This paper explores the ethical challenges in deciding whether to vaccinate individuals lacking the decision-making capacity needed to provide informed consent during a public health emergency like COVID-19. The best interests standard ordinarily governs such decisions, which under the law in jurisdictions like England, Wales and Singapore takes into account the individual’s past wishes and present preferences. However, in a public health emergency, the interests of third parties become more salient: those whom the unvaccinated individual might expose to infection have an interest in the individual’s being vaccinated. While current mental capacity law has not been interpreted to take such public health considerations into account, we argue that such considerations are nevertheless ethically relevant, and can legitimately be weighed up alongside other considerations such as the preferences of the individual and impacts on their health. This is most relevant for individuals lacking decision-making capacity who have previously declined or presently resist vaccination. The public health impact of vaccination may in some instances be enough to outweigh preferences of the individual and justify providing vaccination against their past or present wishes.

中文翻译：

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突发公共卫生事件期间缺乏决策能力的个人接种疫苗

本文探讨了在决定是否为缺乏在 COVID-19 等突发公共卫生事件期间提供知情同意所需的决策能力的个人接种疫苗时面临的伦理挑战。最佳利益标准通常适用于此类决定，根据英格兰、威尔士和新加坡等司法管辖区的法律，这些决定会考虑个人过去的意愿和现在的偏好。然而，在突发公共卫生事件中，第三方的利益变得更加突出：未接种疫苗的个人可能会受到感染的那些人对该个人接种疫苗感兴趣。虽然目前的心智能力法尚未被解释为考虑到此类公共卫生因素，但我们认为此类因素在伦理上仍然是相关的，并且可以合理地与其他考虑因素一起权衡，例如个人的偏好和对他们健康的影响。这与以前拒绝或目前拒绝接种疫苗的缺乏决策能力的个人最相关。在某些情况下，疫苗接种对公共卫生的影响可能足以超过个人的偏好，并有理由根据他们过去或现在的意愿提供疫苗接种。