Docs 'firing' patients for refusing to be vaccinated? What say you...

[DwayneEMTP]

This is an article about doctors pediatricians refusing to see patient's any further if they have chosen to remain unvaccinated secondary to autism or other possible side effect fears.

For the record, to perhaps help keep things on track, the vaccination/autism link has been well and thoroughly debunked to the satisfaction of most of us in that community.

http://www.kxlh.com/news/doctors-fire-patients-who-refuse-vaccines-for-their-children-ethical-/

[ERDoc]

Yup, it happens quite a bit. Just like you don't have to go to a doctor you don't agree with, a doctor doesn't have to continue to care for a pt they don't agree with. Doctors are under no obligation to take care of someone (except ER doctors because we are just that awesome).

[Kiwiology]

I cannot agree with this; in fact I am aghast and feel quite ill at the notion that a Physician would (or is even allowed to) refuse to see a patient because of something like this.

A competent patient (or their parent or guardian) has the right to refuse treatment (including vaccines and life saving treatment) until proven incompetent and subject to a Compulsory Treatment Order under the Mental Health Act and I dare say the equivalent flavour exists in your respective jurisdiction, hell hole or other such locality as may be expressed from time to time, batteries not included, no refunds, large is an extra $1 and not valid on Sunday.

The Medical Council of New Zealand, the Royal New Zealand College of General Practitioners, the Health and Disability Commissioner, the Health Practitioners Disciplinary Tribunal, the College of Kiwiologists and the Centre for the Advancement of Kiwiology in Medicine (1) have all agreed that a doctor-patient relationship may only be ended by the Physician if they are incompetent to treat the patient.

General Medical Council of the United Kingdom in Good Medical Practice (2,3) also states it is ethical only end a relationship with a patient when doctor-patient trust has been broken and only then in rare circumstances, specifically citing theft, assault or violence as specific appropriate examples; it goes to to specifically state that a patient must not be denied access to medical care or discriminated against based on their religion or beliefs.

Doctors' and Patients' Rights and Responsibilities as published by the South African Medical Association (4) also takes the same view; that a doctor has the right to choose their patients but must not discriminate against or decline medical care to a patient because their beliefs differ from their own and that a patient has the right to refuse any treatment if competent.

The Code of Ethics of the American Medical Association (5,6) supports the view taken by the funny-talking, national regulators mentioned previously. Specifically it states a patient may refuse any recommended health-care or treatment but here is where it gets interesting! It states that a physician has a right to end a doctor-patient relationship and does not specify the same cautionary notes as others.

The Australian Medical Council and the Canadian Medical Association both in their respecitve Codes of Ethics (7,8) have the same view; that the patient can refuse any treatment or care, the doctor must respect the patients wishes but can also exercise the right to cease being that patients' physician if a suitable alternate is arranged; the Canadian document warns such termination must be for a "legitimate" reason.

I am not arguing that a Physician should be able to end the relationship with a patient if it is truly necessary for reasons the UK GMC specifies and those like it i.e. assault, theft from the practice or clinic, if the patient is being threatening or if the doctor is retiring etc. Canada warns that such termination again must be "legitimate" and the natural test of such interpretation will come down to the disciplinary bodies or perhaps an additional civil suit in the US and a reasonable person, and indeed a reasonable Physician or at least all the ones I know, would say the reason "Little Molly's mommy didn't want her vaccinated" is not legitimate.

Sorry Doc I have to disagree with you on this one, now excuse me while I nick off to the Resident Medical Officer lounge to eat the House Surgeons lunch, he died from fatigue and will not be requiring it

(1) http://www.mcnz.org.nz/portals/0/publications/2011%20-%20Ending%20a%20Relationship.pdf

(2) http://www.gmc-uk.org/guidance/good_medical_practice/good_clinical_care_decisions_about_access.asp

(3) http://www.gmc-uk.org/guidance/good_medical_practice/relationships_with_patients_ending_relationships.asp

(4) http://www.samedical.org/patients-corner/doctors-and-patients-rights-and-responsibilities.html

(5) http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion1001.page?

(6) https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fE-8.115.HTM

(7) http://ama.com.au/codeofethics

(8) http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf

[chbare]

I can choose to go to a certain physician and a physician can choose to provide me a service. Seems to be a simple concept to me. I go to a doctor as a customer seeking a service. The physician can decide not to have me as a customer. Personally, I like being able to choose who best fits me and would appreciate a physician terminating the relationship if he/she had an issue with me. The thought of a system that would force somebody to provide this service in spite of them having personal issues with me is terrifying. The patient/physician relationship should be based on mutual trust and respect. Forcing somebody to care for me violates that basic tenant IMHO.

[Kiwiology]

Personally I ... would appreciate a physician terminating the relationship if he/she had an issue with me.

You are welcome to your opinion and I respect that (unlike Dwayne, he doesn't respect me at all! I had to save him from being beat down by hookers in Las Vegas after he refused to pay citing poor service, jeez! lol) but I would be interested to explore your thoughts some more because this seems to have been carefully covered by various regulatory bodies internationally (as outlined above in my post) that the "issue" must be one of serious nature i.e. patient is violent or abusive or the doctor is no longer capable of providing care for the patient.

The thought of a system that would force somebody to provide this service in spite of them having personal issues with me is terrifying. The patient/physician relationship should be based on mutual trust and respect. Forcing somebody to care for me violates that basic tenant IMHO.

It depends what the issue is and this is where we must carefully balance the right of the patient not to be discriminated against regardless of their opinion or beliefs and their right to choose which treatment they receive vs the right of the physician to freedom of choice of who they have as patients and their rights to end being a patients' physician.

None of the guidance given by the various regulators I have sourced above "forces" a patient on a physician.

Immunisation is a much more political and societally controversial topic than say something like diuretics for hypertension or salbutamol for asthma but none-the-less it is a treatment and the patient or their parent in the case of a paediatric patient has the right to choose whether or not they receive it.

International guidance on ending patient-physician relationships varies from strongly saying it is inappropriate to end it for reasons other than criminal matters or issues of non-competence on part of the physician (UK, SA and NZ) to a bit more liberal view (AU and US); the Canadian Medical Association is in the middle putting in that ending a relationship must be for a "legitimate" reason.

I've worked in a number of service industries often in management, I've offered thousands of customers what I think is best for them based on the evidence at hand, just like a physician does, some people have chosen to decline my recommendation and we still service them regardless. On par with the medical regulatory guidance we could refuse or stop servicing customers but only in extreme situations; drunk, theft, endangering staff etc

A patient may choose not to receive a treatment on other grounds e.g. a moral objection or a religious one, which is the same as them deciding not to get Little Billy vaccinated, should they be treated the same?

Edited February 18, 2012 by kiwimedic

[chbare]

I am afraid I am not compelled to change my stance. If my physician chooses to terminate our relationship based on my refusal to vaccinate my children, all the better. I'm probably better off finding somebody who's views resonate with my own.

Clearly, this contrasts to an emergency physician or on call admitting physician. Accepting patients and providing care unconditionally is part of their job description. Primary care physician on the street corner, not so much.

[Kiwiology]

I'm not trying to change your position, you are perfectly entitled to it and I respect that.

I find your view that it is appropriate for a physician (GP) to terminate their care of a patient based on the patient choosing not to receive care somewhat perplexing but I'm not passing judgement on you for it.

[island emt]

Good for them: Why should they have to accept whiney ass Parents who refuse to follow the accepted norm in preventing childhood disease and potential life threatening diseases.

Not to mention the fact that these unvaccinated kids are more likely to spread these diseases to those with weakened immune systems which could prove fatal to them.

[chbare]

Good for them: Why should they have to accept whiney ass Parents who refuse to follow the accepted norm in preventing childhood disease and potential life threatening diseases.

Not to mention the fact that these unvaccinated kids are more likely to spread these diseases to those with weakened immune systems which could prove fatal to them.

I think it's a bit more complex than "whiney" parents in some cases however.

[Kiwiology]

Good for them: Why should they have to accept whiney ass Parents who refuse to follow the accepted norm in preventing childhood disease and potential life threatening diseases.

Because it is the right of a patient or their parent in the case of a paediatric patient to refuse any treatment or care recommended, including lifesaving treatment?

Because the Physician has a duty of ethics in care towards that patient and must respect the wishes, opinions and beliefs of the patient (or their parents for a paediatric patient)?

Again, speaking of a physician who has that patient as an established consumer at their practice; not a "I'll only see you today because it is urgent and won't take you on as a permanent patient" situation which is different.

Wow, I mean wow, this is totally got me deer-in-the-headlights'd especially considering the strongly worded ethical guidance from various international medical regulators including the GMC, the New Zealand Medical Council and the Medical Association of South Africa; all of which we could consider comparable nations to the US in terms of ethical issues and medical ethics.

What is of interest is that the article Dwayne quoted is that even this practice has been the subject of guidance to the contrary by the American Academy of Paediatrics (sic)