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Physician Dismissal of Families Who Refuse Vaccination: An Ethical Assessment

Published online by Cambridge University Press:  01 January 2021

Douglas S. Diekema
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Extract

Childhood vaccination has made an important contribution to the health of children, preventing millions of deaths worldwide each year,1 yet thousands of U.S. parents choose to refuse or delay the administration of selected vaccines to their children. Some choose not to vaccinate their children at all. This can be frustrating for physicians, especially for those who have personally witnessed the positive impact of vaccines on child health during their lifetime. While most physicians continue to care for these families over time, using each visit as an opportunity to educate and encourage vaccination, an increasing number of physicians report dismissing these families from their practice unless they agree to vaccinate their children. This paper will examine this emerging trend along with the reasons given by those who advocate such an approach. I will argue that the strategy of refusing to allow families into a clinic unless they agree to vaccinate their children is misguided, and the arguments for adopting such a policy fail to stand up to close scrutiny.

Type
Independent
Information
Journal of Law, Medicine & Ethics , Volume 43 , Issue 3 , Autumn 2015 , pp. 654 - 660
Copyright
Copyright © American Society of Law, Medicine and Ethics 2015

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References

Centers for Disease Control and Prevention, “Achievements in Public Health, 1900–1999: Impact of Vaccines Universally Recommended for Children – United States, 1990–1998,” Morbidity & Mortality Weekly Report 48, no. 12 (1999): 243–248; Centers for Disease Control and Prevention, “Ten Great Public Health Achievements – United States, 1900–1999,” Morbidity & Mortality Weekly Report 48, no. 12 (1999): 241–243; Bonanni, P., “Demographic Impact of Vaccination: A Review,” Vaccine 17, Supp. 3 (1999): S120–S125.Google Scholar
Freed, G. L. Clark, S. J. Butchart, A. T. Singer, D. C. Davis, M. M., “Parental Vaccine Safety Concerns in 2009,” Pediatrics 125, no. 4 (2010): 654–659; Salmon, D. A. Moulton, L. H. Omer, S. B. deHart, M. P. Stokley, S. Halsey, N. A., “Factors Associated with Refusal of Childhood Vaccines among Parents of School-Aged Children,” Archives of Pediatric and Adolescent Medicine 159, no. 5 (2005): 470–476; Dempsey, A. F. Schaffer, S. Singer, D. Butchart, A. Davis, M. Freed, G. L., “Alternative Vaccination Schedule Preferences among Parents of Young Children,” Pediatrics 128, no. 5 (2011): 848–856; Kennedy, A. M. Brown, C. J. Gust, D. A., “Vaccine Beliefs of Parents Who Oppose Compulsory Vaccination,” Public Health Reports 120, no. 3 (2005): 252–258; Wenger, O. K. McManus, M. D. Bower, J. R. Langkamp, D. L., “Underimmunization in Ohio's Amish: Parental Fears Are a Greater Obstacle Than Access to Care,” Pediatrics 128, no. 1 (2011): 79–85.CrossRefGoogle Scholar
See Salmon, et al. , supra note 2.Google Scholar
Olpinski, M., “Anti-Vaccination Movement and Parental Refusals of Immunization of Children in USA,” Pediatria Polska 87, no. 4 (2012): 381–385; Chen, R. T. Hibbs, B., “Vaccine Safety: Current and Future Challenges,” Pediatric Annals 27, no. 7 (1998): 445–455.CrossRefGoogle Scholar
Kata, A., “A Postmodern Pandora's Box: Anti-Vaccination Misinformation on the Internet,” Vaccine 28, no. 7 (2010):1709–1716; Mayer, M. Till, J., “The Internet: A Modern Pandora's Box?” Quality of Life Research 5, no. 6 (1996): 568–571.CrossRefGoogle Scholar
See Freed, , supra note 2.Google Scholar
See Salmon, , supra note 2.Google Scholar
See Dempsey, , supra note 2.Google Scholar
Freed, G. L. Clark, S. J. Hibbs, B. F. Santoli, J. M., “Parental Vaccine Safety Concerns: The Experiences of Pediatricians and Family Physicians,” American Journal of Preventive Medicine 26, no. 1 (2004): 11–14.CrossRefGoogle Scholar
Flanagan-Klygis, E. A. Sharp, L. Frader, J. E., “Dismissing the Family Who Refuses Vaccines: A Study of Pediatrician Attitudes,” Archives of Pediatrics & Adolescent Medicine 159, no. 10 (2005): 929–934.CrossRefGoogle Scholar
Kempe, A. Daley, M. F. McCauley, M. M. Crane, L. A. Suh, C. A. Kennedy, A. M. Basket, M. M. Stokley, S. K. Dong, F. Babbel, C. I. Seewald, L. A. Dickinson, L. M., “Prevalence of Parental Concerns about Childhood Vaccines: The Experience of Primary Care Physicians,” American Journal of Preventive Medicine 40, no. 5 (2011): 548–555.CrossRefGoogle Scholar
Grossman, Z. van Esso, D. del Torso, S. Hadjipanayis, A. Drabik, A. Gerber, A. Miron, D., “Primary Care Pediatricians' Perceptions of Vaccine Refusal in Europe,” Pediatric Infectious Disease Journal 30, no. 3 (2011): 255–256.CrossRefGoogle Scholar
Mejia, B., “Doctors Turning Away Unvaccinated Children,” Los Angeles Times, February 10, 2015, available at, <http://www.latimes.com/science/la-me-vaccination-policy-20150210-story.html#page=1> (last visited August 28, 2015); Kluger, J., “Vaccinate or Leave. More Pediatricians Are Firing Families for Not Giving Their Kids Shots,” Time, August 22, 2011; Wang, S. S., “More Doctors ‘Fire’ Vaccine Refusers,” Wall Street Journal, February 15, 2012, available at <http://online.wsj.com/article/SB10001424052970203315804577209230884246636.html> (last visited August 28, 2015).+(last+visited+August+28,+2015);+Kluger,+J.,+“Vaccinate+or+Leave.+More+Pediatricians+Are+Firing+Families+for+Not+Giving+Their+Kids+Shots,”+Time,+August+22,+2011;+Wang,+S.+S.,+“More+Doctors+‘Fire’+Vaccine+Refusers,”+Wall+Street+Journal,+February+15,+2012,+available+at++(last+visited+August+28,+2015).>Google Scholar
Committee on Bioethics, American Academy of Pediatrics, “Policy Statement – Physician Refusal to Provide Information or Treatment on the Basis of Claims of Conscience,” Pediatrics 124, no. 6 (2009): 1689–1693.CrossRefGoogle Scholar
Misegades, L. K. Winter, K. Harriman, K. Talarico, J. Messonnier, N. E. Clark, T. A. Martin, S. W., “Association of Childhood Pertussis with Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010,” JAMA 308, no. 20 (2012): 2126–2132; Centers for Disease Control and Prevention, “Pertussis Epidemic – Washington, 2012,” MMWR 61, no. 28 (2012): 517–522; Clark, T. A. Messonnier, N. E. Hadler, S. C., “Pertussis Control: Time for Something New?” Trends in Microbiology 20, no. 5 (2012): 211–212.CrossRefGoogle Scholar
Simmering, J. E. Polgreen, L. A. Cavanaugh, J. E. Polgreen, P. A., “Are Well-Child Visits a Risk Factor for Subsequent Influenza-Like Illness Visits?” Infection Control and Hospital Epidemiology 35, no. 3 (2014): 251–256; Saiman, L., “More Support to Reduce the Burden of Respiratory Illnesses through Improved Infection Prevention and Control in Ambulatory Settings,” Infection Control and Hospital Epidemiology 35, no. 3 (2014): 257–258.CrossRefGoogle Scholar
Pellegrino, E. D. Thomasma, D. C., A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions (New York: Oxford University Press, 1981); Pellegrino, E. D. Thomasma, D. C., For the Patient's Good: The Restoration of Beneficence in Health Care (New York: Oxford University Press, 1988).Google Scholar
Gust, D. A. Darling, N. Kennedy, A. Schwartz, B., “Parents with Doubts about Vaccines: Which Vaccines and Reasons Why,” Pediatrics 122, no. 4 (2008): 718–725; Wheeler, M. Buttenheim, A. M., “Parental Vaccine Concerns, Information Source, and Choice of Alternative Immunization Schedules,” Human Vaccines & Immunotherapeutics 9, no. 8 (2013): 1782–1789.CrossRefGoogle Scholar
Stokes, T. Dixon-Woods, M. Windridge, K. C. McKinley, R. K., “Patient Accounts of Being Removed from their General Practitioners List: A Qualitative Study,” British Medical Journal 326, no. 7402 (2003): 1316–1325.CrossRefGoogle Scholar
Buttenheim, A. M. Cherng, S. T. Asch, D., “Provider Dismissal Policies and Clustering of Vaccine-Hesitant Families: An Agent-Based Modeling Approach,” Human Vaccines & Immunotherapeutics 9, no. 8 (2013): 1819–1824.CrossRefGoogle Scholar
See Stokes, et al. , supra note 19.Google Scholar
Id.Google Scholar
Diekema, D. S., “Improving Childhood Vaccination Rates,” New England Journal of Medicine 366, no. 5 (2012): 391–393.CrossRefGoogle Scholar
Id.Google Scholar
Diekema, D. S., Committee on Bioethics, American Academy of Pediatrics, “Clinical Report: Responding to Parental Refusals for Immunization,” Pediatrics 115, no. 5 (2005): 1428–1431.CrossRefGoogle Scholar
See Diekema, , supra note 23.Google Scholar