Pediatric Vaccines: What Can You Do When Parents Refuse to Vaccinate?

Nothing is more troubling to a practitioner than when a parent makes a decision that could jeopardize their child’s health, such as vaccination refusal. Ultimately, the parent has a right to refuse any medical intervention or treatment for their child, including a vaccine. Their decision, however, may conflict with a pediatrician’s advice. 

Policyholders who treat pediatric patients often ask if they can either refuse to treat an unvaccinated patient or discharge a patient whose parents refuse to vaccinate them. 

The American Medical Association advises that:

A physician should not refuse a patient simply because the individual is not vaccinated or declines to be vaccinated…Nor may a physician ethically turn a patient away based solely on the infectious disease status, or for any reason that would constitute discrimination against a class or category of patients. 

However, the strength of a physician’s obligation to treat may vary under different circumstances, and determining whether, in a particular instance, a physician may ethically decline a patient requires careful reflection. In the context of a highly transmissible disease that poses significant risk of severe illness for which a safe, effective vaccine is available, the decision to accept or decline a patient must balance the urgency of the individual patient’s need; the risk the patient may pose to other patients in the physician’s practice; and the need for the physician and staff, to be available to provide care in the future.

In its Strategies for Improving Vaccine Communication and Uptake report, the American Academy of Pediatrics (AAP) discusses the impact of pediatric practice policies to discharge patients from the practice when parents refuse or delay vaccinations. The report calls attention to results of a national survey in which “51% of pediatricians have reported that their office had a policy to dismiss families if they refuse vaccines in the primary series for their children” and 46% have reported policies to not accept “new patients whose parents do not agree to give their children all vaccines according to the recommended schedule.” The AAP presents ethical arguments for and against creating such policies. The report recommends that when considering discharge of a patient whose parent refuses vaccinations, “verify that less drastic alternatives are not feasible and work to minimize potential negative impacts on the child.”
 

Risk Recommendations

 

Be Vigilant When Parents Refuse Vaccinations

Educate parents who refuse vaccinations for their child, utilizing health literacy principles such as plain language and teach-back. Address any questions parents may have. Try to understand their perspective and reasons for vaccine refusal or hesitancy and strive to dispel myths, if possible.

• Continue to educate parents who decline vaccinations at every visit.
• Consider providing parents Why Vaccinate information developed by the Centers for Disease Control and Prevention (CDC).
• Document the counseling and education the parent received along with the parent’s response.

Conduct an informed refusal discussion if the parents still choose to not vaccinate their child. Document this discussion and the educational materials provided to the parents in the medical record. 

• Inform parents about clinical presentations of vaccine-preventable diseases, including early symptoms and steps to take if the parent identifies these symptoms.
• Continue to conduct and document informed refusal discussions with parents when vaccines are offered and declined. 
• Consider utilizing the AAP’s refusal to vaccinate form. 

Know when minors may consent to care. Recognize that some states allow minors who have a certain status or who have reached a certain age to consent to immunizations. Educate minors who may consent on the importance of vaccinations. 
 

Be Cautious With Unvaccinated Patients

Implement precautions when an unvaccinated child presents to the healthcare organization to prevent contact with other patients. 

• Consult with an infection prevention professional to determine how best to implement precautions in your organization, such as having unvaccinated patients enter through a separate door and/or go to a separate room. 

Keep unvaccinated patients safe. Consider following guidance from the CDC’s Talking with Parents about Vaccines for Infants.

• Remind parents to call before bringing in an unvaccinated child so healthcare professionals can take precautions. 

Consider Policy Development

Think carefully about whether to develop a policy for discharging or screening out patients whose parents refuse vaccines. 

• Consult an attorney who knows your state rules and regulations and nuances in your region. 

Be consistent and communicate the policy if you do develop a policy for discharging or screening out patients. 

• Train staff to ensure consistency with policy. 

Be prepared for social media backlash. Recognize that parents may be upset with a policy to discharge or screen out patients. Know how to handle negative posts. 

Recognize limitations to discharge. Evaluate each relationship on a case-by-case basis to determine whether discharge is appropriate. Consider the patient’s underlying state of health, severity of the disease process, prognosis, and course of treatment, in addition to the availability of comparable medical care. 

• Review Best Practices for Patient Discharge.
• Discharge the patient correctly, including checking with health plan contracts prior to discharge.

Resources

CDC

• Pregnancy and Whooping Cough: Surround Babies with Protection
• Provider Resources for Vaccine Conversations with Parents