Re: immunization refusal

From: Michael Roberts <>
Date: Wed Nov 16 2005 - 07:23:13 EST

A difficult topic, one I know little about. However it does raise issues on the ethics of science as applied to medicine. Hence on these I can make little useful contribution but will have to listen. That is the same for arguments on probability which are part of the whole science and religion sphere, but again my maths is pretty useless.


0From: jack syme
  Sent: Wednesday, November 16, 2005 12:40 AM
  Subject: immunization refusal

  I was serious about my question about what were appropriate topics for this forum. I did not imply that what Glenn posted was not appropriate, I was asking what is or is not.

  Michael Roberts suggested medical ethics. I chair our hospital ethics committee so I am always looking into some ethical issue or another. But I had never thought to bring up the issues here, I never really thought they were appropriate. I could bring these issues up from time to time now that I think about it.

  So, to give this a whirl, this is what we discussed at our last hospital ethics committee meeting. Admittedly, there are other medical ethical issues that would be more appropriate for this forum, this is just the most recent issue we were dealing with.

  Many pediatricians say they would not continue care for families who refuse vaccines
  More than one-third of pediatricians say they would dismiss a family from their practice for refusing all vaccinations, according to a study in the October issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
  The rate of unvaccinated children has risen significantly since 1995, according to background information in the article. While most parents continue to believe that vaccination is important, a large number express concern about vaccine safety. Although most parents depend on their pediatrician's advice and counsel in their decision to vaccinate their children, when a parent refuses one or all vaccines the relationship between parent and pediatrician may be weakened. Some pediatricians may choose to end their participation in the care of children whose parents refuse vaccinations, the authors suggest.

  Erin A. Flanagan-Klygis, M.D., of Rush Medical College, Chicago, and colleagues surveyed pediatricians who provide routine vaccinations in a primary care setting. The survey included questions on the pediatrician's experience and type of practice; a question asking the pediatrician to rate the importance of the seven most common vaccines; and a set of questions about parental vaccine refusal and the pediatrician's response, including reasons for dismissing a family from the pediatrician's practice.

  Of the 302 pediatricians completing the survey, 85 percent (256) reported encountering a family refusal of at least one vaccine during the previous 12 months, the researchers report. Fifty-four percent (162) of pediatricians reported encountering a parent who refused all vaccines. Pediatricians reported that parental reasons for both partial and full refusal of vaccines were similar. The most common reasons were safety concerns, concern at giving multiple vaccines at once, philosophical reasons and religious beliefs.

  "In the case of parents refusing specific vaccines, 82 (28 percent) said that they would ask the family to seek care elsewhere; for refusal of all vaccines, 116 (39 percent) of pediatricians said they would refer the family," the authors write. The most important factors for pediatricians in the decision to dismiss families who refuse vaccines were lack of shared goals and lack of trust. There were no significant differences between pediatricians who would dismiss families for vaccine refusal and those who would not with respect to age, sex, number of years in practice or number of patients seen per week.

  "Does the practice of family dismissal, in fact, promote or undermine immunization for particular children or children as a group?" the authors write. "Might family dismissal generally damage relationships between pediatricians and families such that parents become less likely to seek or successfully obtain other needed primary preventive services or care for acute or chronic illness? Given the changing climate of confidence in childhood vaccination, future research should address these and other potential implications of practice dismissal in the face of parental vaccine refusal. The answers obtained may provide insight into the influence physician behavior has on the health and welfare of children and communities for many years to come."
Received on Wed Nov 16 07:27:56 2005

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