COMMENTARY

So Wrong! Doctors 'Sell' Exemptions for Vaccinations

Arthur L. Caplan, PhD

Disclosures

January 29, 2019

Hi. I'm Art Caplan. I'm the head of the Division of Medical Ethics at NYU Langone Medical Center. We are in the flu season and many patients are going to need to get flu shots.

Older patients may need high-dose flu shots because their immunity may be lower. There are plenty of people who can't get any shots because their immune systems are not properly functioning. We've also seen, in many parts of the country, outbreaks of measles and chickenpox, which are also vaccine-preventable. We encourage all of our patients and their children to get their shots.

Approximately a year ago, California toughened up its law governing vaccines for children, [stating that only medical exemptions would be accepted]—no more philosophical, religious, or conscientious exemptions would be valid. This was probably triggered in part by the measles outbreak they had at Disneyland, which scared everyone and [prompted policymakers to] be more serious about vaccination and toughen up policies.

Indeed, vaccination rates have increased in California as a result of the passage of that law, with more kids getting vaccinated. However, it has led to a difficult ethics problem that I find morally troubling. Some doctors—not many, but a few—are advertising that they will grant medical exemptions. They're trawling out there on the Internet or running ads saying, "Come to my office if you don't want your kid to get vaccinated. I'll write you a medical exemption."

Some people have wondered, "Is that something that's legal?" I'm not sure. Is it something that's ethical? Absolutely not. [It is not ethical to offer] exemptions when you don't know whether the child has a health issue, or to feed off of fears that parents have about the safety of vaccines, which are bogus. We know, for example, that the autism-vaccine link simply doesn't exist.

[Providing inappropriate medical exemptions] also puts people at risk, including elderly people with weak immune systems, children with immune diseases, transplant recipients, and people post–cancer treatment who can't protect themselves against infectious disease. They need their neighbors to be vaccinated.

Putting up a notice that says, "I write exemptions" is, I think, the worst of medical practice. I don't think it's honoring choice but advancing dangers to the community. That's not what medicine should do.

Vaccination isn't only a question of what a parent wants to do with their child; vaccination is an issue about how to protect the weak and vulnerable in our communities and in our society. California did the right thing in saying that legitimate health reasons should exempt you but it isn't right to concoct them in the name of choice.

The best thing to do is make sure that everyone receives their vaccines so that they—and their neighbors—can be protected. I'm Art Caplan at the Division of Medical Ethics at NYU. Thanks for watching.

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