The Scope of the State's Power in Matters Affecting Health: the Case of Jacobson V. Massachusetts 1905

The Scope of the State’s Power in Matters Affecting Health: The Case of Jacobson v. Massachusetts 1905

The federal government does not have the explicit power to regulate public health so it bases its regulations on the federal government's exclusive ability to regulate interstate commerce. As an illustration of this power, there is a famous case - we will call it the fried chicken case - where the federal government was able to end a practice which forbid African Americans from buying food at a fried chicken restaurant a southern state in the 1960's. The Greyhound buses would stop at this restaurant for a break for the drivers. The federal government came in and said that the sale of chicken at the restaurant affected interstate commerce. Therefore, the federal government, and not the state, could control whether or not African Americans were allowed to eat there.

States base their control over public health matters on their police powers. State police powers have been upheld in many public health situations from food inspection to health professional licensure, to mandatory vaccination, to fluoridation of water to restaurant inspections. The controversy brews when individual rights are at issue. When does the state have the authority to abridge one's individual or constitutional rights? The Courts weigh the purpose of the law against the individual's rights. Individual rights (also called civil rights) are not absolute. For example, the First Amendment to the US Constitution provides for freedom of speech. However, the courts have well established that while you have a right to free speech your right to free speech ends when that speech endangers others. In other words, you can't yell fire in a crowed theater.

Mr. Jacobson believed that the scientific basis for vaccination was unsound and that he would suffer if he was vaccinated. The Massachusetts Supreme Court found the statute consistent with the Massachusetts state constitution, and Jacobson appealed to the United States Supreme Court. The Supreme Court examined the issue of whether involuntary vaccination violated Jacobson's "'inherent right of every freeman to care for his own body and health in such way as seems to him best . . . " The Court bifurcated this question, first considering the right of the state to invade Jacobson's person by forcing him to submit to vaccination:

This court has more than once recognized it as a fundamental principle that "persons and property are subjected to all kinds of restraints and burdens, in order to secure the general comfort, health, and prosperity of the State; of the perfect right of the legislature to do which no question ever was, or upon acknowledged general principles ever can be made, so far as natural persons are concerned."'

With this language, the Court stated the basic bargain of civilization: an individual must give up some personal freedom in exchange for the benefits of being in a civilized society. Jacobson sought to enjoy the benefit of his neighbors being vaccinated for smallpox without personally accepting the risks inherent in vaccination. The Court rejected Jacobson's claim which it viewed as an attempt to be a free-rider on society.

The Court next considered Jacobson's right to contest the scientific basis of the Massachusetts vaccination requirement. Accepting that some reasonable people still questioned the efficacy of vaccination, the Court nonetheless found that it was within the legislature's prerogative to adopt one from many conflicting views on a scientific issue.

The right of the State under police power to enforce vaccination upon its inhabitants has not yet been determined, or more than remotely considered by this court; references are made to it in Lawton v. Steele, 152. U.s. 133; Hammibal & St. J.r.r. Co. v. Husen, 95 U.s. 465; Am School of Healing v. McAnnulty, 187 U.s. 94. Mr. Jacobson knows of no other cases in which the subject of vaccination has been considered by this court. From a summary of vaccination laws and vaccination statutes in the United States it appears that thirty-four States of the Union have no compulsory vaccination law, as follows: Alabama, Arkansas, California, Colorado, Delaware, Florida, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, West Virginia and Wisconsin.

Compulsory vaccination exists in eleven States, as follows: Connecticut, Georgia, Kentucky, Maryland (of children), Massachusetts, Mississippi, North, North Carolina, Pennsylvania (in second class cities), South Carolina, Virginia and Wyoming.

In thirteen States exclusion