A shot in the arm for the military: consent to immunisation against biological warfare agents

The risk to Britain's Armed Forces from Biological Warfare (BW) is low but without protection their use would be devastating. Available protective measures include immunisation. The Government owes a legal duty of care to Servicemen to provide protection against a range of hazards, including those of BW. The State also owes Servicemen a duty of care to allow free and informed consent or free and informed refusal to medical procedures, including immunisation. However, refusal by key personnel to accept BW immunisation could degrade operational capability. Resolution between these two, potentially conflicting, duties of care may be controversial. To override a soldier's expressed interests would rank society's needs higher than those of the individual. Yet there are circumstances, such as exposure of Servicemen to BW used by an aggressor, where this would be ethically acceptable. The State's interests, combined with the best interests of the Servicemen, provide adequate ethical argument for both occupational immunisation (where it is an entry criterion for the Armed Forces) and mandatory immunisation (where disciplinary action may be taken against the non-compliant). Historically, both approaches have been used for public health immunisations and the legal framework already exists for both.