To the Editor In their Viewpoint article, Deem et al1 argue that dismissal of vaccine-refusing families places an unfair burden on other health care clinicians and, furthermore, erodes the profession’s commitment to the health of children. While counterintuitive, dismissal policies may actually do just the opposite. Having such a policy sends a powerful message: “Your child’s health is important to me, and immunization is such an important part of keeping children healthy, that I cannot in good conscience continue to care for your child if you refuse all vaccines.” What happens when a clinician takes this position? Does the family transfer to the practice across town that draws a softer line, as suggested by the authors? Or, as has also been suggested,2 do the parents reconsider their refusal and accept vaccination, moved as they are by the passion implicit in the clinician’s stance? If this happens frequently enough, dismissal policies may actually help maintain high immunization rates.3
Marshall GS, O’Leary ST. Dismissal Policies for Vaccine Refusal. JAMA Pediatr. 2018;172(11):1101. doi:10.1001/jamapediatrics.2018.2663
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