Pediatricians report a growing concern about parents refusing to have their children vaccinated and many believe that dismissing these families from their practice is an acceptable strategy to deal with this situation, according to a report in the October issue of the Archives of Pediatrics and Adolescent Medicine.
According to the report, 85% of the 302 pediatricians responding to a survey said that they had encountered a parent who refused to allow their child to be inoculated with a particular vaccine and 54% reported encountering a parent who refused all vaccines.
For parents who refused some vaccines, responding pediatricians said 73% of the parents cited safety concerns about vaccines in general, 22% were concerned about simultaneous multiple vaccines, 13% had "philosophical objections to vaccines," and 7% refused for religious concerns.
The report's authors said vaccination is a foundation of the pediatric core value of practicing preventive medicine. And they reported that many pediatricians believe that parents who won't let their child be vaccinated display a lack of trust and shared healthcare goals. Because these are such barriers to the physician-patient relationship, the doctors believe that termination of the relationship is the only way to proceed.
In fact, 39% of the respondents said they would "fire" a family from their practice for refusing all vaccines, while 28% said they would dismiss families for refusing selected vaccines.
"Pediatric training puts a great deal of emphasis on prevention, so it's sort of part of their soul and part of their professional identity," said one of the report's authors, Joel Frader, M.D., a professor of pediatrics, medical humanities and bioethics at Northwestern University's Feinberg School of Medicine in Chicago. "Pediatricians believe and -- I will editorialize a little here -- for good reason, that vaccines are safe and effective."
If parents are going to dismiss something that pediatricians believe so strongly in, the physician-patient relationship will not flourish, said another of the study's authors, Erin Flanagan-Klygis, M.D., an assistant professor of pediatrics at Rush Medical College in Chicago.
"When faced with a family who refuses vaccines, it makes us wonder if we're on the same page with healthcare," she said. "Some pediatricians feel it may be hard to forge a relationship with families who disagree with them on this issue."
Flanagan-Klygis added that pediatricians try their best to obtain informed consent by providing literature on vaccines and being available to answer any questions. So, she said, firing a family is a sign of the commitment a pediatrician has to preventive medicine and should not be seen as a form of coercion.
Nevertheless, she said the report helps expose an issue that is both a public health concern and an ethical dilemma.
"If these kids continue not to get immunized, it's a public health issue," Flanagan-Klygis said. "On the ethics side, you have to ask whose interests are we serving when we ask families to seek care elsewhere."
An expert in both public health and medical ethics, Leonard Morse, M.D., said terminating the relationship should be done only when all other attempts to persuade parents fail, but he added that it is also an appropriate act to take.
Morse, who serves as the public health commissioner for the city of Worcester, Mass., and who formerly chaired the American Medical Association's Council on Ethical and Judicial Affairs, noted how diseases such as poliomyelitis have been nearly eradicated "and it's only through immunization that it's happened."
He added that pediatricians have a responsibility to individual patients, but physicians also have a duty to the health of society at large. The preventive medicine focus of pediatrics is one that all medical specialties should emulate, he said.
"To prevent a disease makes more sense that treating it after it occurs," Morse said. "Staying healthy is the most effective way of lowering the cost of healthcare, lowering the rate of preventable deaths, lowering suffering and all sorts tangential concerns."
View the study abstract.