We unfortunately have a growing anti-vaccine movement in this country. Last night I participated in a heated discussion with a group of medical students. The expressed outrage at parents who refused to vaccinate their children.
For the first 30 years of my medical career I never saw or heard of a patient having pertussis. Today pertussis represents a serious problem in our society and is the only vaccine preventable disease showing an increasing mortality in the U.S. Pertussis mortality is increasing because we are losing "herd immunity."
Vaccination nihilists disbelieve scientific data. They have accepted a superstitious belief that vaccinations endanger their children, despite all the data proving vaccination safety and effectiveness.
This stance leaves us with a most challenging ethical dilemma. The decision to refuse treatment as an adult represents autonomy, but what about the children. Children cannot decide for themselves. Do parents have the right to endanger their children?
Even worse, we must ask whether they have the right to endanger others.
We do not let patients with TB have the freedom to infect others. We try to isolate many infectious diseases.
So now imagine a pediatrician's office. Some of the patients have received vaccination, while some have not. Some have not yet had their vaccination, and some have had their vaccination immunity become inactive (immunity only lasts for 5-10 years after vaccination, and some have argued that it may only last 3-6 years).
When a parent's decision puts their child at risk, and others at risk, how do we handle that decision.
Our students expressed great angst over their problem. What do you think?
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.
