There was much buzz in the media last week about a recent Wall Street Journal article suggesting that more physicians are “firing” families who refuse to vaccinate their children. The article cites two recent studies that found that a range of 21-30% of physicians admit to this practice, versus 6% in a 2001 study. While this is still a minority of physicians, it seems to be a growing minority.
Since publication, many people on both sides of the debate have weighed in. Some health care providers state that they should definitely be allowed to fire these families, as the non-vaccinated children in crowded waiting rooms pose a potential risk to other children, especially young infants. They also say that, given such strong philosophical differences, the patient-doctor relationship in these circumstances is unlikely to be a good one.
Others, including families who have chosen not to vaccinate their children, have commented that physicians should not dismiss them. They cite physicians’ responsibility to their patients, the parents ultimate ability to decide what is best for their child, and the resulting limited access to medical care for some children that this practice would cause if widespread.
Immunization is is a big enough issue in pediatric practice that most pediatricians and family physicians have (and should) read and thought about it a great deal. The great majority of my patients’ parents tend to worry more about whether their child has somehow missed a needed vaccination, and come in hoping to get caught up. Nonetheless, the particular issue of families who are hesitant about vaccinating their children is something all child health providers have come across. I won’t dismiss patients/families for this reason. Here’s why:
- Firing families does not get kids vaccinated. If I believe that receiving vaccinations improves children’s health- and I do- then it doesn’t really make sense for me to send them away. It makes sense for me to care for their acute and chronic health needs and, over time, to form a relationship. I ask them to bring in the information they have found that leads them to be worried about vaccines, and I share the information that makes me believe that vaccines are truly important and safe for the vast majority of children. We discuss this information. Over time, if there are vaccines that they feel comfortable giving, it makes sense for me to administer them. And, there are logistical ways to reduce waiting room risk to newborns and other vulnerable patients in order to keep them safe.
- Firing families may decrease access to care for children. I work with families and communities who have difficulty accessing quality, timely healthcare. I just can’t stomach the idea of turning a patient away. This is particularly salient for those of us taking care of children. Should I dismiss them, disregarding their overall health, due to a difference of opinion with their parents? This is a slippery slope.
- Firing families does not increase trust. Ultimately, all good relationships are based on trust and mutual respect. . . even when there are differing opinions. The only way to form a relationship is to open dialogue. Refusing to see families with a different opinion from my own would certainly not increase their trust in pediatric health providers or the medical system in general. This could potentially be detrimental to their child’s future health. My ethical obligation is to provide quality care and do my very best to keep all of my patients safe and healthy.
Ultimately, I believe that child health providers, and certainly parents, are trying to do what they believe is best for children. We do that best by working together, not by standing behind battle lines.
For more information:
- National Network for Immunization Information: The mission of the National Network for Immunization Information (NNii) is to provide the public, health professionals, policy makers, and the media with up-to-date, scientifically valid information related to immunization to help them understand the issues and to make informed decisions.
- NY Times Armchair Ethicist from November 2011 with many, many reader answers to the question, “Is it ethical for pediatricians to refuse routine care to families that do not immunize their children?”
- AAP Policy “Responding to Parental Refusals of Immunization of Children”
“First and most important, the pediatrician should listen carefully and respectfully to the parent’s concerns, recognizing that some parents may not use the same decision criteria as the physician and may weigh evidence very differently than the physician does. Vaccines are very safe, but they are not risk free; nor are they 100% effective. This poses a dilemma for many parents and should not be minimized. The pediatrician should share honestly what is and is not known about the risks and benefits of the vaccine in question, attempt to understand the parent’s concerns about immunization, and attempt to correct any misperceptions and misinformation.”
What do you think? How should child health providers respond to this issue?