MacDonald Noni E, Harmon Shawn, Dube Eve, Taylor Beth, Steenbeek Audrey, Crowcroft Natasha, Graham Janice
Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia.
JK Mason Institute for Medicine, Life Sciences and Law, University of Edinburgh, Edinburgh, UK.
Paediatr Child Health. 2019 May;24(2):92-97. doi: 10.1093/pch/pxy116. Epub 2018 Oct 1.
Despite robust evidence that routine immunization is effective and safe, some parents refuse some or all vaccines for their children. In 2007, concern that Canadian paediatricians and family physicians might be considering dismissal of vaccine refusers from their practices prompted an ethical, legal, and public health analysis which concluded that dismissal was professionally problematic. We now reassess this important issue in the Canadian context updating ethical, legal, and public health considerations highlighting changes since 2007. In light of the recent strengthening of Ontario's school immunization requirements that include stiffer steps to qualify for a medical, conscience, or religious belief exemption, physicians and health care workers may be under more pressure from vaccine refusers in their practice leading some to contemplate dismissal or even consider no longer offering immunizations at all in their practice. Given the challenges that vaccine refusers may present, we offer an overview for managing vaccine refusal by parents/patients in a medical practice.
尽管有充分证据表明常规免疫是有效且安全的，但一些家长仍会拒绝为孩子接种部分或全部疫苗。2007年，有人担心加拿大的儿科医生和家庭医生可能会考虑将拒绝接种疫苗的患者从其诊所中除名，为此进行了一项伦理、法律和公共卫生分析，结论是除名在专业上存在问题。我们现在在加拿大的背景下重新评估这个重要问题，更新伦理、法律和公共卫生方面的考虑因素，突出自2007年以来的变化。鉴于安大略省最近加强了学校免疫要求，包括采取更严格的措施以获得医疗、良心或宗教信仰豁免，医生和医护人员在执业过程中可能会受到拒绝接种疫苗者更大的压力，导致一些人考虑将其除名，甚至考虑不再在其诊所提供免疫接种服务。鉴于拒绝接种疫苗者可能带来的挑战，我们概述了在医疗实践中处理家长/患者拒绝接种疫苗的方法。
