Ethical Jab?
I discovered this very interesting poll on Medscape today:
What is interesting is that 17% of physicians who answered this survey think it is ethical to refuse to see a child whose parents have chosen not to vaccinate (this has remained stable at around 17% for the past 500 or so votes). I find this quite bizarre. How many doctors would refuse to see a smoker because they won’t stop smoking? Or an obese person because the won’t stop eating? Or a diabetic because they are non-compliant with their medication? In my experience it is virtually unheard of for a doctor to remove a patient from his practice for unhealthy behavior. And this unhealthy behavior is entirely volitional – they choose to do this to themselves.
Yet 17% of physicians see nothing wrong, apparently, with not seeing a child because his/her parents have made what they consider to be a healthy choice. That strike me as a very peculiar double standard. Do they somehow think that not immunising children is some form of child abuse? That is the only reason I can think of for refusing to see a child. Even that is a bit of a stretch. The last thing an “abused” child needs is to be abandoned by his/her doctor.
While it is probably not unethical in a medico-legal sense to refuse to see a child for being un-immunised, it certainly seems entirely unreasonable. The un-immunised child will be at risk of developing certain severe childhood diseases and is therefore more in need of a physician than ever. It is highly unlikely that this negative attitude will cause parents to rethink their position on immunisation. In my experience, a rational discussion with parents is possible, if you treat their opinion with respect and are prepared to counter their arguments with facts. I have managed to persuade many parents to have at least the DTP and polio series and the HiB series, as I consider these essential vaccines, due to the dangerous nature of the diseases they prevent. If I cannot persuade parents, I abide by their decision without rancor.
Last time I checked, the hippocratic oath contains the words “To keep the good of the patient as the highest priority.” I do not see how discriminating against them based on their immune status achieves this.
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Nov 27 09 7:05 am
I suppose we can hope that when the question was put to them it was a hypothetical situation but perhaps in reality they’d act differently.
Do many doctors currently dismiss children as patients because their parents don’t vaccinate them?
Nov 27 09 8:38 am
Yeah, I read that 17% as a sign of frustration more than a personal intent to not see such kids.
Still, with modern one or at most two child families and helicopter parents there’s going to be increasing resistance to immunisation because of the (small) risk of an adverse reaction. One kid is not a very diversified portfolio
JC
Nov 27 09 9:09 am
Read your post again: “While it is probably not unethical in a medico-legal sense to refuse to see a child for being un-immunised, it certainly seems entirely unreasonable.”
Probably 99.5% of physicians agree it would be unreasonable.
Nov 27 09 11:06 am
More concerning is the 5% who selected option ‘d’. Good to see that concrete thinking is alive and well in the profession.
Nov 28 09 12:29 am
Perhaps not widespread in NZ, but check out the 65 pages of testimonials from Texas parents who were harassed by their doctors for not letting their kids get immunized- even after the kid got seriously sick straight after a vaccination. An under-reported problem in NZ methinks.
http://vaccineinfo.net/harassment/report.pdf
I think recent rumblings about ‘closer connections’ between doctors and CYFS is really a foreshadowing of the same sorts of behaviour these Texas parents are complaining about- if you don’t vaccinate your kids, then you are abusing them.
In Auz, welfare payments to families will have ‘income management measures’ removed if the families can present a completed vaccination schedule for the child. Welcome to the brave new world….
http://www.theaustralian.com.au/politics/new-law-to-quarantine-all-welfare-payments/story-e6frgczf-1225803474284
Nov 28 09 1:42 pm
As one of those parents who didn’t continue with vaccinating my second child after he had convulsions the night after the first immunisation I find this whole subject very fraught… The doctor at A & E told me catagorically that my otherwise healthy child did NOT have convulsions due to the vaccine (sorry I don’t believe that) My GP accepted my decision without discussion, agreed that in the same situation he would possibly make the same decision. Preschools and other organisations demanded explanation for his under vaccinated status over the years and accepted it. He’s a healthy adult now.
More recently someone I know actually wanted to discuss whether vaccination was the best move given some of the childs other health problems and went into the pediatrician with a lot of information printed off the internet asking to talk about it. She was called a negligent mother and a disgrace. Whether the pediatrician in question was willing to continue to see the baby if unvaccinated is unknown – he won’t be anyway.