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Posted on May 15, 2019 at 8:58 AM
Steve Phillips

Last week I wrote about the issue of parental responsibility
and medical decision-making for children. We have good reasons for having
parents be the primary decision makers for children who are not capable of
making their own medical decisions. However, as I discussed in the last post,
there are some situations in which parents make decisions that are not in the
best interest of their child. When those decisions reach the point at which the
child’s life is in danger, society clearly has a moral obligation to intervene
to save the life of the child.

Parental refusal of recommended immunizations for their
children raises similar issues but is more complex. We can clearly demonstrate
that it is in a child’s best interest to receive at least most of the commonly
recommended immunizations for children. Those immunizations help to prevent a
child being affected by diseases that can be serious and have a very low risk
for serious adverse effects. However, the chance of an individual child being
affected by many of these diseases is relatively small and the situation is
quite different from a child whose life is in immediate danger due to a
parental refusal of treatment. Since the risk to an individual child is
relatively small and there is some possible risk to the child from receiving
the immunization, it is not clear that a parent who refuses immunizations for a
child is being negligent in the same way as a parent who refuses treatment for
a life-threatening illness. It can be argued that the best way to deal with
this type of situation is education. Many times, parents refuse immunizations
for their children because of misconceptions about the risks and a lack of
understanding of the benefits of doing the immunizations. It can be difficult
to counter widespread misconceptions, but physicians have the responsibility of
trying to do that the best that we can. However, this is not the only issue
involved in determining whether society has an obligation to intervene and
mandate childhood immunizations when parents refuse.

Immunizations are unique in the way that they work. They
help protect the individual who is immunized, but they also help protect the
community as a whole when we can achieve sufficient levels of immunity to halt
the spread of an infectious disease within the community. This is sometimes
called herd immunity. We have an excellent example of how this works with the
current measles outbreak in the United States. Measles happens to be one of the
most easily transmittable infectious diseases that we know of. It also can be
deadly in a small percentage of the people who acquire the disease. It is also
primarily a disease of children and is transmitted by children. When about 97%
of children have been immunized in a community the disease will not be
transmitted through that community and those who have not been immunized or
cannot be immunized are protected from acquiring the disease. This level of
immunity was accomplished in the United States about 20 years ago and for some
time the only cases of measles that were seen in the United States were cases
that originated elsewhere. However, because of parents refusing to have their
children immunized for measles in significant numbers in some parts of the
country, herd immunity is no longer present and we are having outbreaks of
measles this year that are more than we have seen in 20 years.

That raises a different question. Should we mandate
immunization of children for diseases such as measles and override parental
decision-making not solely for the benefit of the children whose parents refuse
to have them immunized but for the common good of the community? There are some
children and other individuals who cannot be immunized or for whom
immunizations would not be effective who are put at increased risk when herd
immunity is not achieved in the community. This makes the decision about
whether to immunize a child not just a decision about what is best for that
child but also a decision about what is best for the community. For Christian
parent it makes the decision about whether to immunize a child a decision about
love of neighbor. Immunizing one’s own child helps to protect the child, but it
also helps to protect the most vulnerable in the community. If we truly love
our neighbor, we should do that even if there is a small risk to our own child.
The final question is whether we as a society should require children to be
immunized for these diseases when a parent is not willing to authorize it out
of either concern for the best interest of the child or concern for those who
are vulnerable in the community.

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