Get Vaccinated or Else (Yay! or Boo!)
When I first read " 'Vaccinate your child or find another doctor,' U.S. medical practitioner tells parents" on Daily Mail Online, I cheered. Chalk another one up for folks who stand up to dangerous dopes! (See also Christie, Chris and Walker, Scott.)
Andrew Lieber, a paediatrician with Rose Paediatrics in Denver, tries to convince his clients to see the benefits of immunisation but if they still refuse he takes a very hard line.
'By four months, if I can't help you come to terms with the scientific fact that vaccines are helpful, then I've done about all I can do to educate you,' he told MedPage Today.
'I feel like I have a bigger responsibility to all the other kids walking through my waiting room.'
Dr Lieber said he has to turn people away because of the vaccination issue a couple of times a year.
But then I paused for a second. Dr. Lieber's choice certainly punishes the moms and dads who bought a bill of goods, but it punishes, perhaps tragically, the innocent children. They didn't opt out of vaccines. They didn't choose to open themselves up to measles, mumps or rubella.
What should an ethical doctor do?
Thinking about it another way, if a doctor said to you, "Do X or leave my practice" would you cave? Or would you move on, angry and resentful, willing to go to a less reputable or unproven doctor for your principles? If a doctor said, for example, "Lose 50 lbs or leave my practice" how would you react? Some could say you, the overweight patient, are part of a cult of "fat." Clueless. Brainwashed by high fructose corn syrup. After all, science seems to prove that carrying around an extra 50 lbs can be fatal in any number of preventable ways. Kind of like walking around without being vaccinated.
Fair analogy? What's ethical?
- Comment (61)
- · Quote
- · UnfollowFollow (2)
Comments :
Oct '10
Re: Get Vaccinated or Else (Yay! or Boo!)
Businesses can refuse service to customers. Same with doctors. We need to stop thinking in terms of magical idealism that health care is "different" than any other product or service.
No shirt, no shoes, (no vaccinations), no service.
Edited on Mar 7, 2011 at 10:49amRe: Get Vaccinated or Else (Yay! or Boo!)
Ken Sweeney: Businesses can refuse service to customers. Same with doctors. We need to stop thinking in terms of magical idealism that health care is "different" than any other product or service.
No shirt, no shoes, (no vaccinations), no service. · Mar 7 at 10:48am
Edited on Mar 07 at 10:49 am
I have no magical idealism. Yet I think there is something different in doctors. It's not a pure profit motive, in most cases. There's an ethical component that they (and patients) take seriously. Most of the time.
May '10
Re: Get Vaccinated or Else (Yay! or Boo!)
At some point though, the client is not following through. The outcome will be bad, or could be. As the therapist, I can "fire" a client. If someone does not want to do the work of therapy to get better, then it is more ethical to stop taking their money since they won't get better.
May '10
Re: Get Vaccinated or Else (Yay! or Boo!)
I think more market-oriented behavior in healthcare is a healthy development (*groan*). Yes it's a sacred trust, but if every pediatrician took such a principled stand, perhaps this would not be such a problem. I am firmly in the "yay" camp.
Dec '10
Re: Get Vaccinated or Else (Yay! or Boo!)
I have a question: If the good doctor is actively keeping unvaccinated children out of his office, who is it that he's protecting?
Vaccinated kids are not at risk, or if they are, what kind of vaccination is he pushing?
Sep '10
Re: Get Vaccinated or Else (Yay! or Boo!)
Now, does the Doctor inform the patient that there is a guarantee from the manufacturer of the vaccine that no tissue from aborted babies went into it so they can exercise freedom of conscience and either find another doctor or select a vaccine that wasn't derived that way if they have moral objections? The existence of this derivation is available from the Physician's Desk Reference, so its not exactly an onerous requirement.
Sep '10
Re: Get Vaccinated or Else (Yay! or Boo!)
Jun '10
Re: Get Vaccinated or Else (Yay! or Boo!)
"It's not a pure profit motive, in most cases."
I can't think of many careers that are undertaken for a pure profit motive by everyone who enters the field. Medicine isn't a field populated by saintly folk any more than law or teaching or engineering. And most people I know, reagardless of their field, approach their jobs with a strong commitment to practice ethically. I agree with Ken. The elevation of doctors in our society led to many abuses and unchecked practices. It was the need to reform much of that which helped feed the instense, intrusive government interference & ultimately gave us ObamaCare.
Many doctors are primarily motivated by profit -- believe me, I've met many who fit this description. However, this pediatrician is behaving like a true professional. He has no authority to vaccinate a child against the will of the parents so he is not punishing the child at all. He is protecting both his other patients, his staff, and his own paractice & family. A granola-type doc can certainly be found who buys into the anti-vaccination hype.
Jun '10
Re: Get Vaccinated or Else (Yay! or Boo!)
"Vaccinated kids are not at risk, or if they are, what kind of vaccination is he pushing?"
Kids receive their vaccinations in a series of many doses/boosters stretched out over a period of years. So yes, a child who is on track and diligently keeping up the proper schedule can still be susceptible to diseases that are carried by unvaccinated kids. Particularly infants. Staff memeber, too, can be affected. A child with active chicken pox can triger a case of shingles in an adult. Parents & grandparents in the waiting room with compromised immune systems are also at risk.
Good for the doc.
May '10
Re: Get Vaccinated or Else (Yay! or Boo!)
Ursula Hennessey: If a doctor said, for example, "Lose 50 lbs or leave my practice" how would you react? ....
Fair analogy?
Yes, that's a fair analogy. This doctor is within his rights, but he's a fool. No one will be helped by his refusal.
Oct '10
Re: Get Vaccinated or Else (Yay! or Boo!)
Ursula Hennessey
Ken Sweeney: Businesses can refuse service to customers. Same with doctors. We need to stop thinking in terms of magical idealism that health care is "different" than any other product or service.
No shirt, no shoes, (no vaccinations), no service. · Mar 7 at 10:48am
Edited on Mar 07 at 10:49 am
I have no magical idealism. Yet I think there is something different in doctors. It's not a pure profit motive, in most cases. There's an ethical component that they (and patients) take seriously. Most of the time. · Mar 7 at 11:01am
"First do no harm" is the primary ethic of doctors. If, through inaction, these parents are doing harm, what is the ethic of treating them? There are plenty of doctors around. Let them go somewhere else. Sometimes people use ethics has a constraint in behavior, rather than liberating them to do what is right. Just as doctors should not be made to perform abortions, or pharmacists made to issue the abortion pill, why do you think this doctor's ethics should compel him to treat these people?
Dec '10
Re: Get Vaccinated or Else (Yay! or Boo!)
StickerShock at #9 is right. In addition, some childhood vaccinations lose their effectiveness over the years, leaving adults unprotected.
Above the direct risks, unvaccinated children are biological hosts that allow virulent diseases to remain endemic in the general population.
May '10
Re: Get Vaccinated or Else (Yay! or Boo!)
In my state parenst must present a complete vaccination record to enroll their children in public school. So if parents refuse them I hope they are fully prepared to home school their child.
Dec '10
Re: Get Vaccinated or Else (Yay! or Boo!)
Ursula Hennessey
I have no magical idealism. Yet I think there is something different in doctors. It's not a pure profit motive, in most cases. There's an ethical component that they (and patients) take seriously. Most of the time. · Mar 7 at 11:01am
We have the expression "doctor's orders," but in fact physicians do not have the authority to force patients to comply with their professional advice. Indeed, if you leave a hospital without undergoing prescribed treatment, the hospital requires you to sign a form saying you are leaving "against medical advice."
There is no ethical mandate for physicians to keep dropping sound medical advice on deaf ears. There is an ethical argument that the physician's duty is to turn his attention to patients whom he can treat effectively rather than lecture impotently.
And why would parents who think vaccines are bad or useless for their children want to consult a physician who disagrees with them on that fundamental question?
Re: Get Vaccinated or Else (Yay! or Boo!)
StickerShock: "It's not a pure profit motive, in most cases."
I can't think of many careers that are undertaken for a pure profit motive by everyone who enters the field. Medicine isn't a field populated by saintly folk any more than law or teaching or engineering. And most people I know, reagardless of their field, approach their jobs with a strong commitment to practice ethically.
I'm not sure I agree with this. I know that many doctors are motivated completely by their work, not at all by pay. I would say that about many teachers, too. Not all, obviously. But doctors, especially, since life and death are in their hands, consider more than just job environment + pay + fulfillment, which I would guess is most people's trio of considerations, perhaps not in that order. I don't think doctors are saints. However, I would say they deal with events and actions that are of a more saintly nature than, say, lawyers. I would say that ethics and consideration of the welfare of others comes into the daily life of doctors more than most professions.
Re: Get Vaccinated or Else (Yay! or Boo!)
Stuart Creque
There is no ethical mandate for physicians to keep dropping sound medical advice on deaf ears. There is an ethical argument that the physician's duty is to turn his attention to patients whom he can treat effectively rather than lecture impotently.
And why would parents who think vaccines are bad or useless for their children want to consult a physician who disagrees with them on that fundamental question? · Mar 7 at 11:58am
Yes, Stuart, I agree. This gets at the heart of the matter.
Dec '10
Re: Get Vaccinated or Else (Yay! or Boo!)
This reminds me of a joke involving a glass eye, a proctologist, and the punch line, "Mr. Smith, if you can't show me a basic level of trust, I can't conduct this examination!"
If a doctor can't trust a patient to follow his advice and a patient doesn't trust the doctor's advice enough to follow it, they should part ways.
May '10
Re: Get Vaccinated or Else (Yay! or Boo!)
Since when did medical care become a positive right? I think the unspoken assumption here is the same one that leads Congress to mandate free access to our emergency rooms and best hospitals by uninsured individuals and families who are often here illegally. And in turn, this is the same impulse that leads us to spend billions of dollars trying to move the educational needle on low-potential kids while neglecting excellent students from whom the returns would be orders of magnitude greater. Everyone doesn't "deserve" the same level of care and attention. We earn it by the choices we make every day, the ways in which our personal priorities affect how we allocate our finite resources. This is true in medicine, and it's true in education.
Doctors are a finite resource. They should be permitted to spend their time on patients who are willing to follow their guidance. If this doctor shocks a few parents into getting over their voodoo science, he could save the lives of their kids and maybe some of the people they would otherwise infect. If not, at least his waiting room will be safer, and his overall outcomes will be better.
Mar '11
Re: Get Vaccinated or Else (Yay! or Boo!)
Losing 50 lbs isn't as easy as receiving a shot. People can struggle their whole lives with their weight without buying in to' a cult of fat' (which would be a great band name, by the way). As others have said, I think it's fair to turn away patients if they refuse to follow your advice, but I also share your misgivings.
Ursula Hennessey I have no magical idealism. Yet I think there is something different in doctors. It's not a pure profit motive, in most cases. There's an ethical component that they (and patients) take seriously. Most of the time. · Mar 7 at 11:01am
I know quite a few physicians, and I agree with you. Everyone is motivated by the bottom line to some extent, but if making money is your sole motive, then becoming a physician is a tactical error. Many physicians are motivated by the intellectual challenge, the desire to do something meaningful, and (yes) to help people. Of course, that doesn't mean that they don't want (or deserve) to be paid well.
Oct '10
Re: Get Vaccinated or Else (Yay! or Boo!)
I don't see the slightest difference in choosing a physician than selecting any other service provider, except that the stakes are higher compared to choosing an indolent or incompetent plumber or auto mechanic. As with most things involving human performance, I suspect the quality of medical care provided by doctors follows a power law rather than Gaussian distribution, and that the outliers are not priced according to their performance, which means that identifying one, while requiring substantial research, may actually be a bargain.
The outlier physician is more likely to be selective in the patients he or she takes on, both due to demand but also because people motivated to produce good outcomes have little interest in working with those who will not follow their advice or treatment regimes.
In selecting professionals in all fields, I've found a useful heuristic is to ask, “Who do the smartest people I know use?”