Physicians can be put in difficult situations when parents refuse immunizations

I read with interest the Ethics Forum reply by Erin Flanagan-Klygis, MD, on counseling patients who refuse immunizations for their children (Column, Jan. 5): While her advice to pediatricians was appropriate and accurate, I feel that three important points were not mentioned.

First, if a parent refuses immunizations, one of the most important and effective preventive measures in medicine, what else will they refuse? Will they follow your advice on a future recommendation for a life-saving procedure or medication? Will they refuse hospitalization for an illness that is serious? Where does a parent's right to choose medical care for their child versus the issue of child neglect (refusing a known, safe, intervention such as immunization) come into play?

Second, where does our liability fall with respect to "failure to immunize"? While polio is gone from the Americas, and one could make the argument to not immunize against this disease, the same doesn't hold for tetanus or Haemophilus diseases, which are not going to "go away."

I fear more liability from a family suing for failing to immunize than from any risk of a lawsuit from side effects of the vaccines themselves. Therefore, I would seriously consider discharging the patient from my practice, in contrast to Dr. Flanagan-Klygis' advice. While having the parents sign a waiver sounds nice, and may offer some protection for the physician, I'm sure that at some point this will be challenged by the clever plaintiff attorneys.

Third, it is amazing how quickly news travels. I have an acquaintance in practice who has a family who has refused immunizations. The word got around, and now more and more families who don't want their kids immunized are seeing him, because of his implied approval of this action.

I agree with the advice given: to be proactive, resourceful, flexible, respectful, and to have resolve. But there are other issues that need to be considered.

Albert G. Karam, MD, Dallas

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/03/01/edlt0301.htm.