Is Mandatory Neonatal Eye Prophylaxis Ethically Justified? A Case Study from Canada

This article examines whether a policy of mandatory neonatal eye prophylaxis is ethically justified within the Canadian context. An existing framework for public health ethics is used to examine criteria that would justify state intervention in parental decision-making authority in order to protect public health. The benefits, harms, and utility of mandatory neonatal eye prophylaxis are described. Established criteria for the infringement of basic individual liberties in the interests of public health, including effectiveness, proportionality, necessity, least infringement and public justification, are considered. The extent and limits of parental decision-making authority are then discussed, and conditions that warrant state intervention in parental decision-making based on the harm principle are reviewed. Ultimately, infringement of parental authority is not deemed to be necessary to protect public health or to protect the newborn in this case and existing circumstances do not meet any criteria that would justify such an infringement. Mandatory eye prophylaxis is found not to be ethically justified in the current Canadian context.