforts of citizens is important to confronting Covid-19
ravaging the world.
We maintain that sensitization
instead of compuls6ry vaccination is an essential
contributor to aiding human understanding of a pandemic
and avoid worsening the global health crisis. We hopethat this paper will open the entrance to scholars, who are
curious about the moral dimensions of compulsory
vaccination against Covid-19.
Referencesff

Ben Pandemic Ethics, 8 Big Questions of COVID-19. Bartleby
Books 2020. Available from https://creativecommons.org/
licenses/by-nc-sa/4.0/
Dave Blanchard The Unintended Consequences of Social
Distancing. Staying at home isn’t always the safest place to be.
SEP 01, 2020. https://www.ehstoday.com/covid19/article/
21140779/the-unintended-consequences-of-social-distancing.
Eric C. Ip COVID-19 Lockdowns: a Public Mental Health Ethics
Perspective. Asian Bioeth Rev. 2020 Aug 18: 1–8. DOI:
10.1007/s41649-020-00144-0
European Centre for Disease Prevention and Control(2021).Covid-19 situation update worldwide, as of week 11
updated 25 march 2021. https://www.ecdc.europa.eu/en/
geographical-distribution-2019-ncov-cases
Fischer, M. L., Cunha, T. R. D., & Burda, T. A. M. (2021).
Perspectivas de brasileiros durante a pandemia da Covid-19:
uma análise sobre autocuidado e bioética ambiental. Saúde em
Debate, 45, 733-747.
Heshu S, Masrur S, Ridha Hassan, Hemn H, Shirwan H, Eman S,
Nusayba A, Kawa A, and Rasedee A. The transmission modes
and sources of COVID-19: A systematic review, International
Journal of Surgery Open. 2020; 26: 125–136.
Howard, A Huang, Z Li, Z Tufekci, V Zdimal, V- D Westhuizen, V
Delft, A Price, L Fridman, L Tang, V Tang, G-L Watson, C-E Bax,
R Shaikh, F Questier, F Hernandez, D.; Chu, L.F.; Ramirez, C.M.;
Rimoin, A.W. Face Masks Against COVID-19: An Evidence
Review. Preprints 2020, 2020040203 (DOI: 10.20944/
preprints202004.0203.v2).
h t t p s : / / w w w. w h o . i n t / h e a l t h - t o p i c s / v a c c i n e s - a n d immunization#tab=tab_1
Human right Watch. Human right dimension of covid 19. March
19,2020 https://www.hrw.org/news/2020/03/19/humanrights-dimensions-covid-19-response
Human Rights Watch. Human right dimension of covid 19. March
19,2020 https://www.hrw.org/news/2020/03/19/humanrights-dimensions-covid-19-response
Lockdown. Sri Lanka Journal of Child Health, 2020; 49(3):308-309.
Michael, J and. Chapter 4 Disease Prevention and Control. Public
Health Ethics: Cases Spanning the Globe (Internet). https://www.ncbi.nlm.nih.gov/books/NBK435775/
Mondayb O.I Is Organ Farming a Panacea to Organ Crisis? EthicalImplications. EJAIB Vol. 28 (3) May 2018. https://
philpapers.org/rec/MONIOF-4
Monday. O. Reintroduction of native centric education forchildren in COVID-19

27

Mondayc O Ethics Of Cognitive Restructuring: A Rehabilitation Of
Rape Victims And Offenders. Voices In Bioethics (internet)
2020. ( cited 2020 November 14 ) Vol.6 DOI Https://Doi.Org/
10.7916/Vib.V6i.7223
Noemi Anja Brog, Julia Katharina Hegy, Thomas Berger &Hansjörg Znoj (2021) .An internet-based self-help intervention
for people with psychological distress due to COVID-19: study
protocol for a randomized controlled trial. Trials, 22: 171.
https://trialsjournal.biomedcentral.com/articles/10.1186/
s13063-021-05089-9
Peter S. Moral Philosophy. Encyclopedia Britannica 2019.
Available from https://www.britannica.com/topic/ethicsphilosophy
Ravi Philip Rajkumar. (2020). Covid 19 and Mental Health . A
Review of the Existing Literature. Asian Journal of
Psychiatry,52 (January), 102066.
Vanguard Newspaper (September 2 2021) Our directive onc o m p u l s o r y C OV I D - 1 9 va c c i n a t i o n i n E d o s t a n d s
Obasekihttps://www.vanguardngr.com/2021/09/ourdirective-on-compulsory-covid-19-vaccination-in-edo-standsobaseki/
World health organization COVID-19 advice for the public:
Getting vaccinated English version last updated on 14 July
2021. https://www.who.int/emergencies/diseases/novelcoronavirus-2019/covid-19-vaccines/advice
World Health Organization Vaccines and Immunization
World Health Organization. Coronavirus Disease (COVID-19)
Situation Report – 115. https://www.who.int/docs/defaultsource/coronaviruse/situation-reports/20200514-covid-19sitrep-115.pdf?sfvrsn=3fce8d3c_6
World Health Organization. Coronavirus Disease (COVID-19)
Situation Report – 115. Available https://www.who.int/docs/
default-source/coronaviruse/situation-reports/20200514covid-19-sitrep-115.pdf?sfvrsn=3fce8d3c_6
World Health Organization. COVID-19 and mandatory
vaccination: Ethical considerations and caveats Policy brief 13
April 2021.
World Health Organization. Vaccines and Immunization. https://w w w. w h o . i n t / h e a l t h - t o p i c s / v a c c i n e s - a n d immunization#tab=tab_1

Allocation of Healthcare Resources
During Public Health Emergencies
Should Not Perpetuate Ageism- Czeazar Ianne E. Lupo
Email: czeazariannelupo@g.cjc.edu.ph- Rogelio P. Bayod
Email: roger.bayod@gmail.com
Cor Jesu College, Philippines
Abstract
Making ethical decisions in the context of a pandemic
emergency due to the limited availability of healthcare
resources is a pervasive problem that healthorganizations are trying to counter. As the coronavirus
disease emerged worldwide, some countries wereexperiencing unanticipated challenges regarding resource
allocation. While some were consistent with following the
ethical guidelines in allocating these scarce resources,
others acknowledged a different approach in theirrespective jurisdictions. A committee in Italy recognized
the need to set an age limit for ICU admissions after
seeking ethical counsel because the demand for criticalcare surprisingly exceeded supply. On the other hand,Philippine healthcare systems responded in a way that is28

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

not the same. They allocate resources reasonably and seek
help from the Philippine government to avoid the scarcity
dilemma. This paper will explore how scarce medical
resources should be administered by healthcare systems
without leaving the elderly behind. Afterward, this gives apossible approach to be taken in dealing with pandemics
and other emergencies in the future. This paper will argue
that in public health emergencies, age is an irrelevantcharacteristic when determining healthcare resource
allocation amid the COVID-19 pandemic, and decisions
should not be based on how scarce resources are. This
paper supports an egalitarian view, speci ically John
Rawls’ theory of justice, to ease the deep-rooted ageism insocieties. The author believed that overlooking the mostvulnerable populations during the pandemic must not be
perpetuated despite the lack of preparedness for thissudden public health emergency.
Keywords: resource allocation, ageism, elderly, COVID-19,
John Rawls

f

f

f

f

f

f

f

f

f

Introduction
The coronavirus (COVID-19) outbreak caught everyone bysurprise when it emerged. The World Health Organization(WHO) declared it a pandemic that changed the capabilityof healthcare systems, particularly intensive care units(ICUs) worldwide. The demand for critical care services insome parts of the world, such as Italy and somedeveloping countries, rapidly exceeded. Given this,healthcare organizations and individuals face unforeseenchallenges in providing the best healthcare to those whoneed it the most. The COVID-19 has disputed medical,
ethical, and social challenges which health organizations
are trying to counter because of the increasing demandfor healthcare services. It has led to many concerns,
especially pushing healthcare organizations to makeethical decisions regarding resource allocation.
Even in the wealthiest countries, life-saving ventilators
have become scarce, and physicians were left with nochoice but to weigh these resources by following theguidelines in their respective jurisdictions. This
circumstance was true in China and Italy (Patel et al.,2020). The United States, Spain, United Kingdom, and thePhilippines also face the same problem. Although theguidelines did not suggest that age should be a factor inresource allocation in Italy, the committee decided to set
an age limit for ICU admissions due to the fact that it has
been impossible to meet the needs of many. They seemed
to be more focused on saving people with the highest
chance of surviving this deadly disease, followed by thosewith the lowest survival chance (Rosenbaum, 2020).
Meanwhile, the Canadian Geriatrics Society (CSG,
2020) reported that age should not drive the decisions forresource allocation. The CSG community did not consider
age as a factor in deciding access to limited healthcare
resources. According to them, decisions on access to
medication for adults should be individualized bymeasures of patient frailty. From an ethical perspective,
decisions during public health emergency should not bebased on the consequences of having limited healthcare
resources. Just because resources are scarce it does nothave to consider a utilitarian approach in admitting
patient where the old people have to suffer. In fact, since

they are the most vulnerable members of the population
during the pandemic, they should be prioritized in termsof hospital admission. This paper tries to understand thereasonable resource allocation option of healthcare
systems in a situation of scarcity. The paper starts withthe de inition of rationing and ageism. It then explores
how scarce medical resources should be allocatedethically. This paper further argues that in public healthemergencies, age is an irrelevant characteristic indetermining healthcare resource allocation amid the
COVID-19 pandemic.
Rationing (Egalitarianism and Utilitarianism)
If healthcare resources are scarce, how should they be
distributed? Rationing in the allocation of scarce
resources in the face of limited availability, which inhealth care necessarily means that bene icial
interventions are kept from some individuals (Truog et al.,2006). It refers to intentionally excluding certain people
from getting what they need, such as treatment. Rationing
resources during a pandemic suggests making
unfavorable choices, but these choices can be morally
justi ied through ethical principles Because of theincreasing demand and the growing healthcare
expenditures that limit supply, rationing is said to be
exercised.
There are two main theories relevant to rationing
limited resources and distributive justice in healthcare:egalitarianism and utilitarianism. For egalitarians, allpeople should get the same treatment for equal needs. It
speaks about making things fair. Egalitarian theories ofjustice believe that persons should receive an equal
distribution of goods such as health care. However, no
prominent egalitarian theory requires equal sharing of all
possible social bene its. Egalitarianism gives people thesame starting points to have the same opportunity
regardless of race, gender, religion, and the likes. However,
the real question is how to get it? It says that we should
put equal shares on both sides of the scale, bringing theratio closer to equal. Meaning it will never make the two
scales equal. It will only improve the ratio and make thesituation a lot better. In contrast, according toutilitarianism, the right course of action maximizes overallbene its at the societal level. Father of utilitarianism,
British Philosopher Jeremy Bentham is famous for his
phrase, "the greatest good for the greatest number." Thecorrect action is the one that makes the greatest balanceof happiness over suffering. However, utilitarianism has aproblem with values like justice and human rights. For
example, assume a hospital has ive people, and the doctor
has four doses left of medicine. All patients need the
medicine to survive. However, one of them will survive
only if the doctor gives him the ive doses of the drug. The
remaining four patients can only survive on a single dose
each. In this situation, utilitarianism tells us to divide thedrug, save the four patients, and allow the other patient todie. Why? Because saving the four patients maximizes thebene its and preserves much more happiness than saving
one life. However, more needs to be done to make society
fair. This paper also uses John Rawls’ theory of justice the most widely discussed theory of distributive justicethat he proposed.

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

f

f

f

f

f

f

f

f

Ageism
Dr. Robert Butler, a psychiatrist, and gerontologist coined
the term ageism in 1968, which describes "the systematic
discrimination by a particular age group against older
people." Ideally, ageism is broadly de ined as prejudice ordisapproval of older adults, whether through society's
stigmatization or discriminatory practices andinstitutions. Much of the research exploring the content ofolder worker stereotypes in the United States isrecognized but suggests that people often hold lawed andinaccurate beliefs about older workers (Konrad et al.,2005). For example, older individuals have been perceived
as ineffective and are not performing well. On thecontrary, there is also evidence that beliefs about older
workers are not always seen as unfavorable, just like older
workers are often perceived to be more reliable and haveintegrity. Ageism is manifested in how we think, feel, andact towards age and aging. It is directed towards people ofany age group and can be positive and negative (Ayalon
and Tesch-Romer, 2018). However, ageism is an internal
experience and manifests in various settings and contexts.
Ageism does not always begin at the individual level.
Groups, organizations, and other institutions can also
be the perpetrators of ageism. A very concrete example is
the rules in exiting and entering an organization. The
labor force and the work setting is another critical social
arena that re lects the depth and scope of ageism (Dennis
and Thomas 2007). In the labor market, age can be afactor in seeking a company or withdrawing from acompany. Furthermore, ageism is expected in thehealthcare sector (Robb et al. 2002). According to Mahler(2021), a UN expert, the COVID-19 pandemic revealed
widespread ageism and age discrimination against older
persons. They are being blamed for lockdowns andlabeled as vulnerable and burdens society. On the occasionof the International Day of Older Persons on October 1,
2021, Claudia Mahler, the UN Independent Expert on theenjoyment of all human rights by older persons, calls forurgent action against ageism and age discrimination. A
portion of her statement includes:“Ageism and age discrimination violate the humanrights of older persons and exacerbate inequalities indifferent ways, including leaving older persons behind in
our increasingly digitalized world. For example, ageist
assumptions make it more dif icult for older persons to get
equal access to medical care. The use of telemedicine andremote technology sharply increased during the pandemic
without equivalent attention to improving digital literacy
and access to digital technology, infrastructure and devices.
This aggravated inequality in the enjoyment of the right tohealth by older persons owing to the existing digital divideand exclusion from information related to the pandemic
and health care when provided only in digital or nonaccessible formats” (Mahler, 2021 p.1).
This statement means that ageism is not new. There isalready an existing stigma of ageism in access towards
medical care because older persons are left behind in theadvancement of medical technology. The use oftelemedicine during the pandemic in advanced economies
has created a divide against older persons, with most ofthem facing limited access to digital technology. Without

29

proper attention to digital literacy it will be difficult for
older persons to catch up and get equal access to medicalcare. Without improving digital literacy, they cannot enjoy
their right to health. The same problem goes withallocating scarce resources by deprioritizing older persons
just because resources are not enough to sufficeeveryone’s needs. Old age has been a criterion forrationing health care resources and occurs at all levels in
the health sector. The structure of healthcare systems
which expects a lower chance from a senior’s ability torecover should not be the problem because being old is
not a status that people choose to become. Instead, it iswhat people inherit by virtue of living. Although ageism isuniversal, people do not always take ageism as a serious
form of inequity. Treatment decisions should only be taken
on individual basis and not on other factors such as age.
Allocation of Scarce Medical Resources in the Time of
Covid-19
In the context of the covid-19 pandemic, hospitals try to
maximize bene its as much as possible. Is the distributionof healthcare resources fair and equitable? Who gets theventilator? This questions raise dif icult decisions about
who will and will not receive these scarce resources. As arule, the guidelines suggest that resources are allocated insuch a way that "the greatest number of lives will be saved
and will favor those with the most number of life-years."
Maximization of bene its can be described as saving themost individual lives or the most life-years or prioritizing
patients likely to survive the longest after treatment(Emanuel et al., 2020). But is it justi iable to prioritize
those patients who can keep up with the treatment with areasonable life expectancy? On that basis, it seems to havethe effect of favoring those who are young and have ahigher expectancy of remaining life years. It is awful tothink of removing a patient from a ventilator or an ICU
bed or looking at patients queuing for ICU care.
However, many guidelines but not all agree that thedecision to remove a scarce resource to save others does
not require the patient's consent because it is not an act ofkilling (Emanuel et al., 2020). In Italy, Marco Vergano, whoworked on the recommendations between caring forcritically ill patients in the ICU, said that the committee
urged "clinical reasonableness" and what he called a "softutilitarian" approach in the situation of scarcity. The
committee acknowledged the ultimate need to set an age
limit for ICU admission. Even if the guidelines did notsuggest that age should be the only factor determining
resource allocation, but they were asked to do it after
seeking ethical counsel (Rosenbaum, 2020). Althoughapproaches vary but it seems that age was given the mostweight. But in the context of health emergencies such as
the COVID-19, how can we agree with those guidelines? Is
it ethical to favor those who can live longer to maximize
scarce resources? Why do we need to prefer one over theother if all lives are said to be equal? Is it valid to exclude
one because of age? According to the World HealthOrganization (2020), irrelevant characteristics, such as
ethnicity, religion, race, ability, and gender, should not
determine any resource allocation in any pandemic. Theyemphasized that it is their commitment to treating people
with equal respect. It may also be inappropriate to use

30

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

f

f

f

f

f

f

f

f

f

f

f

f

f

critical care triage guidelines that have age-limits that
exclude those who aged 60 years and above. This meansthat age and life expectancy cannot only be the sole basis
for triage decisions and priority setting. Patients shouldhave equal rights to appropriate medical care without
discrimination. For this reason, medical professionals
must recognize these rights and duties at all times, even in
the situation of scarcity. Treating people equally could bedone by assuring everyone that once treatment becomes
available, age should not be used to discriminate elderly
in allocating resources in the context of COVID-19 or any
emergency. Equal opportunity in terms of access to scarce
resources must be implemented to guard against
partiality and bias. However, if the resources are reallyscarce and cannot sustain the needs of everyone, using
Rawls’s difference principle can be a possible solution.
During a public health emergency, it is justi iable toprioritize those who work in the health sector. If they are
given the priority, they can address the concerns of theleast advantaged group without compromising the rightto health of individuals. The difference principle sought tomaximize the availability of primary goods without full
exploitation of vulnerable groups. This principle holds
that inequalities are just provided that they lead toincreased bene its to the well-situated people andparticularly the least-advantaged. Suppose if an advantage
can increase the expectations of the vulnerable group, it
can also increase the expectations of everybody. A very
important argument against the stigmatization of aging, isthe fact that people should have the same rights as others
to receive if not better, a reasonable health care and therights not need to be spurred as of the moment byconsidering their death as good. If professionals will beprioritized well, they can ind ways on how to make thesituation of those who most likely get infected a lot better
because they have the talent and required skills to
address the shortfall of critical care.
In the Ethical Guidelines for Leaders in Health Care
Institutions during the COVID-19 Pandemic, the objectivesof these guidelines are: (1) To offer key principles in two
speci ic ethical dilemmas that are expected to occur
during the pandemic; (2) To offer suggestions on how
leaders of health care institutions can set up a mechanism
for ethical consult and deliberation during the pandemic(de la Vega, 2020). In allocating scarce resources,
principles of Net Utility, Equity, Duty to Care, and Respectfor Persons guide decision-makers. In the guidelines, the“net utility” section is followed by a section on “the duty
to care” that identi ies a need to control what seems to bea utilitarian for allocating resources:
To balance the principle of net utility, a conscious effort
must be made to consider strongly those who are worst off
or those who have lived [the] least number of years (theyoungest). This is to be applied only insofar as it isconsistent with the dictum to maximize bene its (TFG,2020
p.3).
The following points to be taken in thestatement are: (1) consider strongly those who are worst
off (2) consider strongly those who lived the least numberof years. The guidelines on the section of "the duty tocare" can be understood as giving people an equal
opportunity for admission, whether old or young. This

record is accurate, for there must be due diligence tothose seeking care, particularly for the most vulnerable
groups in society.
Elderly patients are one of those who are considered
to be worst off in public health emergencies such as
COVID-19 because the disease most likely infects them.
There was a recent WHO declaration that reports over
95% of COVID-19 related deaths in Europe occurred inpeople older than 60 years (Carrieri et al., 2020).
Internationally, health authorities and governments are
reprimanding older people that they are at a higher risk ofmore serious and possible fatal illness associated with
COVID-19 (Brooke & Jackson, 2020). More so, COVID-19
has contributed intensifying anxiety, loss of con idence inlife, and exacerbating individuals’ fear of the unknown.
This setting calls for a program that prioritizes them. The
author believed that during the COVID-19 pandemic,
there is a need to focus on this since there are signs ofsuch discrimination. The government and policymakers
should ind ways to prevent the scarcity of medical
resources (Emanuel et al., 2020). How can we avoid thescarcity dilemma? Luckily, social distancing has lattened
the curve but this is not always the case. Other restrictions
were a general duty of home quarantine.
In the Philippines, the implementation of different
quarantine measures by the Philippine national
government through its Inter-Agency Task Force (IATF)
has helped slow down the rate of infections and moderatedemand on the health system. Local government units
also adopt measures like prohibiting elders from goingoutside and keeping only essential businesses to operate,
observing public health protocols (S. Talabis et al., 2021).
This action taken by the government is indeed helpful toensure that the cases in the country will not materially
increase over time. Vaccination and other simplest andconsistent way might as well help latten the epidemic
curve and prevent the short supply of resources. As aresult, health workers can allocate scarce resources well.
A health of icial in the Philippines reported that not all
patients who test positive for coronavirus disease or
COVID-19 have to be admitted to hospitals (CNN
Philippines, 2020). As stated in the report, high-riskpatients must be admitted so they will be adequately
monitored. The health of icial said “coronavirus-positive
patients who are not showing symptoms or only havemild lu-like signs will be advised to stay at home forquarantine and strict monitoring by health workers.”
Hence, this means that the Philippine healthcare systems
were advised to strictly monitor and not neglect patients
who are in critical condition. More so, those who undergo
quarantine are also strictly monitored by health workers.
In this way, alarming reports about abandoning older
patients will not be a burden and decisions regarding theallocation of resources will not be so hard for healthcare
systems.
John Rawls’ Theory of Distributive Justice
The most common criticism of the utilitarian approachconcerning rationing in emergencies is that it does notpromote equality for all. There is no fair way of
distributing resources to those who demand them.
Because for them, the right action will be that whichEubios Journal of Asian and International Bioethics 32(1) (January 2022)

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

results in the maximum overall bene it. John Rawls, beinganti-utilitarian, designed his book 'A Theory of Justice'based on the social contract theory. His theory's mostprominent feature is its egalitarian conclusion about how
economic goods are distributed rather than an overallbene it. Moreover, the concept of 'original position' issigni icant in his theory to ensure fair results. Individuals
are said to be behind a veil of ignorance when they are in
the original position. According to him, this concept gives
us the idea to see ourselves in a free and equal position.
Following this view would be rational for the people tochoose his two principles of justice: the liberty principle
and the difference principle. The irst one requires
everyone to receive equal basic rights and duties. The
second principle is divided in two parts.
The irst part requires equality of opportunity bypointing out that society should provide all citizens withbasic means like access to education and health facilities.
For instance, priority setting should only be based onclinical need and these services must not give preferential
treatment to any individual patient. However, relying on
the principle of equal access for equal need may not be
suf icient to ensure fair treatment. Sadly, the Philippines
still struggles with unequal access to medical careparticularly public hospitals. Rawls realized that there isso much inequality in society. Because of these naturalinequalities, Rawls insisted that society should ind ways
to minimize them. Hence, the other principle means thateven if there is an unequal distribution of bene its andwealth, these inequalities are justi iable only if they
bene it the least advantaged members of society. For
instance, the COVID-19 leads to absolute scarcity andundeniably affects all patients. There is no absoluteassurance that everyone can bene it from the scarce
resources in public health emergencies. However, wecannot just ignore the minority for the sake of the
majority and undervalue the unequal distribution ofbene its and duties in society. The idea like individuals
with comorbidities or aged people who are apt to be
deprioritized just because they are less likely to get better
is not a good solution. Allowing such cause further
inequity. The goal of maximizing bene its can beprioritizing those who has the knowledge and talent tohelp the worst off rise from their current situation. Even
though prioritizing health professionals causes inequity, it
is justi iable so long as it improves the situation of theworse off in society. Each person possesses aninviolability based on justice that even the welfare ofsociety as a whole cannot override. For this reason, justicerefuses that the loss of freedom for some is made right by
a greater good shared by others" (Rawls, 1999).
Therefore, life must not be sacri iced for the sake of many.
Denying older persons' right to health and life on thesame basis as others should not be a criterion. However, if
health professionals were prioritized well then theirtalents would be able to help improve the life of thoseolder people who were the worst off in society.
When health professionals are able to perform their
responsibilities and duties in addressing the shortfall ofcritical care in this uneasy situation, the situation will be alittle better.

31

Given this, society has to exercise solidarity and better
protect older persons suffering from the pandemic
despite the inequality it promotes. This issue does notlook into the greater bene it it receives but at society's
values. A paper that examines the fairness ofrecommendations contained in resource allocation
guidelines in the Philippines recommended that medical
indications are more than demographic categories (DeCastro et al., 2020). However, when countries are forced toprioritize the young and otherwise healthy, is that just?
How would a world have to be created to ensure realjustice? The answer is you must wear a blindfold andwon’t have to know what kind of person you are in thesociety so your decisions remain impartial. Behind thatblindfold, you might end up young, old, white, black, born
into a wealthy family, or living with extreme poverty.
Given this, physicians or triage committees who are in thebest place to provide a reasonable healthcare to society
won't have to know what kind of person they are. They
should stop thinking about their families or how they'll
end up in this ongoing crisis. John Rawls' argued that we
had chosen much from behind the veil for a fairer societythat gives more freedom to people and fair equality ofopportunity. While medical rationing is perhaps
unavoidable, this situation should be based on medical
necessity alone. It must not negatively consider individual
identities or experiences such as disability or age (Chen etal., 2020).
Under the circumstances, everyone should agree witha few principles that make for a just society. According to
the difference principle, inequality can be fair if it bene its
the least in society. In other words, it is justi iable to seethat the professionals get the best healthcare regardless of
their age because there is no doubt that they can help
treat those who most likely suffer from this deadly
disease. The difference principle says that this
distribution is just and will make the life of those older
patients better because of their talent. This naturalinequality should help favor the worst-off by providingthem the healthcare facilities they genuinely deserve,
especially in public hospitals. People can never argue withinequality as long as everyone bene its from it. Healthcare workers or even physicians should make sure notprefer any one over the other. John Rawls argues that if we
assume ourselves to be in a situation in which we have to
make choices about how society should be organized, we
can arrive at a fair and just rule only if we do not know
which position we would occupy in that society(Rawls,1999). But to get there, the greatest equal liberty
principle takes priority, followed by the equal opportunityand difference principle. The problem with utilitarianism
is one of rights. Certain rights should not be violated even
if it maximizes bene it in society. It is important to fully
realize these basic liberties. Positions must be open to all
and each has the possibility to fully realize theircapabilities. Discrimination must be prohibited and accessto health should be open to all. These are some ways for
those basic liberties to be protected. De Castro and his coauthors said that our pandemic experiences are provingthat having an egalitarian society will serve the interests
not only of disadvantaged sectors but also of everybody
else, including the privileged. Response measures should

32

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

thus take the opportunity to promote equity by giving
importance to the concerns of the underprivileged andvulnerable while giving preference to initiatives that canbe sustained beyond the period of the current
pandemic. Together, we will judge ourselves based not
only on the number of lives that we would have been able
to save but also on the effort that we place into caring for
the worst-off citizens and human beings in society (DeCastro et al., 2020).
Conclusion
Allocating healthcare resources in COVID-19 can bechallenging, particularly when the spread of new cases
increases drastically. In some countries, due to theunpreparedness of healthcare organizations andincreasing demand for health care, admission of patients
undergoes with guidelines and policies. However, howrationing happens is crucial because it affects individual
lives and expresses what values are the most important tosociety. The fairness and transparency in rationing scarce
resources are essential and must be observed at all times
to have a just healthcare system. The outbreak of
COVID-19 affects the decision-making of physicians andgives rise to ageism (Dubey et al., 2020). Ageism is not
new to the society. It is manifested not only during publichealth emergencies but also in regular times. Luckily, theguidelines for hospital admissions in the Philippines did
not set an age limit despite the rising number ofcon irmed cases in the country. Instead, they prioritizedhigh-risk patients, even those with mild symptoms. Other
strategies like quarantine help prevent the transmissionof COVID-19 and will not crowd hospitals.
Healthcare systems could do more in society to makethings fair. Recommendations must support the principleof equality for all human beings and stop discrimination
against vulnerable groups. Although we live in a world
with endless needs and limited resources, this reality
should not favor anyone. Physicians should not forget that
addressing this pandemic aims to give people fair
opportunities to cope with COVID-19, including theprivileged in society. A patient’s age should not be a solebasis in admission, and decisions must not be based on
how scarce resources are and their bene its to society.
Those who are in a good position to cure patients must
look into the rights that everyone has. Giving people thesame starting points in this dif icult situation will makethem feel loved and cared for. They must not think thatthey are excluded in society for the sake of the majority.
Neglecting the most vulnerable populations in this time ofpandemic will not address the problems and concerns of
the healthcare systems. Instead, the deep-rooted ageism
in societies has become even more apparent.
References

f

f

f

Ayalon L., Tesch-Römer C. (2018) Introduction to the Section:
Ageism—Concept and Origins. In: Ayalon L., Tesch-Römer C.
(eds) Contemporary Perspectives on Ageism. International
Perspectives on Aging, vol 19. Springer, Cham. https://doi.org/
10.1007/978-3-319-73820-8_1
Brooke, J., & Jackson, D. (2020). Older people and COVID-19
isolation, risk and ageism. Journal of clinical nursing.
Carrieri, D., Peccatori, F. A., & Boniolo, G. (2020). COVID-19: aplea to protect the older population. International journal for
equity in health, 19(1), 1-4.

Chen, B., McNamara, D.M. Disability Discrimination, Medical
Rationing and COVID-19. ABR 12, 511–518 (2020). https://doi.org/10.1007/s41649-020-00147-x
De Castro-Hamoy, L., De Castro, L.D. Age Matters but it should
not be Used to Discriminate Against the Elderly in Allocating
Scarce Resources in the Context of COVID-19. ABR 12, 331–340(2020). https://doi.org/10.1007/s41649-020-00130-6
De Castro, L., Lopez, A. A., Hamoy, G., Alba, K. C., & Gundayao, J. C.
(2020). A fair allocation approach to the ethics of scarce
resources in the context of a pandemic: The need to prioritize
the worst-off in the Philippines. Developing World Bioethics.
de la Vega, S. A., & Tan, G. C. (2020). Ethical guidelines for leadersin health care institutions during the covid-19
pandemic. Phillippine Journal of Internal Medicine, iii-vii.
Dennis H, Thomas K (2007) Ageism in the workplace.
Generations 31(1):84–89
DOH revises hospital admission rules for COVID-19 patients.
(2020, March 16). CNN Philippines. Retrieved from https://cnnphilippines.com/news/2020/3/16/Hospital-admissioncoronavirus.html
Dubey, S., Biswas, P., Ghosh, R., Chatterjee, S., Dubey, M. J.,
Chatterjee, S., Lahiri, D., & Lavie, C. J. (2020). Psychosocial
impact of COVID-19. Diabetes & metabolic syndrome, 14(5),779–788. https://doi.org/10.1016/j.dsx.2020.05.035
Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M.,
Glickman, A., ... & Phillips, J. P. (2020). Fair allocation of scarce
medical resources in the time of Covid-19.
Ethics and COVID-19: resource allocation and priority-setting,(2020, April 20). World Health Organization. Retrieved fromh t t p s : / / w w w. wh o . i n t / e m e rg e n c i e s / d i s e a s e s / n ove l coronavirus-2019/question-and-answers-hub/coronavirusdisease-covid-19-ethics-resource-allocation-and-prioritysetting
Konrad, A. M., Prasad, P., & Pringle, J. (Eds.). (2005). Handbook of
workplace diversity. Sage.
Montero-Odasso, M., Hogan, D. B., Lam, R., Madden, K.,
MacKnight, C., Molnar, F., & Rockwood, K. (2020). Age Alone is
not Adequate to Determine Health-care Resource Allocation
During the COVID-19 Pandemic. Canadian geriatrics journal :CGJ, 23(1), 152–154. https://doi.org/10.5770/cgj.23.452
Pandemic exposes ageism and age discrimination in society, says
UN expert. (2021, October 1). United Nations Human Rights.
Retrieved from https://www.ohchr.org/EN/NewsEvents/
Pages/DisplayNews.aspx?NewsID=27572
Patel, L., Elliott, A., Storlie, E., Kethireddy, R., Goodman, K., &Dickey, W. (2020). Ethical and legal challenges during the
COVID-19 pandemic: are we thinking about rural hospitals. J
Rural Health.
Rawls, J. (1999). A theory of justice: Revised edition. Harvard
university press.
Robb C, Chen H, Haley WE (2002) Ageism in mental health andhealth care: a critical review. J Clin Geropsychol 8(1):1–12.
doi:10.1023/A:1013013322947
Rosenbaum, L. (2020). Facing Covid-19 in Italy—ethics, logistics,
and therapeutics on the epidemic’s front line. New England
Journal of Medicine, 382(20), 1873-1875.
S. Talabis, D.A., Babierra, A.L., H. Buhat, C.A. et al. Local
government responses for COVID-19 management in thePhilippines. BMC Public Health 21, 1711 (2021). https://doi.org/10.1186/s12889-021-11746-0
Supady, A., Bode, C. & Duerschmied, D. Procedural justice andegalitarian principles for rationing decisions in the COVID-19
crisis. Crit Care 24, 590 (2020). https://doi.org/10.1186/
s13054-020-03283-w
Truog RD, Brock DW, Cook DJ, et al. (2006) Rationing in theintensive care unit . Critical Care Medicine. 2006
Apr;34(4):958-63;
quiz
971.
DOI:
10.1097/01.ccm.0000206116.10417.d9. PMID: 16484912.
Editorial address, and all correspondence to:Prof. Darryl Macer, Ph.D., Hon.D.
President, American University of Sovereign Nations (AUSN),
https://www.ausovereignnations.org
Email: darryl@eubios.info

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)
Chief Editor: Darryl R.J. Macer
Associate Editor: Nader Ghotbi
Editorial Board: Akira Akabayashi (Japan),
Sahin Aksoy (Turkey), Martha Marcela
Rodriguez-Alanis (Mexico), Angeles Tan Alora(Philippines), Atsushi Asai (Japan), Alireza
Bagheri (Iran), Gerhold Becker (Germany),
Rhyddhi Chakraborty (India/UK), Shamima
Lasker (Bangladesh), Minakshi Bhardwaj (UK),
Christian Byk (IALES; France), Ken Daniels (New
Zealand), Ole Doering (Germany),
Amarbayasgalan Dorjderem (Mongolia), Hasan
Erbay (Turkey), Soraj Hongladarom (Thailand),Dena Hsin (Taiwan), Rihito Kimura (Japan),
Abby Lippman (Canada), Umar Jenie(Indonesia), Nobuko Yasuhara Macer (Japan),
Masahiro Morioka (Japan), Anwar Nasim(Pakistan), Jing-Bao Nie (China, New Zealand),
Pinit Ratanakul (Thailand), Qiu Ren Zong
(China), Hyakudai Sakamoto (Japan), Sang-yong
Song (Republic of Korea), Takao Takahashi(Japan), Noritoshi Tanida (Japan), Ananya
Tritipthumrongchok (Thailand), Yanguang Wang
(China), Daniel Wikler (USA), Jeong Ro Yoon
(Republic of Korea).

EJAIB adopts and complies with the Committee
on Publication Ethics (COPE) Publication
ethics and malpractice policy. Our policy is on
the EJAIB website. All potential authors shouldhave read these guidelines and by submission ofan article for publication you acknowledge thatyou have complied with this policy. Violations
will be handled in proportion to the intention
and seriousness of the violation. If there is a
con lict of interest stated by the authors of anarticle it will be written in the paper.
Registered address of EJAIB: P.O. Box 16 329,
Hornby, Christchurch 8441, New Zealand
Editorial address, and all correspondence to:Prof. Darryl Macer, Ph.D., Hon.D.
President, American University of Sovereign
Nations(AUSN),
https://
www.ausovereignnations.org
Email: darryl@eubios.info
For forthcoming conferences see:www.eubios.info or www.ausn.info
International Public Health Ambassadors
https://www.ausovereignnations.org/
international_public_health_ambassadors
Email to: provost@ausn.info

f

33

34

Eubios Journal of Asian and International Bioethics 32(1) (January 2022)

ASIAN BIOETHICS ASSOCIATION MEMBERSHIP 2022
and 2022 subscription to Eubios Journal of Asian & International Bioethics (EJAIB)____ I wish to pay my annual membership fees of Asian Bioethics Association (ABA), and receive the2022 issues of Eubios Journal of Asian and International Bioethics (EJAIB) (The Of icial Journal).
Regular Price: US$160 Euro 120 ¥18000 (=Credit card price NZ$200)____ I do not require the hard copy of Eubios Journal of Asian and International Bioethics (EJAIB).
____ I wish to make a reduced contribution and register as a member of Asian Bioethics Association I
understand that I should be satis ied with Internet access to Eubios Journal of Asian and International
Bioethics (EJAIB)<http://eubios.info/EJAIB.htm>.
____ I wish to make a donation to Eubios Ethics Institute of ____________ Exchange subscription with journal, newsletter, etc.
(Name________________________________________________ )____ I agree / ____ do not agree to my name being listed on the ABA www site. List Research Interests
to be included:
Send an E-mail with your address to: E-mail: darryl@eubios.info and the details for bank accountpayment , Paypal or Western Union will be provided.
Name:
Mailing address:
E-mail:f

f

Web site: <http://eubios.info/ABA.htm>