In this month’s Ethics Rounds in Pediatrics, Dr. Rebecca Rossi and her coauthors present an unusual case that raises the question of when does vaccine refusal constitute medical neglect (10.1542/peds.2020-0768)?
Vaccination can be viewed as a public health or a clinical intervention. As a public health intervention, one goal of vaccination is to reduce transmission and, in turn, the government can use its powers to require vaccination to protect others. As a clinical intervention, the goal is to promote the individual’s own interests by preventing them from contracting a vaccine preventable illness. While the government can use its jurisdiction as parens patriae to require treatment in cases of medical neglect, vaccine refusal does not usually constitute medical neglect. Un- or under-vaccinated children are not at an imminent risk of death or serious disability.
Rossi et al present a case in which a child’s chronic health condition substantially changes the risk of being inadequately vaccinated. The child is a 2-year-old, partially vaccinated boy with sickle cell disease requiring chronic transfusion therapy. He has developed recurrent splenic sequestration and his providers recommend a splenectomy. His parents agree to the splenectomy but adamantly refuse preoperative vaccination against gram-positive encapsulated organisms. His providers are also concerned that the boy’s parents are nonadherent with his antibiotic prophylaxis. The boy is therefore at substantially higher risk of overwhelming post-splenectomy infection.
How high would this risk need to be to refer his parents to child protective services or rescind the recommendation of a splenectomy? Link on this month’s Ethics Rounds to read Rossi et al’s analysis and recommendations and see if you agree.
