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The Legacy of Jacobson v Massachusetts
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. 2005;95:571-576. doi:10.2105/ AJPH.2004.055145)
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 supplies2 to abortion3 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...