AAP Gateway: Should Pediatric Practices Have Policies to Not Care for Children With Vaccine-Hesitant Parents?
One of the most divisive issues in pediatrics today concerns the proper response by pediatricians to parents who refuse routine childhood immunizations for their children. Many pediatricians refuse to care for such families. Others continue to provide care and continue to try to convince parents that the benefits of immunizations far outweigh the risks. In this Ethics Rounds, we present a case of a pediatric practice trying to decide what their policies should be regarding immunizations. We asked experts in pediatric infectious disease to offer their advice.
Dr. Angela Myers comments:
Physicians are obligated by oath to “do no harm.” Although this obligation sometimes conflicts with other obligations (eg, when we prescribe chemotherapy for a patient with cancer), it is the spirit of this oath that we carry with us every day. In addition, physicians are expected to provide beneficence to patients while minimizing maleficence.
In the pediatric setting, immunization is second only to hand-washing in terms of “doing good” by promoting the health and well-being of children. However, this idea falls flat when a parent refuses to follow our recommendation to immunize their children. Of course, we recommend many things, and parents often do not follow our recommendations. Generally, we continue to care for their children and encourage them to lead healthier lives. I think immunizations are different. Let me explain why.
The difference is in the implications that vaccine refusal has on other children. If we tell people to wear their seat belts and bicycle helmets, and they do not do so, they are only hurting themselves. If, as a result of not following our advice, something terrible happens, such as being thrown from a vehicle during a crash or experiencing an intracranial bleed from hitting their head on a curb, it happens only to that person. There is no risk to others conferred by their reckless decision.
The lack of risk to others is not the case with immunizations. When a nonimmunized child gets measles or an infection with Haemophilus influenzae type b, they have exposed other children to these life-threatening diseases. The exposure begins in the days before the illness even began, when they were completely asymptomatic. Secondary cases can be seen in closed communities of nonimmunized and underimmunized populations but can also be seen in larger populations.
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