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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Pediatrics Perspective

Reasons to Accept Vaccine Refusers in Primary Care

Mark C. Navin, Jason A. Wasserman and Douglas J. Opel
Pediatrics December 2020, 146 (6) e20201801; DOI: https://doi.org/10.1542/peds.2020-1801
Mark C. Navin
aDepartment of Philosophy, Oakland University, Rochester, Michigan;
bDepartments of Foundational Medical Studies and
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Jason A. Wasserman
bDepartments of Foundational Medical Studies and
cPediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan;
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Douglas J. Opel
dTreuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington; and
eDepartment of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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  • Abbreviation:
    AAP —
    American Academy of Pediatrics
  • Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal.

    The American Academy of Pediatrics (AAP) says dismissing families who continue to refuse vaccines is an “acceptable option,”1 but some practices have gone further by not accepting vaccine refusers as patients at all.2,3 The phenomenon of nonacceptance has been underexplored; in both empirical studies and ethics analyses, researchers largely focus on dismissal.4–7 In this article, we first criticize arguments for nonacceptance that invoke a supposed right to choose one’s patients. We then argue that nonacceptance is problematic because (1) some of its motivations are intrinsically immoral, (2) it does not appear to accomplish some of its goals, and (3) even when nonacceptance does accomplish its goals, it fails to appropriately balance the various values it implicates. Throughout the article, we engage with the existing ethics literature about dismissal and conclude that even if dismissal is sometimes justifiable, nonacceptance is not.

    A Right to Choose One’s Patients?

    Some may argue that nonacceptance is ethically justified because they believe the clinical relationship is fundamentally a free association between clinicians and patients, as the American Medical Association Code of Medical …

    Address correspondence to Mark C. Navin, PhD, Department of Philosophy, Oakland University, 746 Mathematics and Science Center, 146 Library Dr, Rochester, MI 48309-4479. E-mail: navin{at}oakland.edu

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    Pediatrics
    Vol. 146, Issue 6
    1 Dec 2020
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    Reasons to Accept Vaccine Refusers in Primary Care
    Mark C. Navin, Jason A. Wasserman, Douglas J. Opel
    Pediatrics Dec 2020, 146 (6) e20201801; DOI: 10.1542/peds.2020-1801

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    Reasons to Accept Vaccine Refusers in Primary Care
    Mark C. Navin, Jason A. Wasserman, Douglas J. Opel
    Pediatrics Dec 2020, 146 (6) e20201801; DOI: 10.1542/peds.2020-1801
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    • Article
      • A Right to Choose One’s Patients?
      • Motivations for Nonacceptance
      • Trust and Nonacceptance
      • Nonacceptance Fails to Appropriately Balance Competing Goals
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    More in this TOC Section

    • Child Care During the COVID-19 Pandemic: A Bad Situation Made Worse
    • Use of Cognitive Shortcuts in Decision-making for Children With Severe Neurologic Impairment
    • Implications of the 21st Century Cures Act in Pediatrics
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