Should Doctors be Allowed to Refuse Treatment if Parents Won’t Vaccinate? - Page 2

[WildKingdom]

Originally Posted by emmy526 

i'm just wondering when the Hippocratic Oath added that vaccine status must be up to date in order for an md to treat someone......

I'm just wondering when the Hippocratic Oath added that doctors must be compelled to care for someone against their will.

[SweetSilver]

Originally Posted by kathymuggle 

No.  Where I live, doctors are paid for with my taxes.  I am not Ok with them refusing service for some Canadians when all Canadians pay for healthcare.

I also do worry about children being left without healthcare.  Who wants that?  There have been threads on here where posters complain that all the doctors in  a reasonable distance will not accept non-vaxxers.  It can leave children without care for what is their parents decision.  Vaccines are only a small part of healthcare - to refuse to see kids based on this one aspect seem punitive to me.  I wonder if they also refuse to see kids whose parents smoke, kids who live on twinkie diets, etc?  I sincerely doubt it.  In my mind it is a form of discrimination to refuse to see some people over their health choices - yet are willing to see others on health choices that are often worse, but not as controversial and media driven.

I could see some circumstances where I might get so frustrated with the parents due to the issues you mentioned that I might feel like not wanting to treat them, especially in a private practice and in an area where they can find other doctors.  It can be frustrating when people refuse to take your advice in any arena.  Generally, though, I would agree, especially in a healthcare system like yours where all doctors truly are public servants.  One related frustration here in the states is doctors refusing patients with certain insurance because they don't like dealing with state- and federally-funded health programs (because of red tape or losing money or whatever).

But, you are probably right about this issue getting singled out above all other health-related issues.  It is quite an overreaction when you break it down like that.

[Turquesa]

It's interesting that your quote focuses on children. Do you feel that adults who are not "up-to-date" on their vaccines should sit in that same room?

Originally Posted by prosciencemum 

I think no actually. Although I think it's reasonable to segregate them from the normal well child check waiting rooms.

[pek64]

When discussing a radius, keep in mind that not everyone has a car. I don't, and would have to be able to reach someone by public transportation.

I think doctors should have to accept patients regardless of vaccination status, because being vaccinated is *not* a guarantee that the patient does not have a vpd. So, there is no legitimate reason to refuse the patient.

[chickabiddy]

Originally Posted by marsupial-mom 


I agree with this if we add another caveat: if there isn't another doctor within 20 miles or so, then the doctor should not refuse patients on the basis of vax status.

I don't think I agree with that.  I don't think doctors in rural/isolated areas should have less control over their practices.

[chickabiddy]

Originally Posted by pek64 

When discussing a radius, keep in mind that not everyone has a car. I don't, and would have to be able to reach someone by public transportation.
I think doctors should have to accept patients regardless of vaccination status, because being vaccinated is *not* a guarantee that the patient does not have a vpd. So, there is no legitimate reason to refuse the patient.

Doctors can terminate relationships if patients are "non-compliant" with recommendations.  I think that's fair.  Patients can certainly terminate professional relationships if they disagree with the doctors.

[emma1325]

Originally Posted by prosciencemum 

I think no actually. Although I think it's reasonable to segregate them from the normal well child check waiting rooms.
For me the pro argument would be about trust. If you dont trust your doctor to have your best interests at heart, and you can't come to agreement over treatment/preventative measures, then there's probably a deeper problem. I can potentially agree with a doctor refusing to continue to treat someone who repeatedly rejects their medical advice..... But thats bigger than just refusing vaccines.
Of course this is a real concern of privilege too. Many people have no choice over a doctor who could/would treat them.

Would you be ok with segregating immune children from the non-immune based on mandated titer testing?

I would hope you mean to separate the subsets to protect the non-vaccinated, right? But such a thing would only further myths associated with vaccine free children and their capacity to spread disease. Without blood tests, no one can tell which children might spread illness, vaccinated or not, and separating kids out based on shot status would promote an atmosphere of ignorant discrimination.

[kathymuggle]

Originally Posted by chickabiddy 

I don't think I agree with that.  I don't think doctors in rural/isolated areas should have less control over their practices.

Who should have more rights - a doctor to see only patients they want or a child to health care?  That is what it might come down to in rural and isolated areas.

[MamaMunchkin]

I'm not familiar with the law  ... is it ok for a doctor to refuse treating a patient for any reason whatsoever - based on, say, color, religion, race, sexual orientation, gender, age etc?  Is there anything in the federal or state level?

Edited by MamaMunchkin - 9/30/12 at 8:46pm

[Jennyanydots]

Refusing to see any non vaxxing patients is not the same as dismissing a problem patient. Some non vax patients may be problems, sure, and some may be taking unreasonable risks (for argument's sake if a hepb + mom refused to vax her newborn against the dr's advice), but not every parent questioning vaccines presents such a difficulty that a pediatrician can't continue to work with that family. If this were a case of occasional individual discretion rather than blanket policies for denying care, that would be one thing, but it's not. We're talking about a political decision by many drs en masse to deny care to a subset of parents who want better information before we trust then to administer a prophylactic drug treatment with real risks to our children's health. Whatever you decide for your family with respect to vaccinating, you can probably admit that concern over these drugs is not unreasonable. If it is reasonable to question them, you will likely find reasonable people making different decisions.

This is not simply a bunch of doctors across the country standing on their professional integrity in refusing to see people who disregard medical advice, it is organized coercion. It is political. Whether it is spurred by pharmaceutical propaganda, contingent insurance reimbursements, loss of revenue from well baby visits scheduled by the cdc's vax schedule, or the systemic arrogance of doctors who bristle at having their recommendations questioned, it is not ok.

[pek64]

Originally Posted by chickabiddy 

Doctors can terminate relationships if patients are "non-compliant" with recommendations.  I think that's fair.  Patients can certainly terminate professional relationships if they disagree with the doctors.

Patients can be terminated for not following recommended *treatment*. Vaccinations are *not* treatment (unless you are going to consider good health to be an adverse condition). Therefore, they have no cause for terminating the relationship.

[emmy526]

Aren't vaccinations considered to be 'prophylactic treatment'?  

Originally Posted by pek64 


Patients can be terminated for not following recommended *treatment*. Vaccinations are *not* treatment (unless you are going to consider good health to be an adverse condition). Therefore, they have no cause for terminating the relationship.

[WildKingdom]

Originally Posted by Jennyanydots 

Refusing to see any non vaxxing patients is not the same as dismissing a problem patient. Some non vax patients may be problems, sure, and some may be taking unreasonable risks (for argument's sake if a hepb + mom refused to vax her newborn against the dr's advice), but not every parent questioning vaccines presents such a difficulty that a pediatrician can't continue to work with that family. If this were a case of occasional individual discretion rather than blanket policies for denying care, that would be one thing, but it's not. We're talking about a political decision by many drs en masse to deny care to a subset of parents who want better information before we trust then to administer a prophylactic drug treatment with real risks to our children's health. Whatever you decide for your family with respect to vaccinating, you can probably admit that concern over these drugs is not unreasonable. If it is reasonable to question them, you will likely find reasonable people making different decisions.
This is not simply a bunch of doctors across the country standing on their professional integrity in refusing to see people who disregard medical advice, it is organized coercion. It is political. Whether it is spurred by pharmaceutical propaganda, contingent insurance reimbursements, loss of revenue from well baby visits scheduled by the cdc's vax schedule, or the systemic arrogance of doctors who bristle at having their recommendations questioned, it is not ok.

I disagree. The political lobby group for pediatricians is the AAP. Their stance is that doctors should not discharge based on vaccination status.

[pek64]

Originally Posted by emmy526 

Aren't vaccinations considered to be 'prophylactic treatment'?  

Technically, so are birth control pills. There has to be a line drawn somewhere. I think all preventative care should belong together and be at the patient or guardian discretion.

[Mirzam]

Open letter to pediatricians - Legal and Ethical Ramifications of Refusing to Treat Unvaccinated Children

[Taximom5]

Originally Posted by Mirzam 

Open letter to pediatricians - Legal and Ethical Ramifications of Refusing to Treat Unvaccinated Children

That is so good, I am starting a thread with it!

[prosciencemum]

Originally Posted by Turquesa 

It's interesting that your quote focuses on children. Do you feel that adults who are not "up-to-date" on their vaccines should sit in that same room?

Originally Posted by prosciencemum 

I think no actually. Although I think it's reasonable to segregate them from the normal well child check waiting rooms.

 

Do adults have well checks. Oh I guess maybe they do in the US. In the UK we only see Doctors as adults if we're sick..... 

And now I think of it this would be really hard to implement. So maybe it's stupid anyway.....  :) 

[kathymuggle]

A large percentage of adults do not get their tetanus and pertussis booster, and many do not get the flu vax.

A decent number of kids are undervaxxed.

The only people being kicked out for non-compliance are those whose parents declare themselves as non-vax or sel/delayed.

This is not about vaccines and VPD's ( if it was, most adults and many kids would be kicked out of practices).  It is about the fact that some hcp don't like their opinions and recommendations being questionned.  

[emma1325]

Originally Posted by kathymuggle 

A large percentage of adults do not get their tetanus and pertussis booster, and many do not get the flu vax.

A decent number of kids are undervaxxed.

The only people being kicked out for non-compliance are those whose parents declare themselves as non-vax or sel/delayed.

This is not about vaccines and VPD's ( if it was, most adults and many kids would be kicked out of practices).  It is about the fact that some hcp don't like their opinions and recommendations being questionned.  

In other words, it's a pissing contest.

[erigeron]

I do think doctors should be able to terminate professional relationships if they deem it necessary... if the patient is persistently noncompliant, the doctor needs to be able to, at some point, stop accepting responsibility for a patient who won't listen to them or work with them. Assuming that non-vaxing patients/parents are otherwise paying about as much attention to their doctor as the average patient, this would not necessarily apply.

But on the other hand, if you do not vax, do you really want to be treated by a doctor who would love to dismiss you from their practice for not vaxing and is only seeing you because some rule or regulation is compelling them to? (Assuming such a rule or regulation could be drafted.) Doctors probably shouldn't refuse patients on the basis of vax status. But that's just a signal that the ones who do are probably doctors most of us would want to avoid. 

I think there is some sort of rule that a doctor can't completely drop a patient, they have to provide 30 days notice so the patient has time to find care elsewhere. If there is truly no other primary care doctor within a certain radius, I wonder if this rule would come to bear and force doctors in small isolated communities to accept all patients... anyone?

I don't think this is analogous to a pharmacist conscience clause, though, which is a refusal on moral grounds. Whereas an insistence on vaccines is on medical grounds (however much an individual may agree with said medical grounds). As a pharmacist myself, I'm adamantly opposed to conscience clauses and think they're destroying our profession. As a health care provider, I don't think doctors *should* refuse patients based on vax status, all other factors being equal. But I don't think that forcing doctors to accept particular patients would be productive either. That's different with pharmacists too, because there's a qualitatively different patient relationship between me selling a patient Plan B one time and a primary care doctor seeing a patient for years. Pharmacies do fire patients sometimes (all the instances I've encountered are either for being persistently very rude to the staff or for persistently abusing narcotics).

Obviously this is about primary care providers. I don't think it should come to play with acute care or specialty providers at all.