November 9, 2020
Mark Navin, Ph.D., professor and chair of philosophy at Oakland University, recently co-authored an article for Pediatrics — the official journal of the American Academy of Pediatrics — about the non-acceptance of vaccine refusers in primary care.
“My children’s pediatrician does not accept vaccine refusers into her practice,” Navin said. “She is an amazing pediatrician, and I know she has good motivations for her policy, but I think she’s wrong. There are many other outstanding pediatricians who have similar non-acceptance policies. My co-authors and I wanted to unpack what we thought were the ethics issues involved in their decisions.”
Navin collaborated on the article with Jason Wasserman, Ph.D., an associate professor in the Department of Foundational Medical Studies in the Oakland University William Beaumont School of Medicine (OUWB); and Douglas J. Opel, M.D., associate professor of pediatrics at the University of Washington School of Medicine.
“Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health,” the authors wrote. “Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon.
“In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal. The American Academy of Pediatrics (AAP) says dismissing families who continue to refuse vaccines is an ‘acceptable option,’ but some practices have gone further by not accepting vaccine refusers as patients at all. The phenomenon of non-acceptance has been underexplored; in both empirical studies and ethics analyses, researchers largely focus on dismissal.”
In the article, Navin, Wasserman and Opel argue that non-acceptance is problematic because (1) some of its motivations are intrinsically immoral, (2) it does not appear to accomplish some of its goals, and (3) even when non-acceptance does accomplish its goals, it fails to appropriately balance the various values it implicates. Throughout the article, the authors engage with the existing ethics literature about dismissal and conclude that even if dismissal is sometimes justifiable, non-acceptance is not.
“From a moral point of view, there's a world of difference between kicking a family out of your pediatric practice after they have consistently refused vaccines and accepting families into your practice only if they agree in advance to allow their children to receive all vaccines,” Navin said. “The AAP says the first practice is sometimes OK, but no one has been talking about the latter practice, even though we know it's been going on, and even though it's pretty clearly not covered by the AAP's policy.
“Pediatricians have an obligation to do their fair share to promote the health of children and others in their community,” Navin added. “This involves building relationships with parents who present their children for care, and attempting to get those children vaccinated. Pediatricians who ultimately dismiss some vaccine-refusing families, after efforts at persuasion have failed, may have done their part to promote vaccination. But pediatricians who do not even accept vaccine-refusing families into their practices have likely not done enough.”
To read the complete article, visit pediatrics.aappublications.org.