An Online Symposium on Liability for Exercising Personal Belief Exemptions from Vaccination

Michigan Law Review

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Parents Should Not be Legally Liable for Refusing to Vaccinate their Children

Parents Should Not be Legally Liable for Refusing to Vaccinate their Children

Jay Gordon 

* Fellow, American Academy of Pediatrics.
† Suggested citation: Jay Gordon, Commentary, Parents Should Not Be Legally Liable for Refusing to Vaccinate Their Children, 107 Mich. L. Rev. First Impressions 95 (2009), http://www.michiganlawreview.org/firstimpressions/vol107/diekema.pdf.

Introduction 

Should a parent who takes advantage of a personal belief exemption to avoid vaccinating a child be held liable if that child infects other people? No, because there are valid medical reasons for choosing this exemption and tracing direct transmission of these illnesses from an unvaccinated child to another person is virtually impossible. 

I have been a pediatrician in private practice for nearly thirty years. I was conventionally trained, completed a residency in pediatrics at Children’s Hospital of Los Angeles and was the Senior Fellow in Pediatric Nutrition at Memorial Sloan-Kettering Institute in New York City. Over many years, seeing thousands of children, my point of view about childhood vaccines has changed. I believe that parents have the right to decide when and how their children receive vaccinations and also have the right to decline any or all vaccines. Like many medical interventions, vaccines have risks and benefits, and parents may elect nonvaccination as the better choice for an individual child. The societal ramifications are significant and should certainly be a part of any discussion. 

When children or babies who have been in contact with other children (or adults) contract most illnesses, there is no feasible way to know from whom they got the disease. Whether one is talking about a routine winter viral illness, chickenpox, or whooping cough, the contagion could have come from a child with overt disease signs and symptoms, an asymptomatic carrier, or another, perhaps mutual, contact. Vaccines are not 100% effective, so that even a fully vaccinated child can contract an illness or carry that illness and give it to another child. Blaming a specific individual—let alone suing one—because your child gets sick has no credible medical basis.  

I. Parents May Be Justified in Declining to
Vaccinate Their Children

There are many valid reasons to support vaccination, but they don’t support removing the right to refuse vaccinations. There are also situations—medical and personal—which justify waiving all or some childhood vaccines, but these are not good reasons to abandon vaccines altogether.

Twenty states (including Michigan) allow parents to waive any or all vaccines for personal or philosophical reasons. These children may still attend school at all levels, but the school system reserves the right to exclude these children in the event of an outbreak. This is a firm commitment on the part of the government to protect the rights of parents to participate fully in this important healthcare decision. Parents who feel that the risks of vaccinating outweigh the benefits are entitled medically and legally to waive vaccines. Section 6051 of the California Code states that “[a] pupil with a permanent medical exemption or a personal beliefs exemption to immunization shall be admitted unconditionally.” Similar wording appears in most of the state laws allowing a personal belief exemption. These are not whimsical choices on the part of the legislators, the parents, or the doctors who support this right. Parents who vaccinate their children base their decisions on the advice they receive from their pediatricians and the other knowledge they have gathered. Parents who choose to waive vaccinations do so for similarly valid reasons.

Adverse outcomes can occur from both vaccination and nonvaccination. Vaccines work very well at creating immunity to illnesses, so there are very few situations that would likely lead to transmission of an illness from an unvaccinated child to a vaccinated child. The obvious exceptions would be infants too young to have received a full complement of shots and immuno-compromised children. Parents must protect these two groups of children by keeping them away from too many other children. Period. Newborns and young babies are at risk any time they are in public. We can only vaccinate against a very small minority of contagious illnesses; it is unwise to bring your newborn into preschool when you pick up your toddler, and equally risky to attend older children’s birthday parties with this baby. Further, parents of children taking high dose steroids for asthma or receiving immunosuppressive medicine for other diseases are strongly cautioned by their doctors to avoid the potential dangers I have described.

There are valid reasons for giving all the recommended vaccines, but parents’ ambivalence is supported not just by instinct or alleged self-interest but also by medical literature questioning the effectiveness of immunizations. The Centers for Disease Control and Prevention (“CDC”) funded a peer-reviewed article about flu shots published in the October 2008 issue of the highly respected Archives of Pediatric and Adolescent Medicine. It concluded:

[S]ignificant influenza VE [vaccine effectiveness] could not be demonstrated for any season, age, or setting after adjusting for county, sex, insurance, chronic conditions recommended for influenza vaccination, and timing of influenza vaccination (VE estimates ranged from 7%–52% across settings and seasons for fully vaccinated 6- to 59-month-olds). . . . In 2 seasons with suboptimal antigenic match between vaccines and circulating strains, we could not demonstrate VE in preventing influenza-related inpatient/ED or outpatient visits in children younger than 5 years. Further study is needed during years with good vaccine match.

We have known for years that flu shots do not work well in older adults; newer research questions their efficacy in children, too. 

Another example involves chickenpox. The Varicella Zoster virus (“VZV”) causes chickenpox in children; the illness is virtually always benign and leaves the child with immunity to chickenpox. In adults, this virus also can cause “shingles,” an extremely painful illness. VZV can live in the nervous system for years and then reactivate in adults whose immune systems no longer suppress it.  

Fortunately, continued occasional exposure to children with chickenpox usually keeps the antibody level against the virus high enough so that shingles is not terribly common. That is the state of medical care in most of Europe where governments and the medical establishment have refused to officially recommend universal vaccination against chickenpox. Among many studies supporting this refusal is a report in the prestigious medical journal Vaccine written by researchers at Britain’s Public Health Laboratory Service, who found that “eliminating chickenpox in a country the size of the United States would prevent 186 million cases of the disease and 5,000 deaths over 50 years. However . . . they said it could also result in 21 million more cases of shingles and 5,000 deaths.”

Of course, we have been quite successful in reducing certain childhood diseases to almost insignificant numbers in the United States, Western Europe, and many other places. (Somalia experienced its first polio-free year in 2008.) And widespread vaccination directly led to this success. 

In March 2005, Julie Gerberding, Director of the CDC, held a press conference to announce that “[t]he elimination of rubella in the United States is a tremendous step in protecting the health and well being of pregnant women and infants.” A viral illness feared by pregnant women “is no longer considered to be a major public health threat in the United States.”  

Another success story involves measles. The United States averages about 60 cases of this viral illness each year. In 2008, the country is on course to have about 160 cases among 300 million Americans. However, the media have managed to turn these extra 100 cases into a cause célèbre for vilifying parents who question the currently recommended schedule of twenty-five or more separate injections over the first two years of life.  

In 1960, if a parent were presented with a dilemma about the polio vaccine and hypothetical side effects, the decision would not have been too difficult given the prevalence of polio during that time period. In 2008 or 2009, the illness is rare worldwide: we are on target for about 1700 cases on the entire planet in 2008 with all but 100 of the cases being in India,
Nigeria, Pakistan, Angola, or Afghanistan. The benefits, both personal and societal, of the polio vaccine were so clear thirty or forty years ago that parents and doctors easily agreed on universal vaccination.

“Childhood vaccines save 33,000 lives each year in the United States.” This statement has been made so often that no one seems to question the absence of logical thinking behind it. The numbers are based on medical care in the early to mid-1900s. There is no way to estimate how many lives vaccines are saving, and a similar estimate of harm from vaccines is difficult to calculate. As a result, a parent’s decision not to vaccinate a child is being unfairly vilified. 

II. Parents Should Not Be Liable for Placing Their Children’s Best Interests Above Universal Vaccination Policies  

In the absence of facts, doctors and others are trying to frighten people into vaccinating or not vaccinating. That fear includes the notions that unvaccinated children pose a great threat to others and that parents of these children are not being responsible. In fact, these parents are choosing what they consider to be the safest course of action for their children and pose very little, if any, danger to other children and adults. 

Some medical interventions are not controversial, and some prompt only mild controversy. For example, if a child has acute lymphocytic leukemia, the cure rate with conventional medical care approaches ninety percent, and very few doctors or parents will argue against the standard treatments offered in spite of their known complications and adverse reactions. But vaccines are presently controversial, and purported truths about safety and efficacy are challenged daily by lay people and physicians. 

Very few medical actions are risk free. Prior to surgery or when medication is prescribed, your doctor explains the risks and benefits. For surgery, the consent form is often many pages long with dire warnings about what can go wrong. Childhood vaccines are shipped to my office with a long thin package insert detailing how the shots are manufactured, what they contain, and what can and has gone wrong. The last lines in many of these inserts sound ominous: “This vaccine has not been evaluated in animals for its carcinogenic or mutagenic potentials or for impairment of fertility.” I seriously doubt that vaccines are a large source of cancer, genetic mutation, or impaired fertility. However, any time I inject a vaccine into a child there is potential for adverse outcome. I respect parents’ questions and objections to our current vaccine schedule. Parents have the absolute right to participate in these medical discussions, and not giving them the information they need to make informed decisions is inadequate medical care. Not seeking out this information is an abrogation of parental responsibilities. 

The list of side effects from adverse reactions to vaccines, in a Physicians’ Desk Reference “warning” section, given out of context, would probably frighten many parents out of vaccinating at all. There are thirty or more items on that list. Similarly, the list of symptoms and complications of the illnesses against which we vaccinate could scare parents into giving every shot available as soon as possible.

Pediatricians and other physicians use the latter option on a daily basis. I share my colleagues’ disdain for scare tactics from the “antivaccine” camp, but I object equally to doctors using fear and misinformation to try to convince parents (and legislators) that vaccines are risk free. Both sides are distorting the truth for their own purposes. Childhood illnesses are part of the first decade of life; immunity is acquired, and the consequences are almost always minor.  

Modern medical care has completely changed the morbidity and mortality rates associated with virtually every single infectious disease. Yet, the “33,000” number is used in the media as if we actually know how many children would succumb to these illnesses in the absence of vaccines in the twenty-first century. We do not really have any idea what this number would actually be with twenty-first century medications and care. And unvaccinable diseases are far, far more common and, realistically, a greater concern for parents: toddlers get eight to ten or more colds each year. To restate a very important point, even vaccinated children can carry diseases like pertussis and mumps. There are no completely reliable medical or laboratory tests showing who infected whom. 

Conclusion 

Vaccines work. They carry some risk but are a viable method of preventing contagious diseases. Parents who choose not to vaccinate their children accept responsibility for their actions, do not endanger others, and must retain this right. There is no medical basis for holding them liable. 

N.Y. Sincerity Test

3 part video on a ‘sincerity test’ given to parents in NY by a school lawyer.

Part 1

Part 2

Part 3

keep in mind..no matter what he or the school decides, it can be over turned (if it is denied) by the NYS commissioner.

NY vaccine exemption article

NVIC Vaccine E-Newsletter

New Yorker’s Stand Up for Vaccine Exemptions

 by Barbara Loe Fisher

In the harbor of New York City stands the Statue of Liberty, a symbol of freedom that has welcomed millions of immigrants for 112 years, half of the time that the United States of America has been a nation. And on the base of the statue is an inscription that says in part “…..Give me your tired, your poor, your huddled masses yearning to breathe free….”

I remembered that phrase when we were driving from Washington, D.C. to New York City and our van got caught up in the Sunday afternoon Manhattan traffic that led us past the Empire State Building on our way to Long Island. Freedom was very much on my mind as we headed for Stony Brook University to participate in the December 15 Vaccine Education Roundtable sponsored by New York state Assemblymen Marc Alessi (D-1st Assembly District) and Richard Gottfried (D-75th Assembly District), who is Chair of the House Health Committee.

Americans have always cherished the freedom to breathe free; to speak, write and dissent without fear of retribution; to believe in God and worship freely without being persecuted; to vote for whom we want to represent us in government and know our vote counts; to follow our conscience and stand up for what is right. Although America is only 222 years old, which is very young compared to other countries that have existed for several thousands of years, during our short history there is no other nation that has defined and defended the freedom of citizens to live in a society based on the principle of equal rights and consent of the governed any better than the United States of America.

These are troubled times for parents in New York and New Jersey and other states. Every day parents are facing more hostility from pediatricians throwing them out of doctor’s offices for questioning vaccine safety and are being harassed by government officials determined to force their children to get dozens of doses of state mandated vaccines without voluntary, informed consent. New York currently mandates more than two dozen doses of 11 vaccines for school attendance while New Jersey leads the nation with nearly three dozen doses of 13 vaccines, including annual influenza shots.

Religious exemptions are being pulled by state officials after they throw parents into rooms and grill them for hours about the sincerity of their religious beliefs. Last year in Maryland, state officials threatened several thousand parents with jail time and stiff fines for failing to show proof their children had gotten hepatitis B and chickenpox vaccinations.

It is in this climate of fear and crisis of trust between parents, who want a more equal role in making vaccination decisions for their children, and pediatricians and public health officials, who are determined to strengthen their power to tell parents what to do, that Assemblymen Alessi assembled a panel representing both sides to discuss whether or not a philosophical exemption to vaccination should be added to New York’s vaccine laws. Currently New York only provides for a medical and religious exemption, even as 18 other states allow a personal, philosophical or conscientious belief exemption to vaccination.

After the Roundtable, Assemblyman Gottfried expressed strong support for First Amendment rights and told the audience of parents, doctors and legislative staff that he is sponsoring two bills to clarify rights defined under existing religious and medical exemptions so they cannot be violated by state officials. After the Roundtable concluded, he said “Important issues were raised. I look forward to seeing additional data from all sides, especially about the impact of the personal objection laws in other states. I will be reintroducing my bills to strengthen the religious and medical exemptions in the 2009 session. I urge parents to contact their local assembly members and state senators to urge them to co-sponsor.”

Assemblyman Alessi commented that “The discussion framed the fact that there is still a large debate on the issue. And although some people in the medical community are adamant that this debate is over, it has only just begun. The amount of conflicting evidence parents are presented with regarding the effects of certain vaccines is staggering. This forum opened the lines of communication between experts in the debate and provided concerned parents with the most recent information on the safety of vaccines. As a parent, I know how difficult it is to make the right decisions regarding our children’s health, but if we are to make good decisions, we need to be well informed and continue to have discussions like this roundtable.”

At the beginning of the Roundtable, I framed the vaccine safety and informed consent debate and outlined how the informed consent principle relates to philosophical/conscientious belief exemption. I reviewed the general health ranking of New York (25th) compared to the 18 states which have philosophical exemptions (six of the top 10 ranked states have philosophical exemption) and noted that the U.S. uses more vaccines than any nation in the world but ranks 39th in infant mortality. Click here to read my entire presentation with live links to references (see text below).

Other panelists supporting philosophical exemption to vaccination included New York pediatrician Lawrence Palevsky, M.D. , who called for an authentic dialogue that “moves past what appears to a growing number of citizens to be a one-sided, paternalistic, and patronizing set of policies and language with an unwillingness to engage in a real discussion about the science of vaccines.” He challenged many of the myths and misconceptions about the safety and effectiveness of vaccine policies.

New York’s John Gilmore, executive director of Autism United, who has a vaccine injured son with autism and said “without trust, the proponents of forced vaccination have nothing but authority and authority is an unacceptable basis for any public policy in a democratic society.” He pointed out operational flaws and conflicts of interest in vaccine safety regulation and policymaking. Louise Kuo Habakus, of the New Jersey Coalition for Vaccination Choice, who has two young sons recovering from vaccine injuries, presented slides summarizing vaccine risks and questioning whether vaccines can be credited with major infectious disease morbidity and mortality decreases in the 20th century. She recounted her impression of the day’s events at www.ageofautism.com. (In related events, New Jersey parents held several open houses this week to educate New Jersey legislators about the need to support pending conscientious belief exemption legislation in that state.)

Panelists defending current vaccine policies and opposing philosophical exemptions included New York pediatricians Paul Lee, M.D. , who agreed vaccine safety should be a high priority but disagreed that the amount of mercury and aluminum in vaccines posed a health risk; and longtime vaccine policymaker and American Academy of Pediatrics spokesperson Louis Z. Cooper, M.D. , who agreed trust between pediatricians and parents needs to be strengthened but defended the safety of existing vaccine policies; and Debra Blog, M.D. , medical director of the Immunization Program, New York State Department of Health, who showed slides of children with infectious diseases and strongly opposed adding philosophical exemption to New York state vaccine laws.

Following panelist presentations there was a spirited debate that lasted for more than two hours as panelists argued and defended their positions. NVIC’s videographer, Chris Fisher, will be making a video of the day’s events available on NVIC’s website.

By the end of the day, I thought about how long parents of vaccine injured children have been asking pediatricians to become partners with them in preventing vaccine injuries and deaths. After nearly three decades, parents and doctors inside and outside of government could not be further apart. The failure of pediatricians and public health officials to take seriously the many cases of regression into poor health after vaccination has become the Number One public health problem in the U.S. today.

There will be no resolution until every state has embraced the informed consent ethic and adopted conscientious or philosophical exemption to vaccination in state vaccine laws. At that point, Americans will be free to vote with their feet and the vaccines the public considers to be necessary, safe and effective will be used and those they do not consider to be necessary, safe and effective will be driven off the market. And then, a real time comparison of the long term health of highly vaccinated, less vaccinated and unvaccinated citizens will tell us a lot about the safety and effectiveness of vaccine policies in the last half of the 20th and first half of the 21st centuries.

Statement of Barbara Loe Fisher
Co-founder & President, National Vaccine Information Center
December 15, 2008 at New York Stony Brook University
Vaccine Education Roundtable

Assemblyman Alessi and NY State Legislators:

Thank you for holding this Vaccine Education Roundtable to discuss issues which impact on Assembly Bill 5468 to insert philosophical exemption in New York vaccine laws. I appreciate the invitation to be part of this panel on behalf of New York members of the National Vaccine Information Center, non-profit organization founded in 1982 to prevent vaccine injuries and deaths through public education and defend the informed consent ethic.

Vaccination is a medical intervention performed on a healthy person which carries an inherent risk of injury or death. The risk of harm can be greater for some than others and there is no guarantee that vaccination will, in fact, confer immunity. With very few predictors having been identified by medical science to give advance warning that harm or failure to confer immunity will occur, vaccination is a medical procedure that could reasonably be termed as experimental each time it is performed on a healthy individual.

Further, the FDA, CDC and vaccine makers openly state that often the numbers of human subjects used in pre-licensing studies are too small to detect all adverse events caused by a new vaccine. This makes government recommended use of newly licensed vaccines by millions of children a de facto uncontrolled national scientific experiment. In this regard, the ethical principle of informed consent to vaccination attains even greater significance.

Informed consent means that a patient or guardian has the right to be fully informed about the benefits and risks of a medical procedure and be allowed to make an informed, voluntary decision about whether or not to take the risk. Informed consent is an important check and balance for the relationship between physicians and patients that encourages physicians to obey the Hippocratic oath to “first, do no harm.”

The affirmation of the informed consent ethic in the practice of modern medicine is rooted in a rejection of the traditional paternalistic medical model, which places the patient or guardian in an unequal, powerless position with a physician and facilitates uninformed, involuntary risk taking. The human right for individuals to exercise informed consent to participating in scientific experiments was officially acknowledged by the judges of the Nuremberg Tribunal after World War II. Their ringing endorsement of individual inviolability and the right to self determination when taking medical risks has became an internationally accepted moral guidepost for the ethical practice of modern medicine. The first principle of the Nuremberg Code begins with:

“The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision.”

In America, the closest we come to upholding the informed consent principle with regard to vaccination is in the 18 states which allow personal, philosophical or conscientious belief exemption to vaccination. In the 2008 edition of America’s Health Rankings, Vermont is ranked the number one healthiest state. Vermont allows philosophical exemption to vaccination. In fact, out of the top ten ranked healthiest states, six of them allow philosophical exemption (Vermont, Minnesota, Utah, Idaho, Maine, Washington).

New York ranks 25th in health behind the nation’s most populous state, California. The state of California has twice as many residents as New York, as well as more foreign born residents and those who speak English as a second language. However, in almost all other demographics, California is nearly identical to New York in ethnic diversity; numbers of children under age 18; median household income and persons living below poverty.

California allows philosophical exemption to vaccination.

What is interesting is that in the top 10 healthiest states, four had among the lowest vaccination rates for children ages 19 to 35 months: Utah (37th) , Idaho (45th), Maine (40th) and Washington (48th). California which is ahead of New York in overall health ranking, is 31st in vaccination coverage of 19 to 35 month olds while New York is number 9. The healthiest state, Vermont, is 29th in vaccination coverage.

In fact, health is not primarily measured by high vaccination rates or an absence of infectious disease. High vaccination rates are not the most important measure of the overall health of citizens. The 18 states allowing philosophical exemption to vaccination have not compromised individual or public health when compared to other states.

This past September, the CDC announced that national childhood vaccination rates are at near record levels, with at least 90 percent of young children receiving all but one CDC recommended vaccine. Less than 1 percent of children aged 19 to 35 months remain completely unvaccinated.

Today, the U.S. government recommends the use of more vaccines than any other country in the world: 69 doses of 16 vaccines for girls; 66 doses of 15 vaccines for boys given between the day of birth and age 18. That is triple the numbers of vaccinations recommended by public health officials and physician organizations a quarter century ago, when 23 doses of seven vaccines (DPT, MMR, OPV) were routinely given.

But in comparison to other nations, the overall health of Americans has not improved since 2004 and there are 27 countries that exceed the US in healthy life expectancy while the U.S. ranks 39th in infant mortality.

Today, 1 in every 143 babies born in America dies; 1 child in 450 becomes diabetic; 1 in 150 develops autism;1 in 9 suffers with asthma; and 1 in every 6 child is learning disabled.

The chronic disease and disability epidemic that has developed in the last quarter century is killing and injuring more children than any infectious disease epidemic in the history of our nation, including smallpox and polio. The social, economic, and human costs are enormous: nearly two billion dollars has been paid to vaccine victims by the federal government in the Vaccine Injury Compensation Program while three-quarters of the more than $2 trillion dollar annual price tag for health care is spent to care for the chronically ill and disabled.

The big question vaccine educated parents are asking is: why are so many of the most highly vaccinated children in the world so sick, suffering with all kinds of chronic brain and immune system dysfunction? Why are babies born in the richest country in the world dying more often than babies born in poorer countries, who do not get vaccinated at all or who get far fewer vaccines?

It is a question that has not been answered by any scientific study conducted to date because there has never been a large, prospective study comparing the long term health of highly vaccinated children to unvaccinated children. In the absence of definitive answers, the right to freely exercise medical, religious and philosophical exemption to vaccination is a human right that may well determine the biological integrity of this and future generations in America.

Because vaccines are pharmaceutical products that carry significant risks greater for some than others; because doctors and public health officials are not infallible; because what is considered scientific truth today can be proven false tomorrow; because philosophical exemption to vaccination does not negatively impact on the health of individuals or states; and because informed consent to medical risk taking is a human right, the National Vaccine Information Center urges legislators to affirm the freedom of all New Yorkers to make informed, voluntary vaccination decisions for themselves and their children by supporting philosophical exemption to vaccination.

Georgia State Law (Daycare)

WHAT THE LAW SAYS

Local health officials often tell day care operators their centers are complying with the law as long as 90 percent of their children have proof of vaccinations, a temporary waiver or medical or religious exemption.

But the law says:

“No child shall be admitted to or attend any school or facility in this state unless the child shall first have submitted a certificate of immunization to the responsible official of the school or facility. …”

“Any responsible official permitting any child to remain in a school or facility in violation of this Code section, and any parent or guardian who intentionally does not comply with this Code section, shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than $100.00 or by imprisonment for not more than 12 months.”

To read the full text of the law, O.C.G.A. 20-2-771, go here

To attend day care, depending on the child’s age, Georgia law may require vaccination against measles, mumps, rubella, polio, whooping cough, chickenpox, diphtheria, tetanus, hepatitis A and B, pneumococcal disease, and Haemophilus influenzae type B (Hib). Exemptions are allowed for medical and religious reasons.

Vaccine Information Sheet (VIS)

Vaccine Information Sheet (VIS)

 Vaccine information sheets are produced by the CDC.  In the US, it is a federal law that the VIS sheet be signed prior to any vaccine administration. It became a requirement with the passing of the National Childhood Vaccine Injury Act of 1986. The VIS sheets purpose is to describe a brief overview of the vaccine, the benefits, and the risks.

 

  It is NOT an informed consent sheet. A parent signs the sheet simply as an acknowledgment that they were informed of the benefits and risks.

 

There is no Federal requirement for informed consent. VISs are written to fulfill the information requirements of the NCVIA. But because they cover both benefits and risks associated with vaccinations, they provide enough information that anyone reading them should be adequately informed. Some states have informed consent laws, covering either procedural requirements (e.g., whether consent may be oral or must be written) or substantive requirements (e.g., types of information required). Check your state medical consent law to determine if there are any specific informed consent requirements relating to immunization. VISs can be used for informed consent as long as they conform to the appropriate state laws. (bolding mine)

 

According to an AAP survey regarding consent and immunizations: (bolding mine)

 

  • The majority of pediatricians distribute written information on these vaccines the first time they are administered: 73.0% always distribute written information on the DTP vaccine; 63.8% always do so for MMR; 60.6% always do so for HIB; and 65.4% always do so for OPV.
  • The majority of pediatricians also document provision of information in the patient’s record the first time a vaccine is administered. for the DTP vaccine, 61.3% of pediatricians said they always document provision of benefit/risk information, 56% reported always documenting information on the MMR, 53.8% always do so for the HIB vaccine, and for the OPV, 59.1% always do so.
  • Two-thirds of the pediatricians reported they never record a parent’s specific verbal consent in the patient’s record the first time a vaccine is administered. For the DTP vaccine, 19.1% of the pediatricians said they always record parent’s specific verbal consent and 15.6% said they sometimes do so. For MMR, 17.1% said they always do and 13.3%, sometimes. For the HIB vaccine, 16.4% said they always record the parent’s verbal consent in the record and 13.8% said they sometimes do so; for OPV, 18.9% always and 13.0% sometimes do so.

One-half of the pediatricians always obtain the parent’s signature as evidence of consent the first time a DTP, MMR, or OPV vaccine is administered; 47.5% do so for the HIB vaccine. Most of the balance of pediatricians said they never do so (39.8% DTP, 43.0% MMR, 46.3% HIB, and 42.9% OPV).

 

Another AAP survey:

 Vaccine administration practices vary as a function of practice setting, practice area and region of the country. For example, pediatricians in group practices (45%) are less likely than pediatricians in hospital/clinic practices (59%) or solo practices (51%) to say they discuss vaccine risks/benefits with every dose of at least six of the seven vaccines (p<.01). Pediatricians practicing in rural areas and those in the Midwest and South are more likely to distribute VIS at every dose than are pediatricians practicing in other areas (70% rural vs. 55% inner city vs. 64% other urban vs. 59% suburban, p<.05) or regions of the country (72% Midwest vs. 68% South vs. 54% West vs. 49% Northeast, p<.001). practitioners in rural areas (65%) also are more likely to document provision of VIS with every dose of each vaccine than are practitioners in urban inner cities (43%), other urban areas (58%) or suburban areas (54%) (p<.01).

vis

Doctors “firing’ Patients

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Refuse to get your child a vaccine and get ‘fired’ by your Pediatrician. Who would of thunk?

 Refuse Vaccine, Get ‘Fired’ by Pediatrician?

 Well over a third of pediatricians — 39% — say they would “dismiss” families that refuse all vaccinations, a new study suggests. That’s surprising, says study leader Erin A. Flanagan-Klygis, MD, assistant professor of pediatrics at Chicago’s Rush Medical College.

But another finding surprises Flanagan-Klygis even more. More than one in four pediatricians — 28% — say they would fire families that agreed to some vaccinations but refused one or more other vaccinations.

This study is based on questionnaires filled out by 302 randomly selected members of the American Academy of Pediatrics who give recommended childhood vaccinations. Ref: October issue of Archives of Pediatrics and Adolescent Medicine.

 

Dismissing the Family Who Refuses Vaccines

A Study of Pediatrician Attitudes

Results Fifty-four percent faced total vaccine refusal during a 12-month period. Pediatricians cited safety concerns as a top reason for parent refusal. Thirty-nine percent said they would dismiss a family for refusing all vaccinations. Twenty-eight percent said they would dismiss a family for refusing select vaccines. Pediatrician dismissers were not significantly different from nondismissers with respect to age, sex, and number of years in practice. Pediatrician dismissers were more likely than nondismissers to view traditional vaccines (diphtheria and tetanus toxoids and acellular pertussis; inactivated poliovirus; Haemophilus influenzae type b; measles, mumps, and rubella) as “extremely important,” but they were no more likely to view newer vaccines (7-valent pneumococcal conjugate, varicella-zoster virus, hepatitis B) as “extremely important.”

Conclusions Pediatricians commonly face vaccine refusal that they perceive to be due to parent safety concerns. In response, many pediatricians say they would discontinue care for families refusing some or all vaccines. This willingness to dismiss refusing families is inconsistent with an apparent ambivalence about newer, yet recommended, vaccines. The practice of family dismissal needs further study to examine its actual impact on vaccination rates, access to care, and doctor-patient relations.

 

Logically though, how can you as a parent or your child be ‘fired’?  They provide a service to YOU. You don’t work for THEM. Without YOU, who would THEY WORK FOR? Would you honestly want a physician that didn’t TRUST and RESPECT YOU to KNOW what is best for YOUR child?  Would you really want a physician that didn’t RESPECT your RIGHT to choose what you believe to be in the best interest of your child? Patients can fire their doctors. Doctors can only refuse to see you as a patient in the future. :)

 

 According to the American Medical Association, doctors have “an obligation to support continuity of care for their patients” and “should not neglect a patient.” But if a doctor must end the relationship, they have to provide enough notice so the patient can secure another health care provider.”

I’ve often found that doesn’t happen. Doctors simply tell patients to find a new doctor and in not so nice words. 

Take care when firing a patient

 A physician may legally and ethically decide not to continue treating a patient as long as the patient is not in need of immediate care and has been given a reasonable opportunity to find another doctor, which is consistent with the recommendations of the American Medical Association Council on Ethical and Judicial Affairs.

 

According to the AAP:

Responding to Parental Refusals of Immunization of Children

Douglas S. Diekema, MD, MPH and the Committee on Bioethics

 The American Academy of Pediatrics strongly endorses universal immunization. However, for childhood immunization programs to be successful, parents must comply with immunization recommendations. The problem of parental refusal of immunization for children is an important one for pediatricians. The goal of this report is to assist pediatricians in understanding the reasons parents may have for refusing to immunize their children, review the limited circumstances under which parental refusals should be referred to child protective services agencies or public health authorities, and provide practical guidance to assist the pediatrician faced with a parent who is reluctant to allow immunization of his or her child.

 

So much for the Hippocratic Oath. Or respecting a parents RIGHTS under the LAW. Perhaps they have even forgotten that vaccines are not mandatory. They are only mandated for school or daycare attendance, without an exemption.

 

Parents often feel they have to explain their reason for not vaccinating. Why? If a physician’s belief  is to vaccinate everyone under the sun, nothing you say will make a difference to them. If not vaccinating is your choice, own it. If you do not vaccinate for religious reasons, simply state it. You owe no further explanation and it is against the law for a physician to question your faith or religious beliefs further. If it is against your philosophical beliefs, much like religion, simply state it, and no further discussion needed. You don’t question their religious beliefs, so nothing gives them the right to question or discriminate against yours.

Bullying? Yes, I’ve heard this one too. Remember, only you allow a physician to bully you. If a physician is unethical and unprofessional enough to start it, calmly leave without comment. A physician has no right to bully, yell, discriminate, name call, harass or threaten you, ever. We would call those descriptions ‘abuse’ and that is exactly what they are doing, and they are not above the law.

 

Finding the Right Physician

1. Make a list of physician’s names and get references from friends or families who have similar views as yours.

2.  Call and ask the receptionist if non-vaccinating/selective/delay patients are accepted before making the first appointment.  If you are comfortable with the answers to your questions, book an appointment.

3. Direct any further questions directly to the physician at the appointment.