If it seems like the issue of childhood vaccinations is always surfacing, it's because it is -- except this time it's about doctors.
A new survey reveals that 21 percent of pediatricians and 4 percent of family practitioners dismissed families that chose not to vaccinate their kids. The study, conducted from June to October 2012, also found that these physicians were more likely to be in private practice, from the South and work in a state that did not exempt families that oppose vaccinating their children.
There are ethical implications to consider when deciding to fire these parents. The American Academy of Pediatricians (AAP) and the Centers for Disease Control and Prevention (CDC) discourage practitioners from doing so.
In light of recent outbreaks of vaccine-preventable diseases, which are likely secondary concerns to parents who refuse to vaccinate their children, that development makes this doctor-based topic germaine. Weakening the herd immunity can have disastrous consequences (as demonstrated recently in Disneyland) and places the population at risk. Additionally, if an unvaccinated child comes into contact with a child infected with measles, there is a 90 percent likelihood of getting measles. But if the child has been vaccinated, that youngster is provided a 93-to-97-percent chance of being protected.
The argument can be heated, and it stirs up emotions for those on either side of the debate.
Here's one viewpoint: Being that the physician has a fiduciary obligation to the patient, why dismiss the family and punish the child -- the actual patient -- because the parents refuse to inoculate them against age-old diseases that have been eradicated (thanks, interestingly, to large scale vaccination efforts)? Continuing that line of thinking, by taking a hard line with parents, the physician may be discouraging an appropriate discourse over the parents hesitancy for vaccination, and thereby eliminating the chance to educate them with evidence-based medical reasons for why they are wrong.
On the flip side, if, for example, an unvaccinated child presents to a pediatrician s office with measles, that child has now exposed every single person in that waiting room to a communicable disease. Not every kid can be vaccinated, i.e. children who have weakened immune systems and rely on herd immunity to stay safe. Additionally, is it really fair to punish responsible parents who chose to vaccinate their child, but their child just happens to be one of the 3 to 7 percent who did not mount a proper immune response to the measles vaccine?
Here's another wrinkle: It could also be argued that doctors would not simply kick a patient out of their practice for not following their recommendations, i.e. patients who are repeatedly admitted to the hospital for chronic obstructive lung disease exacerbation, yet continue to smoke. Yes, it is frustrating, but there is still an obligation to treat that patient.
To which, here's the counter argument: That particular patient is doing harm to him- or herself, whereas the parent who chooses not to vaccinate their child also chooses to extend that harm, needlessly, to other children who are vulnerable.
It behooves clinicians to continue the dialogue with parents who have been subjected to misinformation and subjected to false truths propagated in part by celebrities with media influence.
Even though the American Academy of Pediatrics discourages providers from dismissing families, some providers continue to do so," said Sean O Leary, M.D., from the Children s Hospital Colorado in Denver, and one the study s lead authors and a specialist in pediatric infectious disease. "Instead of dismissing families, we need a better understanding of the reasons for vaccine refusal to find evidence-based strategies for communications that are effective at convincing hesitant parents to vaccinate.
A physician is bound by many obligations, and many ethical issues will present themselves over his/her career. A doctor is duty-bound, ultimately, to the person being treated. As tough and as frustrating as it can be, the opportunity to build physician-patient relationships will flourish if the patient (or their parents) are treated with respect and provided the courtesy of communication that everyone deserves.
