Appellant
Commonwealth of Massachusetts
Appellee
Henning Jacobson
Appellant's Claim
That a state statute authorizing compulsory vaccination and delegating to a municipality the authority to determine when compulsory vaccination was necessary was constitutional.
Chief Lawyers for Appellant
George Fred Williams and James A. Halloran
Chief Lawyers for Appellee
Frederick H. Nash and Herbert Parker
Justices for the Court
Henry Billings Brown, William Rufus Day, Melville Weston Fuller, John Marshall Harlan II (writing for the Court), Oliver Wendell Holmes, Joseph McKenna, Edward Douglass White
Justices Dissenting
David Josiah Brewer, Rufus Wheeler Peckham
Place
Washington, D.C.
Date of Decision
20 February 1905
Decision
Upheld the constitutionality of the statute, and affirmed defendant's conviction and fine for refusing to be vaccinated.
Significance
In this decision, the Supreme Court addressed for the first time the issue ofcompulsory vaccination. The decision upheld the right of a state under its police power to provide for compulsory vaccination and to delegate to a municipality the authority to determine when compulsory vaccination was necessary.The decision was welcomed by states in an era when smallpox epidemics were common.
In the fourteenth century, when the bubonic plague was sweeping through England, the English government attempted to control the spread of the disease bypassing public health laws imposing quarantines and requiring the burning ofvictims' household goods and the mandatory cleaning of city gutters. Failureto comply could result in criminal punishment, e.g., the searing of an ear lobe with a hot iron to brand the law breaker. In the nineteenth century, the concern was not the plague, but smallpox, a highly contagious and deadly disease. In 1796, the British physician Edward Jenner discovered a vaccination forsmallpox, and vaccination became compulsory in Britain in 1853. Medical studies during the last half of the nineteenth century reported a significant reduction in the prevalence of the disease, and in mortality, amongst vaccinatedpopulations. In the United States, by the early 1900s, most states had passed public health laws authorizing compulsory smallpox vaccination of all inhabitants in the event of an outbreak. Although by 1900, most physicians and most of the public had accepted vaccination as a effective preventative measure,this acceptance was not unanimous. Some physicians and some of the public objected to vaccination on health or philosophical grounds.
In 1902, the board of health of the city of Cambridge, Massachusetts adopteda regulation requiring all inhabitants of the city to be vaccinated against smallpox. A Massachusetts statute authorized the board of health to impose compulsory vaccination if it were necessary for public health or safety. HenningJacobson, an inhabitant of the city, refused to be vaccinated, and the cityfiled criminal charges against him. A jury convicted Jacobson after the trialjudge excluded his offers of proof and rejected his requested jury instructions. Jacobson offered to prove that vaccination did not prevent smallpox andinstead harmed the person vaccinated and that he and his son had reacted adversely to vaccinations in the past. His requested jury instructions asserted that compulsory vaccination violated the U.S. Constitution. On appeal, the supreme judicial court of Massachusetts sustained the conviction, ordering Jacobson jailed until he paid a $5.00 fine. Jacobson appealed to the U.S. SupremeCourt.
Compulsory Vaccination Lawful
In a 7-2 decision, the U.S. Supreme Court affirmed the conviction, upholdingthe right of the city to impose and enforce compulsory smallpox vaccination on all its inhabitants, including those who objected. On appeal, the Court limited its discussion to Jacobson's claim that compulsory vaccination violatedthe Fourteenth Amendment. With respect to this claim, Jacobson argued that
Before deciding whether the compulsory vaccination statute violated the Fourteenth Amendment, the Court had to determine the scope and meaning of the statute. To do this, the Court looked to the opinion of the supreme judicial court of Massachusetts. Quoting extensively from that opinion, which upheld the exclusion of offers of proof that vaccination was ineffective and dangerous, the Supreme Court defined the scope of the statute to require. As a general rule, adults not under the guardianship and remaining within the limits of thecity had to submit to the compulsory vaccination regulation adopted by the board of health.
The Supreme Court then addressed the issue of the statute's constitutional validity. The Court recognized the state's authority under its police power toenact state health laws and to vest power in local governments to administerthose laws. "Police power" is the power that the state did not surrender to the federal government under the Constitution when it became a member of the Union. This power is limited only by the condition that any local law not infringe upon any constitutional right. The constitutional right Jacobson claimedcompulsory vaccination violated was his "liberty" to care for his own body and health in the way that seemed best to him. The Court rejected Jacobson's broad definition of "liberty," saying
Applying these legal principles to the case before it, the Court ruled firstthat the state did not act unreasonably or arbitrarily in allowing the city board of health to determine that compulsory vaccination was necessary. Moreover, the city did not act arbitrarily in deciding that conditions in the citywarranted compulsory vaccination. At the time the regulation was adopted, evidence indicated that smallpox was prevalent and increasing in the city, and most of the medical profession and the public believed that vaccination wouldstop the spread of the disease. As to the rights of an individual who objectsto vaccination, the Court stated, "it was the duty of the constituted authorities primarily to keep in view the welfare, comfort, and safety of the many,and not permit the interests of the many to be subordinated to the wishes orconvenience of the few." The power of the public to guard itself against imminent danger does not depend "in every case involving the control of one's body upon [a person's] willingness to submit to reasonable regulations established by the constituted authorities, under the sanction of the state, for thepurpose of protecting the public collectively against such danger."
Court Defers to Legislature
The Court ultimately ruled that neither the statute nor the methods employedby the city were unconstitutional, and that application of the statute to Jacobson did not violate his Fourteenth Amendment rights. Underlying the Court'sruling was the Court's unwillingness to second-guess the state legislature,the board of health, and the medical profession as to the efficacy and safetyof the smallpox vaccine. Conceding that some reputable physicians did not believe that vaccination prevented smallpox, the Court nonetheless took judicial notice of the fact that, for generations, the mass of the people, as well as most members of the medical profession had accepted vaccination as a preventive of smallpox. The Court said,
Exemption for Unfit Adult?
Although the Massachusetts statute exempted children whom a physician declared "unfit" for vaccination, it provided no exemption for adults. Jacobson claimed that the city ordinance was broad enough to require a person to submit tocompulsory vaccination even when his physical condition might be such as torender such treatment dangerous to life and even cruelly oppressive. The Court held that Jacobson's case presented no such situation. Although Jacobson claimed that he had, as a child, reacted adversely to a vaccination and his sonhad experienced the same reaction, he did not offer to prove that as an adult, he was not a fit subject for vaccination. However, the Court took great pains to point out the limits of its ruling by acknowledging the possibility that in another case an adult might be entitled to an exemption. The Court said,
Impact
The Jacobson decision is rich in law. It has been used in many subsequent Supreme Court decisions to support rulings on a wide range of issues, including the scope and limits of police power, the right of privacy under the Fourteenth Amendment, and the power of the judiciary to review legislative action. In Zucht v. King, (1922), the Supreme Court dismissed a challengeto an ordinance requiring vaccination for public school admittance on the ground that Jacobson had conclusively decided the issue.
In 1980, the World Health Organization declared smallpox extinct, attributingthe extinction to worldwide efforts and the promotion of vaccination. Today,because state laws have for years required all children to be immunized before attending school, few adults are unvaccinated. However, some people, including physicians, still believe that vaccinations are not always effective andmay produce adverse side effects or consequences. As a result, compulsory vaccination or immunization is still not free of controversy. As a result, somestates allow medical, religious, and even philosophical exemptions from immunizations. In 1986, Congress passed the National Childhood Vaccine Injury Actto provide compensation for vaccine-related injuries and deaths.
Related Cases
The National Childhood Vaccine Injury Act
Even though vaccines are intended to prevent illness, sometimes illness itself results when a patient, because of an allergy or for other reasons, responds adversely to a vaccination. Such a reaction can even be fatal, or at leastpermanent in its damage--a tragedy under any circumstances, but particularlyin the case of a child. Such was the situation for Billy McCarren, whose parents alleged in a 1994 lawsuit that he contracted residual seizure disorder (RSD) and encephalopathy after being administered a diphtheria vaccination in 1990.
Situations such as Billy's had led Congress to pass the National Childhood Vaccine Injury Act in 1986. Among other things, the legislation requires physicians and other health-care providers who administer vaccines to keep permanent immunization records, and to report to the Department of Health and Human Services (HHS) any adverse reaction suffered as a result of a vaccination. Theact also provided for a Vaccine Adverse Events Reporting System (VAERS), which has its own 800-number hotline.
The McCarrens and many others have filed suit for compensation by that fund,only to have their claims denied. The CDC, while noting that three-quarters of its petitioners are the families of injured or dead children, counters thatdenied claimants such as Billy McCarren do not show "recognized vaccine injuries" as stipulated by the act.
Sources
Centers for Disease Control (CDC). http://www.cdc.gov
Commonwealth of Massachusetts
Appellee
Henning Jacobson
Appellant's Claim
That a state statute authorizing compulsory vaccination and delegating to a municipality the authority to determine when compulsory vaccination was necessary was constitutional.
Chief Lawyers for Appellant
George Fred Williams and James A. Halloran
Chief Lawyers for Appellee
Frederick H. Nash and Herbert Parker
Justices for the Court
Henry Billings Brown, William Rufus Day, Melville Weston Fuller, John Marshall Harlan II (writing for the Court), Oliver Wendell Holmes, Joseph McKenna, Edward Douglass White
Justices Dissenting
David Josiah Brewer, Rufus Wheeler Peckham
Place
Washington, D.C.
Date of Decision
20 February 1905
Decision
Upheld the constitutionality of the statute, and affirmed defendant's conviction and fine for refusing to be vaccinated.
Significance
In this decision, the Supreme Court addressed for the first time the issue ofcompulsory vaccination. The decision upheld the right of a state under its police power to provide for compulsory vaccination and to delegate to a municipality the authority to determine when compulsory vaccination was necessary.The decision was welcomed by states in an era when smallpox epidemics were common.
In the fourteenth century, when the bubonic plague was sweeping through England, the English government attempted to control the spread of the disease bypassing public health laws imposing quarantines and requiring the burning ofvictims' household goods and the mandatory cleaning of city gutters. Failureto comply could result in criminal punishment, e.g., the searing of an ear lobe with a hot iron to brand the law breaker. In the nineteenth century, the concern was not the plague, but smallpox, a highly contagious and deadly disease. In 1796, the British physician Edward Jenner discovered a vaccination forsmallpox, and vaccination became compulsory in Britain in 1853. Medical studies during the last half of the nineteenth century reported a significant reduction in the prevalence of the disease, and in mortality, amongst vaccinatedpopulations. In the United States, by the early 1900s, most states had passed public health laws authorizing compulsory smallpox vaccination of all inhabitants in the event of an outbreak. Although by 1900, most physicians and most of the public had accepted vaccination as a effective preventative measure,this acceptance was not unanimous. Some physicians and some of the public objected to vaccination on health or philosophical grounds.
In 1902, the board of health of the city of Cambridge, Massachusetts adopteda regulation requiring all inhabitants of the city to be vaccinated against smallpox. A Massachusetts statute authorized the board of health to impose compulsory vaccination if it were necessary for public health or safety. HenningJacobson, an inhabitant of the city, refused to be vaccinated, and the cityfiled criminal charges against him. A jury convicted Jacobson after the trialjudge excluded his offers of proof and rejected his requested jury instructions. Jacobson offered to prove that vaccination did not prevent smallpox andinstead harmed the person vaccinated and that he and his son had reacted adversely to vaccinations in the past. His requested jury instructions asserted that compulsory vaccination violated the U.S. Constitution. On appeal, the supreme judicial court of Massachusetts sustained the conviction, ordering Jacobson jailed until he paid a $5.00 fine. Jacobson appealed to the U.S. SupremeCourt.
Compulsory Vaccination Lawful
In a 7-2 decision, the U.S. Supreme Court affirmed the conviction, upholdingthe right of the city to impose and enforce compulsory smallpox vaccination on all its inhabitants, including those who objected. On appeal, the Court limited its discussion to Jacobson's claim that compulsory vaccination violatedthe Fourteenth Amendment. With respect to this claim, Jacobson argued that
his liberty is invaded when the state subjects him to fine or imprisonment for neglecting or refusing to submit to vaccination; that a compulsory vaccination law is unreasonable, arbitrary, and oppressive, and, therefore,hostile to the inherent right of every freeman to care for his own body andhealth in such way as to him seems best; and that the execution of such a lawagainst one who objects to vaccination, no matter for what reason, is nothing short of an assault upon his person.
Before deciding whether the compulsory vaccination statute violated the Fourteenth Amendment, the Court had to determine the scope and meaning of the statute. To do this, the Court looked to the opinion of the supreme judicial court of Massachusetts. Quoting extensively from that opinion, which upheld the exclusion of offers of proof that vaccination was ineffective and dangerous, the Supreme Court defined the scope of the statute to require. As a general rule, adults not under the guardianship and remaining within the limits of thecity had to submit to the compulsory vaccination regulation adopted by the board of health.
The Supreme Court then addressed the issue of the statute's constitutional validity. The Court recognized the state's authority under its police power toenact state health laws and to vest power in local governments to administerthose laws. "Police power" is the power that the state did not surrender to the federal government under the Constitution when it became a member of the Union. This power is limited only by the condition that any local law not infringe upon any constitutional right. The constitutional right Jacobson claimedcompulsory vaccination violated was his "liberty" to care for his own body and health in the way that seemed best to him. The Court rejected Jacobson's broad definition of "liberty," saying
[Liberty] does not import anabsolute right in each person to be, at all times and in all circumstances,wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good . . . Real liberty for all could not exist under the operation of a principle which recognizes the right ofeach individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others . . . [Liberty] is not unrestricted license to act according to one's own will. It is only freedom from restraint under conditions essential to the equal enjoyment ofthe same right by others. It is, then, liberty regulated by law.
Applying these legal principles to the case before it, the Court ruled firstthat the state did not act unreasonably or arbitrarily in allowing the city board of health to determine that compulsory vaccination was necessary. Moreover, the city did not act arbitrarily in deciding that conditions in the citywarranted compulsory vaccination. At the time the regulation was adopted, evidence indicated that smallpox was prevalent and increasing in the city, and most of the medical profession and the public believed that vaccination wouldstop the spread of the disease. As to the rights of an individual who objectsto vaccination, the Court stated, "it was the duty of the constituted authorities primarily to keep in view the welfare, comfort, and safety of the many,and not permit the interests of the many to be subordinated to the wishes orconvenience of the few." The power of the public to guard itself against imminent danger does not depend "in every case involving the control of one's body upon [a person's] willingness to submit to reasonable regulations established by the constituted authorities, under the sanction of the state, for thepurpose of protecting the public collectively against such danger."
Court Defers to Legislature
The Court ultimately ruled that neither the statute nor the methods employedby the city were unconstitutional, and that application of the statute to Jacobson did not violate his Fourteenth Amendment rights. Underlying the Court'sruling was the Court's unwillingness to second-guess the state legislature,the board of health, and the medical profession as to the efficacy and safetyof the smallpox vaccine. Conceding that some reputable physicians did not believe that vaccination prevented smallpox, the Court nonetheless took judicial notice of the fact that, for generations, the mass of the people, as well as most members of the medical profession had accepted vaccination as a preventive of smallpox. The Court said,
Since, then, vaccination, as ameans of protecting a community against smallpox, finds strong support in theexperience of this and other countries, no court, much less a jury, is justified in disregarding the action of the legislature simply because in its or their opinion that particular method was--perhaps, or possibly--not the best either for children or adults.
Exemption for Unfit Adult?
Although the Massachusetts statute exempted children whom a physician declared "unfit" for vaccination, it provided no exemption for adults. Jacobson claimed that the city ordinance was broad enough to require a person to submit tocompulsory vaccination even when his physical condition might be such as torender such treatment dangerous to life and even cruelly oppressive. The Court held that Jacobson's case presented no such situation. Although Jacobson claimed that he had, as a child, reacted adversely to a vaccination and his sonhad experienced the same reaction, he did not offer to prove that as an adult, he was not a fit subject for vaccination. However, the Court took great pains to point out the limits of its ruling by acknowledging the possibility that in another case an adult might be entitled to an exemption. The Court said,
We are not inclined to hold that the statute establishes the absolute rule that an adult must be vaccinated if it be apparent or can be shown with reasonable certainty that he is not at the time a fit subject of vaccination, or that vaccination, by reason of his then condition, would seriouslyimpair his health, or probably cause his death.
Impact
The Jacobson decision is rich in law. It has been used in many subsequent Supreme Court decisions to support rulings on a wide range of issues, including the scope and limits of police power, the right of privacy under the Fourteenth Amendment, and the power of the judiciary to review legislative action. In Zucht v. King, (1922), the Supreme Court dismissed a challengeto an ordinance requiring vaccination for public school admittance on the ground that Jacobson had conclusively decided the issue.
In 1980, the World Health Organization declared smallpox extinct, attributingthe extinction to worldwide efforts and the promotion of vaccination. Today,because state laws have for years required all children to be immunized before attending school, few adults are unvaccinated. However, some people, including physicians, still believe that vaccinations are not always effective andmay produce adverse side effects or consequences. As a result, compulsory vaccination or immunization is still not free of controversy. As a result, somestates allow medical, religious, and even philosophical exemptions from immunizations. In 1986, Congress passed the National Childhood Vaccine Injury Actto provide compensation for vaccine-related injuries and deaths.
Related Cases
- Zucht v. King, 260 U.S. 174 (1922).
- Buck v. Bell, 274 U.S. 200 (1927).
- Prince v. Massachusetts, 321 U.S. 158 (1944).
- Griswold v. Connecticut, 381 U.S. 479 (1965).
- Roe v. Wade, 410 U.S. 113 (1973).
- Cruzan v. Director, MDH, 497 U.S. 261 (1990).
- Washington v. Glucksberg, 512 U.S. 702 (1997).
The National Childhood Vaccine Injury Act
Even though vaccines are intended to prevent illness, sometimes illness itself results when a patient, because of an allergy or for other reasons, responds adversely to a vaccination. Such a reaction can even be fatal, or at leastpermanent in its damage--a tragedy under any circumstances, but particularlyin the case of a child. Such was the situation for Billy McCarren, whose parents alleged in a 1994 lawsuit that he contracted residual seizure disorder (RSD) and encephalopathy after being administered a diphtheria vaccination in 1990.
Situations such as Billy's had led Congress to pass the National Childhood Vaccine Injury Act in 1986. Among other things, the legislation requires physicians and other health-care providers who administer vaccines to keep permanent immunization records, and to report to the Department of Health and Human Services (HHS) any adverse reaction suffered as a result of a vaccination. Theact also provided for a Vaccine Adverse Events Reporting System (VAERS), which has its own 800-number hotline.
The McCarrens and many others have filed suit for compensation by that fund,only to have their claims denied. The CDC, while noting that three-quarters of its petitioners are the families of injured or dead children, counters thatdenied claimants such as Billy McCarren do not show "recognized vaccine injuries" as stipulated by the act.
Sources
Centers for Disease Control (CDC). http://www.cdc.gov
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