NPR recently broadcast an interesting discussion – Treating Families That Don’t Immunize. This NPR opinion piece asks the question: Is it okay, or even ethical for pediatricians to refuse routine care to families who refuse to vaccinate their children? The piece features commentary by New York Times Ethicist, Ariel Kaminer, who also recently posted this question to readers at The New York Times. The opinions are very interesting, especially if you read the reader comments on both. Many parents commented that a doctor dismissing a patient due to vaccine non-compliance isn’t fair. Yet, to play devil’s advocate, on the flip side, research shows that parents want their own freedom of choice when it comes to vaccine arrangements, such as many parents want to delay vaccines, have alternative schedules or not vaccinate altogether. It’s a little strange to want freedom of choice yourself, yet deny some doctors the same rights.

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Image via Flickr User edenpictures

How many doctors turn patients away?

Currently it’s unclear just how many doctors actually turn away patients who won’t get vaccinated, but a recent national survey of pediatricians found that around 25% percent, always, often or sometimes will turn a child away if the child’s family refuses to vaccinate for basics such as polio and diphtheria. A MSNBC.com story points out that this is a seemingly growing trend. Some doctor’s offices have instituted policies that require all patients who want treatment to be immunized. This trend of dropping non-vaccinated patients is not supported by the American Academy of Pediatrics (AAP), an organization that does support universal immunization, but who also, according to the above story, says “Refusal to immunize should not be the only reason a doctor turns a family away.” However, the APP does offer doctors an out stating that:

If, after discussion about the importance of vaccination and the risks of not vaccinating, the parent refuses, the pediatrician should document the discussion and have the parent sign a waiver affirming his/her decision not to vaccinate (i.e., AAP Refusal to Vaccinate Form). If the situation becomes such that you are no longer comfortable having the parent/patient in your practice, the AAP manual, “Medical Liability for Pediatricians”, Chapter 3, offers resources for risk communication and termination of the physician-patient relationship.

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Image via CDC/ Amanda Mills

Why would doctors turn patients away?

According to one article, Harvard Vanguard Medical Associates held an ethics meeting covering the issue of turning patients away due to non-vaccine compliance, and  Dr. Lisa Lehmann, director of the Center for Bioethics at Brigham and Women’s Hospital had some theories as to why a doctor may turn a vaccine refusing family away, including:

  • The possibility of eventual potential harm, because when parents won’t vaccinate their children, it may cause potential harm and if the doctor is okay with that, one might say he is complicit in that harm.
  • Children under 22 months are too young to be fully vaccinated and if other patients refuse vaccines, they put these children at risk. On top of that, pregnant women cannot be vaccinated for certain diseases, such as chicken pox, but she could catch a disease in a waiting room, harming both the woman and her unborn baby.
  • There’s a liability issue where if you don’t  vaccinate a child and then he develops measles or another infectious disease, could the doctor eventually be held liable?
  • Also there’s herd immunity, where if not all, but most get vaccinated, the community at large will develop a greater immunity. Some doctors suggest that families who are non-compliant are free riders, which Lehmann says, can be compared to the analogy in the ethics world of, “People who refuse to donate organs but still want to receive organs.

Other arguments reported around the web include it being harder to treat a child who is not vaccinated (due to more likely disease contractions) and not feeling comfortable disagreeing with a patient. Honestly, that last point is reasonable. If a doctor refuses to treat your child based on vaccines, it could be a blessing in disguise. If you and your child’s pediatrician don’t agree about the basics, such as breastfeeding, co-sleeping or vaccines, it’s probably better for you to find a pediatrician you do agree and get along with. After all, this doctor will be treating your child for a long time to come.

Why not tell us what you think. If you and a doctor don’t agree about vaccines is it right or ethical for that doctor to refuse to treat your child? Let us know in the comments.

Lead image via CDC/ Amanda Mills