Dr. Katie Noorbakhsh compares the ethics of not hiring smokers (covered here on The PediaBlog) to the ethics of pediatric practices not accepting parents who refuse vaccinations for their children:
The problem with ultimatums is that they do not really work. Unless the goal is to drive people away. Then, yes, they work. If you are trying to encourage people to make positive changes, they are less effective. Ultimatums communicate that the deliverer only cares about those individuals who agree with him. As health professionals and health advocates, we are supposed to care about everyone. Even the nicotine addicts and the misinformed non-vaccinators.
Pediatricians can, and should, be persuasive when it comes to smoking cessation, no antibiotics for viruses, gun safety, vaccines, and many more issues where science and reason is on our side. But Noorbakhsh reminds us that persuasion takes time:
People deserve to hear the truth, but telling them once – no matter how carefully worded and compassionately delivered – is unlikely to lead to lasting changes. Our advocacy is not in a vacuum. The changes we endorse compete with years of habit, financial limitations, social stressors and conflicting advice dispensed by caring neighbors, grandparents, and the internet.
Not accepting unvaccinated patients often sends the wrong message:
The message had been misinterpreted. Instead of “Vaccines are a very important thing that pediatricians care about,” she heard “Vaccines are the only thing pediatricians care about.” Because the conversation had been ended, there was no opportunity to correct this misconception. Additionally, this mother no longer had the opportunity to be reminded that vaccines save lives from a doctor she had known and trusted for years.
At a recent prenatal “Baby Basics” class I hosted, one expectant mother wanted to know if we accepted families who didn’t vaccinate their children. I replied that we still did because children shouldn’t be punished for their parent’s decisions — unwise, misinformed, and dangerous as they may be. I told this mom that these children need well-trained pediatricians who can recognize and treat childhood diseases that, so common and deadly a few short years ago, are relatively rare now.
The mother seemed satisfied with my response, but I wasn’t, so I continued on. I apologized to the other parents in the room that this was still our policy. I informed them that their children will always be exposed to dangerous diseases by the few who refuse to vaccinate. Unfortunately, that includes the possibility of being exposed in my office where these susceptable kids are seen.
We try our hardest to make sure our offices are as safe as can be for children and their families. I admit that I often resent the selfishness of parents who don’t vaccinate in this regard because they are putting not only their children, but other children (including my children), parents and grandparents, my staff, and me in significant danger.
Pediatricians see the debris field every day in practice: pertussis (whooping cough) in children that are already vaccinated (and those who aren’t); chickenpox in children who aren’t vaccinated (why, in this day and age of MRSA, would parents refuse chickenpox vaccine?); genital warts and oral cancer in those who refuse vaccines for the prevention of HPV (human papilloma virus); influenza (remember the vaccine is not 100% effective and it kills people — 105 children in the U.S. this season alone, so far — who don’t vaccinate). The bacteria and viruses that cause these infections don’t appear out of thin air. They are acquired — from people who are sick — and often these people are undervaccinated or not vaccinated at all.
We try to teach kids that their decisions have consequences that often affect more than themselves. Is this lesson dropped on the doorstep of adulthood? When do people forget the lessons of science, or their responsibilities to others, or the Golden Rule? At what age do we lose the forest for the trees?
The real reason why ultimatums don’t work is that, for many (legitimate) reasons — religion, race, economic status, political ideology, educational level, personal experiences — we’ll all never see eye-to-eye on everything.
It is, after all, a free country. And this is, after all, only my opinion.