Responding to parents who refuse childhood immunizations

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CHILDHOOD immunization programs have successfully prevented large-scale outbreaks of vaccine-preventable diseases and reduced the rates of severe morbidity and mortality associated with these diseases.1 Despite the clear public health benefits of such programs and the policy mandates that promote them, nurses working in pediatric care continue to encounter parents who refuse recommended childhood vaccines for nonmedical reasons.
Vaccine refusal can be frustrating for nurses, particularly after they've had lengthy discussions with parents about the benefits of keeping a child up to date with immunizations. At times, nurses may wonder if parents who persistently refuse one or all recommended childhood vaccines are calling their clinical competence into question—or perhaps even their commitment to the child's well-being. This can lead to tension in the relationship between pediatric healthcare professionals and families, which can adversely affect the child's care.
Vaccine refusal for medical reasons, such as having a child who's immunocompromised or who's experienced a documented adverse reaction to a particular vaccine, is generally not controversial. But how should we respond to parental refusal of immunizations for nonmedical reasons, such as a religious objection to immunization or a belief that too many vaccines are administered during a single wellness visit? This article reviews some of the ethical questions that arise when parents refuse some or all recommended childhood vaccines for nonmedical reasons, and discusses ways in which nurses and other healthcare professionals can respond ethically and effectively to vaccine refusal.
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