Refusing the Refusers

Recently someone asked me whether they thought it was fair for physicians to refuse to treat an unvaccinated child.

“Shouldn’t the pediatrician be even more inclined to care for the unvaccinated child? That is the child who is probably going to get the sickest, right?”

Oh boy.

I’m not a pediatrician.  But I can think of a few reasons why a reasonable physician might refuse to enter into a professional relationship with an anti-vaccine family.  It’s not about trying to take parental choice and autonomy away.  Its about protecting the majority of patients from being potentially exposed to a dangerous, even fatal, disease.  Newborn infants, too young to be immunized, can be exposed to an ill unvaccinated child while in the pediatrician’s office.  Physicians may, reasonably, not want to take the risk of exposing the most vulnerable patients to children who have purposely refused protection from vaccines.

It may also be because many physicians view the decision not to vaccinate as against medical advice.  If you refuse to vaccinate your child, despite it being the best evidence-based choice to protect your child from disease, what other questionable medical decisions will you make? How can the physician best treat your child when there is such a lack of trust in the relationship?  According to the American Academy of Pediatrics, the decision not to vaccinate should not be the sole reason for discharging a patient from a practice, but “when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice.”

While I am not a pediatrician, I am an attorney.   And for better or worse, I often think like an attorney — which in this day and age means I am often thinking of things that might result in a lawsuit.   Aside from the medical reasons, might a physician have legal concerns about treating an unvaccinated child?  What if the unvaccinated child exposes an infant  — too young to be immunized — to a vaccine preventable disease because they are sharing a waiting room together?  If the physician knows that there is an ill and unvaccinated child in the waiting room, potentially exposing other children to a vaccine-preventable disease, is it a breach of the physicians’ duty of care toward the exposed child?

Then there are the potential concerns about liability arising from the unvaccinated child herself.  What if the physician agrees to continue in a relationship with an unvaccinated child and that child contracts a vaccine preventable disease and dies? Could the angry parents turn on the physician, alleging that the risks of not being vaccinated were not clearly presented and therefore the decision not to vaccinate was not  based on informed consent?

Whether these types of lawsuits would prevail is questionable. But, does a pediatrician want to risk it?  Is it really that unreasonable for a pediatrician to refuse a refuser?  Maybe not.

 

 

 

2 Comments

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2 Responses to Refusing the Refusers

  1. Well, I am a pediatrician, and none of it makes me feel good, either way. I completely understand why some practices make this decision. I’m an ER pediatrician so federal law prohibits me from denying basic medical care to kids no matter what I think of their parents. But we also don’t go on to develop a relationship that lasts for years (hopefully!) My only counter argument is that sending that family out the door might mean sending them to an alternative practitioner or a not so great pediatrician and is that even worse? Who are we punishing then? I don’t know. Food for thought.

  2. Pingback: An update to the the “refusers” | The Vaccine Advocate