摘要：February 2005 marks the centenary of one of the most important pieces of public health jurisprudence, the US Supreme Court case of Jacobson v Massachusetts, which upheld the authority of states to pass compulsory vaccination laws. The Court’s decision articulated the view that the freedom of the individual must sometimes be subordinated to the common welfare. We examined the relationship between the individual and society in 20th-century public health practice and law and the ways that compulsory measures have been used to constrain personal liberty for the sake of protecting the public health. ( Am J Public Health. ONE HUNDRED YEARS AGO, the US Supreme Court handed down a 7–2 decision in the case of Jacobson v Massachusetts that upheld the right of states to enact compulsory vaccination laws. In asserting that there are “manifold restraints to which every person is necessarily subject for the common good,” the Court took a firm position on one of the most challenging constitutional dimensions of public health. 1 (p26) It also set the terms for what would eventually emerge as a core question at the heart of public health ethics. Since the Court’s decision, Jacobson has served as a precedent in numerous cases that have challenged vaccination laws. Majority and dissenting opinions in hundreds of other decisions have cited the case in reference to states’ authority to constrain individual behavior. These cases have involved contentious health and medical issues that have ranged from fluoridation of municipal water supplies 2 to abortion 3 to the right to die. 4 Most notoriously, Jacobson was invoked by the Supreme Court in Buck v Bell. In that 1927 case, the Supreme Court upheld a Virginia forced-sterilization law on the ground that society must be protected from the burdens imposed by the progeny of “imbeciles.” “The principle that sustains compulsory vaccination is broad enough to cover cutting the fallopian tubes,” wrote Justice Oliver Wendell Holmes in his now infamous opinion. 5 (p207) But in spite of the problematic uses to which the decision has been put, public health law texts continue to cite the case as an example of the ways that public health practices must resolve the tensions between individual rights and the collective well-being. 6– 8 Nevertheless, it is not clear whether a case that emerged from the legal and social environment of the 19th century remains relevant for the 21st century. In this issue of the Journal, Lawrence Gostin argues for the enduring relevance of the case. 9 Wendy Mariner, George Annas, and Leonard Glantz question whether the case provides an appropriate foundation for thinking about public health in light of subsequent jurisprudence on civil liberties and due process and advances in scientific medicine. 10 Beyond the constitutional issues involved, a more fundamental philosophical disagreement remains over whether and to what extent there is an inherent tension between individual rights and the common welfare. The history of 20th-century public health presents a complicated picture of how such tension has been perceived and resolved. In the case of vaccination policy, where the threat of contagion provided a clear justification for coercion, health officials relied on persuasion for much of the century. Conversely, compulsory measures have been invoked in instances where the threat to the community was more tenuous, (e.g., laws that require the use of motorcycle helmets). The centennial of Jacobson is an opportune occasion for examining how the relationship between the individual and society has been understood in public health law and practice. It also presents an opportunity to examine the social processes by which threats to the public’s health are constructed. Finally, as Mariner et al. and Gostin show in this issue, it permits us to examine the willingness of courts to subject legislative and executive determinations to scrutiny and to understand the standards that have been imposed—whether deferential or skeptical—when making such judgments. In this article, we consider the influence of Jacobson on vaccination programs during the 20th century. We then examine the extent to which compulsory measures have been used in health programs that involved noncontagious threats, where the potential harms to the community are less clear-cut. We conclude by addressing a question that lies at the heart of Jacobson: Is there an inherent tension in liberal democratic societies between the rights of the individual and the claims of the collective?
