Should Doctors Refuse Patients Who Refuse?
Mar 13, 2012

Week after week, I read about doctors who are refusing patients who refuse vaccines.  It’s an ongoing debate that has drawn a great deal of commendation and criticism.
On the one hand, doctors are admired for taking a strong stand in support of timely immunizations.  They typically make these policy decisions based on a number of different reasons.

• They understand that there is no scientific reason to deny vaccines or even delay them.
• They don’t want to see their patients at risk of contracting a preventable disease if they remain unvaccinated.
• They don’t want to put other patients at risk in their waiting rooms.

But until yesterday, I hadn’t even considered that doctors may also want to protect themselves from both liability and disease.
Take the story of pediatrician Dr. Lori Breaux in yesterday’s USA Today article.  Tennessean writer Tom Wilemon explains how Dr. Breaux  had to admit her own 2-week-old infant into an intensive care unit with whooping cough after she had treated a patient with the disease.  Upon reading this I realized that I had never stopped to think about the risk to the doctors.  Not only do they treat patients with preventable diseases, but they can easily bring them home to young or vulnerable family members.
That’s not to say that doctor’s shouldn’t treat these patients.  Of course, that is what is expected.  However, in the case of preventable diseases, I can now understand why a doctor may want to minimize the risk in the same way that Dr. Breaux has done.  She makes parents sign a waiver every time they bring an unvaccinated child in for treatment, because it’s not just about her own personal health, but also about the direct impact that is made upon others when one parent decides not to vaccinate their child.
While it is a doctor’s prerogative as to whether they will treat patients who refuse vaccines or not, I found it interesting to also consider another moral  perspective on this debate.
Just yesterday, Art Caplan from the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine posted a piece on Medscape that urged doctors not to dismiss patients who won’t vaccinate.  He explains,

“…you may have a chance at persuading them to vaccinate their children. I am going to argue that it is important to try hard to not dismiss these people but stick with them to see if you can persuade them.”

Dr. Caplan suggests that there are two reasons that parents hesitate about vaccinations;

“safety concerns and that their child is receiving too many vaccines at once.”

With respect to the safety issue, he explains that

“It isn’t a bad thing for a parent to worry about safety. It’s that they are listening to inappropriate sources. “

His suggestions to doctors were rather straight-forward.
First of all, he believes that one of the most important things doctors can do to try to overcome vaccine hesitancy is to have a good knowledge of the facts themselves. They need to know where the resources are so that they can send people to places where they can get valid information.
Additionally, he suggests that doctors be good role models.  They should not only get themselves and their families vaccinated, but they should openly share that fact with their patients.
Another important concept comes from introducing parents to the moral reasoning in regards to vaccination.

 “You are not just having your child vaccinated because you want to protect them, but you want to protect others who can’t receive vaccines, such as babies, people with immune diseases, people who have had transplants, and the elderly. You want to have your child vaccinated to protect grandmothers, grandfathers, or a new baby in the family.”

Whether it applies to the flu vaccine or the HPV vaccine, studies indicate that a doctor’s recommendations are often one of the most influential factors in parental decisions to vaccinate.  Therefore, it is not surprising that Dr. Caplan continues to suggest that doctors do their best to retain vaccine hesitant parents in an effort to provide appropriate information that may alter their decisions and ultimately lead to more protection among children.
So, what are your opinions on this subject? Should doctors protect themselves and others in their practice by refusing to see patients who refuse vaccines?  Or should doctors retain these patients in hopes of changing their minds?   

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