Ethical Jab?

By Jim McVeagh 27/11/2009


I discovered this very interesting poll on Medscape today:

vaccine_poll

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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