Kansas City,
14:00 PM

Should Pediatricians Refuse to Treat Patients Who Don’t Vaccinate?

Parents who don’t want to vaccinate their children can be a sore subject for doctors. The question bubbled up again this spring at the American Academy of Pediatrics’ Annual Leadership Forum, where academy leaders vote on issues of concern to pediatricians across the country.

Two of the top three resolutions this year were about vaccine refusal. One requested a policy statement calling for the elimination of nonmedical exemptions to the requirement that children be immunized to attend school and day care. The other asked the academy to support “pediatricians who decide to discharge patients after a reasonable, finite amount of time working with parents who refuse to immunize their children according to the recommended schedule, or who fail to abide by an agreed-upon, recommended catch-up schedule.”

This is a strategy for private practices, where families have some choice about which doctors to patronize; “safety net” clinics which serve poor children, cannot “exclude” families in this way. And studies have shown that in this country, those who don’t vaccinate tend to be affluent, white and suburban.

Although the resolution met with general approval at the meeting, there was opposition from some bioethicists present. Dr. John Lantos, a pediatrician who is the director of the Children’s Mercy Bioethics Center in Kansas City, argued that the current A.A.P. statement strikes the correct balance in encouraging pediatricians to keep talking to “vaccine hesitant” parents: “Try hard to work with people.”

Dr. Lantos argued that doctors are saying that this is a question of beliefs so fundamentally divergent that it’s impossible to work together, as if “vaccines are an order of magnitude higher than anything else.” Parents may choose to disregard other pediatric guidelines — smoking in the home, not applying sufficient sunblock — without being asked to leave a practice. The medical obligation is to educate parents, to try to get them to do the right thing for their children, not to give up on them.

If the worry is other children’s being exposed in the waiting room, he said, doctors could focus on measures to keep sick kids separate, or out of the waiting room until a doctor is available. “And if your concern is that these infected kids are going to go out and infect other kids — if you fire them from your practice, there would be more unimmunized kids in the world,” he said, since the hope is that if the families stay in the practice, eventually they may be persuaded. “Most people don’t say, nobody should see these kids; they just say, my practice shouldn’t see these kids. But if everybody said it, the world would be a much worse place.”

Read the full story via The New York Times.

Learn more about the Center for Bioethics at Children's Mercy.