Evaluation of Infancy Vaccine Applications within the Scope of Custodial Right
Seda İrem Çakırca YüceoğluVaccine hesitation, described by theWHOas “delay orrefusal in the acceptance of vaccines notwithstanding the availability of vaccine services” and vaccine refusal, defined as the rejection of all vaccines, have been documented in more than 90% of the world’s countries. In Turkey, some parents are increasingly rejecting vaccination of infants. These vaccines are essential to prevent the emergence of preventable diseases, especially in infants, and to prevent deaths caused by these diseases. The discussion of making vaccinations compulsory after the Covid-19 pandemic made it important to reexamine the necessity of infancy vaccinations. In its Halime Sare Aysal decision regarding infancy vaccination in 2015, the Constitutional Court found legal representatives of infants who refuse to consent to infancy vaccination practices to be a violation of rights. However, contrary to the Constitutional Court decision’s reasoning, when the issue of whether to give consent that will make the medical intervention lawful is taken into consideration within the framework of the scope of limitation of the right of custody and “best interests of the child,” mandatory vaccination debates will cease to be a typical constitutional law debate. In the first part of this study, the regulation of infancy vaccination practices in comparative law will be discussed. Furthermore, in the second part, the legislation regarding infancy vaccination practices in Turkey and the position of the national and supranational judiciary will be examined. In the last part, the refusal of the legal representative of the infant to consent to medical intervention will be analyzed in the context of limiting or removing the right of custody on the basis of the best interests of the child.
Bebeklik Dönemi Aşı Uygulamalarının Velayet Hakkı Kapsamında Değerlendirilmesi
Seda İrem Çakırca YüceoğluAşı reddi, Dünya Sağlık Örgütü tarafından kişilerin kendilerine sunulan aşı hizmetlerinin varlığına rağmen aşı yaptırmayı tamamen reddetmesi olarak tanımlanmıştır. Aşı reddi, dünya üzerindeki ülkelerin %90’ından fazlasında rapor edilmiştir. Özellikle bebeklerde aşı ile önüne geçilebilecek hastalıkların meydana çıkmasını ve bu hastalıklar sebebiyle gerçekleşen ölümleri engellemesi için elzem olan bebeklik dönemi aşı uygulamalarının reddedilmesi Türkiye’de de gittikçe artmaktadır. Covid 19 salgını sonrasında daha da alevlenen aşıların zorunlu hale getirilmesi tartışması, bebeklik dönemi aşı uygulamalarının tekrar mercek altına alınması zaruretini doğurmuştur. Anayasa Mahkemesi, bebeklik dönemi aşı uygulamalarına ilişkin 2015 yılında verdiği Halime Sare Aysal kararında hak ihlali tespit ederek, bebeklik dönemi aşı uygulamalarına yasal temsilciler tarafından rıza verilmemesini hukuka uygun bulmuştur. Anayasa Mahkemesi’nin aksine tıbbi müdahaleyi hukuka uygun hale getirecek rızanın verilip verilmemesi hususu, velayet hakkının kapsamı, sınırlandırılması ve “çocuğun üstün yararı” çerçevesinde değerlendirilmeye alındığı vakit; zorunlu aşı tartışmaları tipik bir anayasa hukuku tartışması olmaktan çıkacaktır. Kapsamlı bir analiz yapmak için bu çalışmada öncelikle karşılaştırmalı hukukta bebeklik dönemi aşı uygulamalarının ne şekilde düzenlendiği ele alınacak, ikinci bölümde ise Türkiye’deki bebeklik dönemi aşı uygulamalarına ilişkin mevzuat ve ulusal ve ulus-üstü yargının tutumu incelenecektir. Son bölümde ise bebeğin yasal temsilcisinin tıbbi müdahaleye rıza vermekten imtina etmesi velayet hakkı, söz konusu hakkın çocuğun üstün yararı temelinde sınırlandırılması veya kaldırılması bağlamında değerlendirilecektir.
The Covid-19 pandemic brought with it the question of whether compulsory vaccination applications could be made legally possible. It is seen that with the increasing vaccine hesitancy and vaccine rejection throughout the world over the years, the community immunity for vaccine-preventable infancy diseases is gradually decreasing. In this respect, it has been accepted by many countries that infancy vaccination practices must be mandatory. Turkey is not far away from the current vaccine debates. The Halime Sare Aysal decision of the Constitutional Court in 2015 regarding infancy vaccination practices provided a different direction to this debate. The Constitutional Court built its decision only on the principle of “lawfulness,” without any reference to concepts such as custody, the best interest of the child, the superior public, or private benefit, all concepts that can replace consent to medical intervention. A crucial opportunity was missed by the high court’s strict formal assessment of the concept of legality, as the right of custody is understood in the current literature not only as a right, but as an obligation shaped according to the best interests of the child.
Although the European Court of Human Rights did not find a violation in the Czech Republic’s decision to make infant immunizations mandatory, it missed a significant opportunity by not mentioning the ideas of custody or the best interest of the child in the judgment’s reasoning. The Vavřička and others v. the Czech Rebuplic case was constructed primarily in terms of a conflict between the private life of unvaccinated children and the values of public health and social solidarity. Despite appearances, the underlying issue is not a conflict between one’s freedom to self-determination and public health. Instead, the conflict at hand is between the parents’ right to make decisions on behalf of their children and the state’s right to impose obligations in order to preserve public health as well as the best interests of the child in question. For example, an adult person who refuses a vaccine against Covid-19 does so willingly and voluntarily, knowingly all of the consequences. This decision can be considered as a person’s self-determination. On the other hand, an infant cannot make this choice. As the decision will be made by the parents, it represents their choices instead of the infant’s, even though the consequences will be borne by the infant.
In the first part of the study, I will examine which methods are compulsory for infancy vaccination in the world and especially in Europe. For example, the Measles vaccination is now required for children aged one and up who attend daycare, school, or other community institutions, as well as for individuals who work in those facilities or in medical facilities, according to a German legal rule that alters various statutes. Vaccinations against measles will also be required for those living or working in refugee and asylum-seeker facilities. Noncompliance will result in fines, as well as the exclusion of unvaccinated children and adults from the appropriate facilities. In the second part of the study, I will discuss Turkey’s legislation on infancy vaccination practices and the position of national and supra-national jurisdictions on this issue. The last part is devoted to the evaluation of the right of custody in the context of the best interests of the child. Unfortunately, this concept has found its place neither in the decisions of the Constitutional Court nor in the decisions of the European Court of Human Rights. Thus, the rights and best interests of the child related to infant vaccination practices will be examined. Furthermore, a step that will put an end to the debates on formal legality is to make a legal regulation by the legislator regarding infancy vaccination practices. In this respect, how the new regulation should be designed in order to take into account the best interests of the child will also be discussed.
