Expert Response 10

Updated: July 20, 2020

This is a very difficult situation and one that requires both tact and open communication. The issue of vaccinations is a heated one on all sides, and there is a lot at stake for all parties in a situation like this. A scenario like this potentially puts a doctor’s core conviction at odds with parental autonomy, and it is important to respect all of these beliefs in approaching the situation.

The first thing I would want to do is gather more information. Assuming this is speaking of a particular case, I’d want to understand why the parents are refusing to vaccinate their child. There may be a specific reason, based on the child’s own medical history, and perhaps something has simply been missed in taking that history, leading to a misunderstanding between the parents and the doctor. If this isn’t the case, and the parents are choosing not to vaccinate because of their own beliefs, I’d like to speak with them about their reservations around vaccines. There are a lot of misconceptions about vaccines right now, so I’d want to ensure they have the most up-to-date, evidence-based information about the realities of vaccines, both the benefits and the risks. If it was possible to speak with them, I’d sit down with them in a private location, so that I could fully hear their reasons and concerns. I would be very aware of my own tone of voice, posture, and body language, to ensure I don’t come off as judgmental or condescending. At their core, they are simply worried about their child and want the best for him or her. Even if I don’t think this is the wisest choice, I want to keep in mind their motivations, which are in all likelihood well-intentioned.

I’d also want to talk to the physician about her reasoning in creating a rule like this. I’d like to understand what led to this – whether it was one particular event, or the result of several things together? I’d also want to know if this proclamation applies across the board, or only to this family in particular. Regardless, there is surely a lot of background and history here that I’m simply not aware of, as I am new to this clinic. Again, I’d try to find a private place and a convenient time to meet with the doctor, so that I could more fully understand the situation.

There is quite a lot at stake here. An unvaccinated child is obviously in danger of potentially contracting dangerous illnesses. We’re seeing this in current outbreaks of previously minimized illnesses like measles. As well, if the child comes into contact with other vulnerable, unvaccinated children – for example, those who cannot be vaccinated because they are immuno-compromised – this poses a very real danger to those children. That said, patient autonomy is a key value in our current understanding of medicine, and while the child is a minor, that autonomy is enacted through their legal guardians. Violating this means violating a core and hard-won principle of modern medicine. Yet, doctors, too, are humans with values of their own, and the evidence in the case of vaccines is quite clear – there are risks, but they are minimal, and the benefits far outweigh them.

Personally, I don’t agree with denying care to a child because of the choices of his or her parents. That is putting the child’s health in danger just as much as refusing to vaccinate. If anything, such children need more medical attention, to ensure they grow up healthy and strong. There are many containment and sanitation procedures we can follow to minimize the chance of exposure for other children who come to the clinic – the same procedures we’d follow for children who can’t be vaccinated for medical reasons.

If the doctor was firm in her refusal to see unvaccinated children (this one or others), I would want to find contact information for other pediatricians who will see such children and see if they are taking referrals. Upon gathering such information, I would have it on hand to give to parents who found themselves in this situation. Again, as above, I would try to speak with them privately and calm any fears they may have about vaccines, giving them pamphlets and other materials that carefully explain the evidence behind vaccines that can be easily understood by non-specialists. But, if they remained firm in their refusal, I’d want to try to connect them with health care resources that wouldn’t leave their child without a doctor.

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