REFUSAL TO VACCINATE FORMS
RAISE MEDICAL ETHICAL CONCERNS

By Alan G. Phillips, J.D., Attorney and Counselor at Law
December 2007

One response from healthcare authorities to the growing awareness of vaccine concerns, and an alleged increase in the number of patients and parents opting out of vaccines, has been the use of “refusal to vaccinate” forms. The American Academy of Pediatrics (AAP) recommends that medical doctors require non-vaccinating patients to sign its Refusal to Vaccinate form, or a similar form, to “induce a wavering parent to accept [standard immunization] recommendations” and “reduce any potential liability should a vaccine-preventable disease occur in the unimmunized patient.”[1] However, neither of these rationales really applies to patients exercising a vaccine exemption, and the use of these forms with exempt patients, for this and other reasons discussed below, raises serious ethical concerns.

First, some doctors are reportedly telling patients that they must sign a Refusal to Vaccinate form to get treatment for themselves or their children. This puts the person seeking medical care in the position of having to agree to assertions with which they likely disagree (rather by definition) in order to get care, creating a conflict of interest. Some statements in refusal to vaccinate forms raise additional concerns as well. For example, the AAP form states: “I know that failure to follow the recommendations about vaccination may endanger the health or life of my child and others…” This assertion may not only contradict patients’ and parents’ beliefs, it contradicts—and frankly, insults—federal and state legislatures which, by their enactment of vaccine exemption statutes, have previously determined that exercising a vaccine exemption does not pose a significant risk of harm.[2] Therefore, asking a parent to sign a contrary statement is a misplaced attempt to reopen that previously resolved matter with patients directly, in circumvention of the appropriate political process.[3]

Compounding the above concerns is the often-exercised policy of requiring a form to be updated, or a new form to be signed, at each and every subsequent doctor visit. This is done not to address a legitimate liability concern or to convince “wavering parents” to vaccinate,[4]but to provide repeat opportunities to coerce patients and parents into vaccinating against their will and their legal right to refuse. Each time this previously resolved matter is again raised, the doctor-patient relationship is eroded (for how can you work with a physician who repeatedly challenges a previously resolved issue and lawful decision?), and makes some otherwise professional healthcare practitioners "repeat offenders."

For patients exercising a religious exemption,[5] medical doctors’ use of refusal to vaccinate forms may raise Constitutional questions, as there is a body of federal legal precedent supporting First Amendment rights to refuse vaccinations for religious reasons. Doctors refusing treatment to those exercising a religious exemption may be violating their patients’ Constitutional rights and subjecting themselves to potential liability accordingly.

Of course, there are published peer-reviewed medical studies and other authoritative information sources that cast significant doubt on the pro-vaccine assertions and implications in refusal to vaccinate forms.[6] So, despite the AAP’s claim of unanimity among the American Academy of Family Physicians, the Centers for Disease Control and itself on the merits of vaccination,[7]the assertions in its form present at best only one side of an inherently complex, multifaceted issue. Therefore, medical doctors’ requiring patients to sign refusal to vaccinate forms amounts to an attempt to coerce endorsement of one particular viewpoint among many different ones held by members of the medical community, raising yet another serious ethical concern.

Finally, some doctors modify the AAP form or design their own form without proper consideration for the ethical and legal implications. For example, at least one North Carolina pediatrician’s office reportedly requires parents to sign a form that would have parents admit, in effect, to being negligent or abusive by refusing to vaccinate their children. Surely it is unethical to require parents to falsely admit to unlawful behavior to get medical treatment for their child.[8]

            What can patients and parents do? First, never sign anything you don’t agree with, and never allow yourself to be pressured into signing anything before you’ve taken as much time as you need to fully understand what you’re signing. You could draw a line through and initial sections you disagree with, though physicians may not accept such a modification of their form. If you are coerced into signing a form that you later regret having signed, consider sending a follow-up letter withdrawing your agreement, and if applicable, share your concern at having been pressured into signing something against your will or before you had time to fully consider the matter, and underscore the ethical questions raised by being required to sign a Refusal to Vaccinate Form in order to get treatment or care.

Doctors' use of Refusal to Vaccinate Forms raises serious ethical questions, especially when required of those exercising a valid, legal exemption to immunizations, or when signing these forms is required to get medical care. This policy appears to be an attempt by vaccine advocates to supplant a rational and reasonable exploration of the many legitimate concerns about vaccines and vaccine policy with a forced “win” based on coercion and fear.[9] If you are confronted with a Refusal to Vaccinate Form, consider writing your state medical board about the relevant ethical concerns, and requesting that a policy be implemented prohibiting their use.[10] I stand ready to assist any who may request it.

Disclaimer: The above is for educational purposes only, and not intended to constitute legal advice.