Ethics of Childhood Immunizations
According to the World Health Organization, immunization is defined by the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. (http://www.who.int/topics/immunization/en/) Routine childhood immunization is critical to both individual and public health. It is strongly encouraged by the World Health Organization and by governments, public health authorities, and health professionals worldwide. Most parents have their children vaccinated. However, continuing concerns about the safety and efficacy of vaccines and whether immunization programs are needed, have led to a significant number of parents that refuse vaccination. (Klein, 2017) This paper will cover the ethical, legal and clinical issue of parental decision-making and the physician-patient relationship.
Parents have a duty to make decisions in the best interest of their children. When children are not yet able to make decisions about their treatment, then according to common law and in statutes that govern both consent to health care and child welfare, their parents or guardians are authorized to act as their substitute decision-makers and consent to or refuse treatment on their behalf. (Diekema, 2014) However, what determines the child’s “best interests” will differ and are affected by value systems, religious and other beliefs, perceptions of risk and benefit, and other considerations.
When advising parents, health care providers should provide full and complete information in clear language about the diseases targeted and the risks and benefits of proceeding with immunization or refusing it. The information needs to be presented in a way that bests supports informed decision making, which ensures parents have the information to make a sound decision. Dr. Paul Hunter, former AAFP Vaccine Science Fellow, stated in an article “The Center for Disease Control collaborated with the AAFP and the American Academy of Pediatrics, created free resources to help physicians talk to parents about vaccinations. The resources include immunization schedules and information about vaccine-preventable diseases, as well as information for those parents who choose to delay or refuse immunizations.” (Hunter, 2015)
Many physicians encounter parents who refuse vaccines for their children. Ethically speaking are these physicians justified in rejecting these children from the practice and what reasons will they provide the family? One reason may be the concern for the other children that are in the practice. There may be children in the practice who have not been immunized for medical reasons or the immunization may have been unsuccessful. Another reason a physician may want to exclude a family from the practice is the family’s values and beliefs are not aligned with the physicians and are not comfortable treating patients and families who do not respect their professional advice. (Haelle, 2016) However, a physician may respectfully disagree with the decision-maker to not vaccinate the child and continues to treat the child may see an opportunity to build a relationship of trust and change the parent’s views.
In an article published by the American Academy of Pediatrics, a survey from 2006 and 2013, describing pediatrician perceptions on vaccine refusals, delays, parental reasons for the refusal or delays and physician dismissals was completed. The results were staggering, 74.5% in 2006 to 87% in 2013 parents refused vaccines. The physicians perceive reasons parents refused the vaccinations because they feel they are unneeded (63.4% in 2006 and 73.1% in 2013). In 2006, pediatricians reported that 75% of parents delayed vaccines because of concern about discomfort and in 2013 72.5% denoted a delay because of concern for immune system burden. A total of 6.1% of pediatricians reported “always” dismissing patients for continued vaccine refusal, and in 2013 the percentage increased to 11.7%. Figure 1.1 is the analyzed data from the study showing the percentage of pediatricians reporting their perceptions of parent’s reasons for refusals of vaccinations between 2006 and 2013. (Hough-Teleford et al.,2016)
In 2012 U.S. Vaccine Rights Attorney, Alan Phillips, sent an open letter to pediatricians in the United States regarding the legal and ethical ramifications of refusing to treat unvaccinated children. In the letter Phillips says, “Physicians who refuse to treat unvaccinated children due to a parent’s exercise of a lawful exemption to immunizations may be violating the parent’s Constitutional rights and state ethical rules, and risking liability and/or sanctions accordingly.” Although he went on to say, “an unvaccinated child whose parents are not exercising a lawful exemption may pose a legitimate liability risk, as those parents may not be in compliance with the law. In this case, you may be justified in requiring a waiver from the parents, or in temporarily refusing to treat a child until the parents vaccinate or a parent exercises an exemption.” (Phillips, 2012)
Under the law physicians can discontinue professional services to a patient, but may not abandon the patient. If a physician is planning to sever the relationship with a patient it is imperative to look into the legislations, regulations, and policies in the local jurisdiction. (Rose ; Arias, 2015)
In the end, physicians must inquire about their patients’ and parents’ beliefs in a respectful manner, maintain open communication and understanding relationship with families. Physicians can use their role in providing continuing care as an opportunity to educate the families while building trust to continue the discussion. When a parent has a question, or hears information that is untrue about a vaccine a physician needs to be able to have a nonjudgmental discussion and provide evidence based materials to clear up and questions.