1 in 3 Pediatricians Would Dismiss a Family That Refuses Vaccinations

A recent study published inJAMA Pediatricsfound that about half of pediatricians' offices had a policy of dismissing families from their practice if they refuse vaccinations for their children, and 37% would do so with or without such a policy.

That means a large number of children in the United States could go without care. According to the most recentNational Immunization Survey,the number of unvaccinated kids in the U.S. has grown significantly in the last 30 years. This rejection of unvaccinated children could lead to a much larger public health crisis if the issue is neglected.

Vaccine Rates Decline

The decline of vaccination rates is a result of the rising issue of parental refusal of routine childhood vaccinations in the U.S. In fact, in 2019 theWorld Health Organizationdeclared vaccine hesitancy as one of the 10 biggest threats to global health, calling vaccinations one of the most “cost-effective ways of avoiding disease.” But ironically, that’s a big part of the problem.

“The success of vaccines has made certain diseases uncommon, so many people have never seen disease like measles, polio, or diphtheria,” says Trina Blythe, MD, FAAP, a pediatrician with Way To Grow Pediatrics and assistant professor of pediatrics at Washington University. “The lack of common experience of these diseases makes it difficult to convince families of the importance of vaccines.”

How Does COVID-19 Affect This?

Indeed, childhood vaccines are more important than ever as we enter our eighth month of a global pandemic. “COVID-19 has everyone scrambling for a vaccine as potentially our best protection from this deadly virus. The current pandemic is eerily reminiscent of a time before vaccines, with large numbers of people suffering and dying before the current vaccines were available,” says Blythe.

And although drug companies are working hard to produce a vaccine,informal pollsindicate a relatively low rate of parental acceptance even for the COVID-19 vaccine, despite everyone’s overwhelming desire to return to life as we knew it before. Some of this rejection comes from the same suspicions leveled at childhood vaccinations like TDAP, MMR, and even the flu shot. In other cases, it is rooted in historical incidents of medical malpractice done to marginalized communities. Scientific experts are working hard to alleviate everyone's concerns before the vaccine is ready.

Pediatricians Dismissing Families for Lack of Vaccinations

Now, doctors are responding by dismissing these families from their practice. But there are legal and ethical considerations to doing so. “Families that are turned away may not find a medical home, and the child misses out on much-needed well exams and medical care. The child may remain unvaccinated and can have a poor outcome,” Blythe says.

But while it’s not illegal to discontinue care to a family that refuses vaccinations, physicians should be aware that the law tends to fall on the side of the family. A study in theJournal of Pediatrics and Child Healthstates, “In negligence, a physician can be held liable for harm to a patient if the physician had a duty to the patient and if the failure to meet that duty resulted in harm to the patient.”

Legal Considerations

“一旦一个家庭已经成为建立doctor, there is an obligation to that patient,” says Blythe. In those cases, a physician should make an attempt to have the parents understand why they believe strongly in routine childhood vaccinations prior to dismissing the parents.

According to Blythe, “If a patient knowingly refuses to vaccinate and then suffers adverse outcomes, legally they can claim that the doctor had superior knowledge and should have worked harder to convince them to vaccinate."

Ethical Considerations

Whenever a physician and a parent fail to see eye to eye on whether a child will receive vaccinations, the argument goes beyond legal ramifications. From an ethical standpoint, doctors should consider that “patients and families dismissed for vaccine refusal and unable to find a new physician may become marginalized from health care and thus vulnerable,” according to the JAMA study.

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