...A number of state courts have applied this reasoning in holding
that mandatory vaccination of school children does not interfere
with the right to religious freedom. As the Arkansas Supreme
Court noted in one such instance, "In cases too numerous to
mention, it has been held, in effect, that a person's right to exhibit
religious freedom ceases where it overlaps and transgresses the
rights of others."
While it is widely agreed that states do not have a constitutional
obligation to enact religious exemptions, it is somewhat less settled
whether states have the constitutional authority to enact them in the
vaccination context. The Mississippi supreme court has held that
religious exemptions to compulsory vaccination violate equal
protection of the laws under the Fourteenth Amendment inasmuch
as the exemptions "require the great body of school children to be
vaccinated and at the same time expose them to the hazard of
associating in school with children exempted . . . who had not been
immunized as required by the statute." Mississippi is one of two
states that do not permit non-medical exemptions (as of 7/1/02).
For a year, Julee Lacey stopped in a CVS pharmacy near her home in a Fort Worth suburb to get refills of her birth-control pills. Then one day last March, the pharmacist refused to fill Lacey's prescription because she did not believe in birth control.
I'd heard of refusing the morning after pill, but contraceptive?
HOYE: Any birth control that ends the life of a human being will be impacted by this measure.
REHM: So that would then include the IUD [intra-uterine device]. What about the birth control pill?
HOYE: If that falls into the same category, yes.
REHM: So you’re saying that the birth control pill could be considered as taking the life of a human being?
HOYE: I’m saying that once the egg and the oocyte come together and you have that single-celled embryo, at that point you have human life, you’ve got a human being and we’re taking the life of a human being with some forms of birth control and if birth control falls into that category, yes I am.
As patients have become savvier and more willing to challenge doctors, physicians have become increasingly reluctant to deal with uncooperative patients, said Arthur Caplan, a bioethics professor at the University of Pennsylvania. In addition, doctors may feel financial pressure to see more patients and so have less time to contend with recalcitrant ones.
Well – in the United States, I can say that this isn't really a point of contention. Doctors are free to treat whom they choose. There are rules about whether a doctor can turn away patients in an emergency room or things like that, but outside that realm doctors can refuse to treat people for any reason they choose.
To stop a 14-person outbreak that began with one unvaccinated tourist visiting a US emergency room, the Arizona Department of Health had to track down and interview 8,321 people; seven Tucson hospitals had to furlough staff members for a combined 15,120 work-hours; and two hospitals where patients were admitted spent $799,136 to contain the disease.
"In non-emergency situations, a physician is justified in refusing to treat unruly and uncooperative patients. If a patient refuses to follow the physician’s plan of care or to comply with an appropriate treatment regimen, the physician may unilaterally terminate the physician/patient relationship by giving the patient advance notice of the specific reasons for his termination."
This is a really complicated issue
So what can we do about those sociopaths that don't finish their course of antibiotics?
About 98% of these kids are not all that sick and if the family had done nothing, would have made a full recovery on their own. So, what I spend about 98% of my day doing is educating families on how to support their children through extremely common illnesses.
So by this estimation, 100% of parents are unprepared to support their own children through very serious childhood disease, such as those we vaccinate for, even if the child's immune surveillance is high and they contract a relatively minor case.
Craichead--meaning only that if the 98% who have kids with very minor illness need help from a provider to care for their children, and the other 2% with really sick kids need help, I am then just projecting that all families with kids who contract the diseases we vaccinate for (which are typically more virulent than an everyday virus) would, then, need help from a provider to care for them. So--spendy. Sorry if I tired to get too fancy.
Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.
As of 2008, the disease is endemic in the United Kingdom, with 1,217 cases diagnosed in 2008, and epidemics have been reported in Austria, Italy and Switzerland.
If a kid has an active outbreak of measles, he's probably not going to be in a grocery store. Just a hunch.
I think this idea that those of us who are comfortable with pediatricians refusing to take on non-vaxing parents are saying that those children shouldn't get treatment at all, ever, is a red herring. There are still pediatricians who are taking in such patients.
Furthermore, in a true emergency, the ER isn't allowed to turn you away no matter what you may or may not have vaccinated against.
That children are going to die of other causes because they haven't been vaccinated is a total straw man - and this notion that because they won't go to a doctor they're going to somehow *pick up* and start *spreading* a new disease just doesn't even work. Doctors aren't how you avoid getting diseases. They're how you treat the ones you've already got.
Once ubiquitous, measles now is uncommon in the United States. In the prevaccine era, 3 to 4 million measles cases occurred every year, resulting in approximately 450 deaths, 28,000 hospitalizations, and 1,000 children with chronic disabilities from measles encephalitis. Because of successful implementation of measles vaccination programs, fewer than 100 measles cases are now reported annually in the United States and virtually all of those are linked to imported cases (2,3), reflecting the incidence of measles globally and travel patterns of U.S. residents and visitors. During 2006--2007, importations were most common from India, Japan, and countries in Europe, where measles transmission remains endemic and large outbreaks have occurred in recent years (CDC, unpublished data, 2008). Since November 2006, Switzerland has experienced that country's largest measles outbreak since introduction of mandatory notification for measles in 1999 (1).
The San Diego import-associated outbreak, affecting exclusively an unvaccinated population and infants too young to be vaccinated, serves as a reminder that unvaccinated persons remain at risk for measles and that measles spreads rapidly in susceptible subgroups of the population unless effective outbreak-control strategies are implemented.
Although notable progress has been made globally in measles control and elimination, measles still occurs throughout the world. U.S. travelers can be exposed to measles almost anywhere they travel, including to developed countries. To prevent acquiring measles during travel, U.S. residents aged >6 months traveling overseas should have documentation of measles immunity before travel (4). Travel histories should be obtained and a diagnosis of measles should be considered by physicians evaluating patients who have febrile rash illness within 3 weeks of traveling abroad.
Measles virus is highly infectious; vaccination coverage levels of >90% are needed to interrupt transmission and maintain elimination in populations. The ongoing outbreak in Switzerland, which has resulted in hospitalizations for pneumonia and encephalitis, has occurred in the context of vaccination coverage levels of 86% for 1 dose at age 2 years and 70% for the second dose for children aged <12 years. In the United States, vaccination coverage levels for at least 1 dose of MMR vaccine have been >90% among children aged 19--35 months and >95% among school-aged children during this decade. Although not measured routinely, 2-dose vaccine coverage is extremely high among U.S. schoolchildren because of school vaccination requirements.
What, exactly, do you suggest? Should all pediatric practices be required to have separate waiting rooms for sick/well or vax/not-vax?
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