In recent years, a growing number of pediatricians in the United States have adopted policies that refuse care to children whose parents delay or decline vaccines. Some practices go as far as dismissing (or “firing”) existing patients for not following the CDC’s recommended immunization schedule. But is this ethically sound—or even legal?
In this article, we’ll discuss what the leading medical authorities say about vaccine-related dismissal, the principles of informed consent, and what steps you can take if your child’s doctor threatens to end care.
What Do the Medical Authorities Say?
The American Academy of Pediatrics (AAP) and the American Medical Association (AMA) have both addressed the ethics of dismissing patients based on vaccine status, though their positions differ slightly.
The AAP initially advised against dismissal, encouraging providers to preserve the therapeutic relationship even when families decline vaccines. However, in a 2016 update, the AAP acknowledged that dismissal may be ethically permissible in certain circumstances (1).
The AMA, in contrast, takes a more cautionary stance. As of 2021, it states that physicians should not refuse care solely because a patient is unvaccinated or declines vaccination. According to AMA ethics guidance, doing so may violate a physician’s duty to treat and could amount to discrimination against a class of patients (2).
In practice, however, pediatricians are increasingly making these decisions at the individual or clinic level—some continuing to provide care to vaccine-hesitant families, while others enforce strict adherence to the CDC schedule.
Informed Consent
Let’s be clear: vaccines are pharmaceutical products. Like any pharmaceutical, they come with potential benefits and potential risks. The National Vaccine Injury Compensation Program (VICP) exists to pay out damages to families whose children experience serious vaccine injuries (3), and package inserts list serious side effects and even death (4).
Under the principle of informed consent, parents have the legal and ethical right to receive accurate, unbiased information about the purpose, ingredients, known risks, and alternatives related to each vaccine. This includes the right to ask questions, to take time before deciding, and to ultimately accept, delay, or decline based on what they believe is best for their child.
While many pediatricians support the use of vaccines, it is essential that conversations around vaccination occur in an environment of trust, transparency, and respect. When families are rushed through brief vaccine appointments without space for dialogue—or when concerns are dismissed outright—they may feel pressured rather than supported. For some, this leads to deeper hesitancy, not clarity.
Federal law supports the right to informed decision-making. The National Childhood Vaccine Injury Act of 1986 mandates that families receive a Vaccine Information Statement (VIS) prior to administration of any vaccine covered by the CDC schedule (4). These documents, produced by the CDC, outline the risks and benefits of each vaccine and are a key component of the informed consent process. Yet studies show many families don’t receive adequate time to review them, and some providers do not discuss the potential side effects listed in the package inserts.
At a United Nations vaccine summit in 2019, WHO Director-General Dr. Tedros Adhanom made a statement I agree with:
“We must make sure people have reliable information, but we must also take the time to listen to people’s concerns and fears.”
Unfortunately, listening does not happen when families are dismissed or turned away by pediatricians.
Are Unvaccinated Children a Safety Risk to Others?
It’s often argued that pediatric practices should dismiss unvaccinated families in order to protect immunocompromised patients. Let’s talk about this.
First, let’s examine the actual risk that may exist when an unvaccinated child—who is not acutely ill—is present in a pediatric waiting room. Vaccination status alone does not equate to contagiousness. A healthy asymptomatic child who is not vaccinated does not inherently carry or shed a virus. In contrast, children who are acutely ill—vaccinated or not—are far more likely to pose a risk to others.
How does contagion occur? Read these articles to learn more:
- What to Do After Exposure to a Sick Person: Immune Support Tips for Families
- Can Cold Temperatures Make You Sick? The Real Reason Kids Get Sick More Often During Winter
Continuing this line of thought: If an unvaccinated child is acutely ill—whether with a vaccine-preventable illness or any other illness—are we ethically justified in refusing them care? What happens to our obligation to that child in their moment of need? Refusing to treat a sick child because of parental vaccine decisions raises serious ethical concerns, particularly when our role as pediatric providers is to serve and protect all children.
The assumption that “unvaccinated” means “infectious” creates stigma and fear, rather than sound science-based policy. It also fails to acknowledge that vaccinated individuals can and do contract and transmit certain illnesses. For example, during the 2016 mumps outbreak in Arkansas, a total of 2,954 mumps cases were identified. The majority of cases—1,676 (57%)—were school-aged children, and 92% of them had completed the mumps vaccination schedule (5).
Another example is the 2012 Washington State pertussis outbreak, where vaccination records were available for over 90% of the affected children. Among those 3 months to 10 years old, 75.8% were fully up to date on their DTaP vaccinations, and among adolescents 13-19 years, 77.2% had received their DTaP booster. Despite high vaccination rates, a significant number of pertussis cases still occurred (6).
This highlights an important reality: even in highly vaccinated populations, outbreaks can and do occur. It also brings us to an important ethical question: Where do we draw the line when it comes to excluding patients from care?
What About the Safety Concerns of Vaccine-Hesitant Parents?
Now, let’s talk about the other side of the coin. Parents who are vaccine-hesitant are also concerned about safety—and that concern is not without reason.
Vaccine injury is real. Why else would the federal government have paid out approximately $5 billion to date through the National Vaccine Injury Compensation Program (7)? While serious reactions are rare, they do happen. Documented risks listed on vaccine package inserts include seizures, SIDS, encephalopathy, Guillain-Barré syndrome, and death (4). These adverse events may not affect the majority, but for the families who experience them, the impact is profound.
Additionally, there are ways to support your child’s body during immunization through thoughtful timing, supplementation, and more, but unfortunately, many parents are belittled or dismissed when they mention these ideas. The unfortunate truth is that listening often stops when families express hesitation. That’s a problem.
I have a lot to say on this topic, and you can read more here:
What Should I Do If My Child’s Pediatrician Tries to Dismiss My Family for Delaying or Foregoing Vaccination?
First of all, take a deep breath. If you’re facing dismissal from your pediatrician’s office because you’ve chosen to delay, space out, or decline one or more vaccines, you’re not alone—and you have options.
Here are some steps you can take:
1. Ask for a Respectful Conversation (if you’d like)
Sometimes, dismissal policies aren’t personal—they’re clinic-wide protocols. But that doesn’t mean there’s no room for dialogue. If you otherwise like your child’s pediatrician and hope to continue the relationship, consider asking for a meeting to share your concerns, explain your reasoning, and listen to theirs. This kind of honest conversation can sometimes lead to understanding or compromise.
That said, if the relationship has already become tense or you no longer feel safe or respected in that space, you don’t owe anyone that conversation. Trust your instincts and do what feels right for your family.
2. Know Your Rights
Pediatricians have the right to set policies for new patients, but terminating care for existing patients must adhere to legal and ethical guidelines. This includes (8):
- Providing Proper Notice: Typically, a 30-day notice is standard, allowing you time to find another provider.
- Assisting with Continuity of Care: This may involve referring you to another provider or medical group, if possible, or cooperating in sending over medical records, etc.
You are not obligated to sign refusal-to-vaccinate forms that contain language you’re uncomfortable with, especially if they imply neglect or legal liability. The American Academy of Pediatrics provides a “Refusal to Vaccinate” form intended to document parental refusal. However, signing such forms is voluntary, and you should not feel compelled to agree to language that misrepresents your intentions.
3. Seek a Provider Who Respects Informed Consent
There are pediatricians and family doctors who welcome families regardless of their vaccine-preference and who practice with transparency and compassion. I have an ongoing list of medical-freedom providers here. I recommend interviewing potential practices about their policies before transferring care.
4. Document Everything
If your child is being dismissed, request that the reason be provided in writing. Save all communication for your records. This can be helpful if you need to advocate for yourself later on.
5. Trust Your Instincts
You should never feel bullied or threatened into a medical decision. If your current provider isn’t willing to respect your role as your child’s advocate, it may be time to move on.
Summary
In recent years, more pediatricians have chosen to dismiss families who decline or delay vaccines, citing concerns about protecting other patients or clinic policies. But this growing trend raises important ethical questions—especially when it comes to access, discrimination, and informed consent. The American Academy of Pediatrics has stated that dismissal may be allowed under specific circumstances, but the American Medical Association warns that turning patients away based solely on vaccine status may violate a physician’s duty to treat and could be considered discriminatory.
At the heart of this issue is the principle of informed consent. Vaccines, like any medical intervention, carry both benefits and risks. Parents have a legal and ethical right to make these decisions based on full and unbiased information—and to do so without fear of termination of care or judgement.
References:
- Matheny AH. (2020, November 6). Is it Ethical for Primary Care Practices to Refuse to Accept Un- or Under-immunized Patients? American Academy of Pediatrics. https://publications.aap.org/journal-blogs/blog/3563/Is-it-Ethical-for-Primary-Care-Practices-to-Refuse?autologincheck=redirected
- AMA. (2021). Can physicians decline unvaccinated patients? American Medical Association. https://www.ama-assn.org/delivering-care/public-health/can-physicians-decline-unvaccinated-patients
- Institute of Medicine (US) Committee on the Children’s Vaccine Initiative. (1993). Planning Alternative Strategies. Mitchell VS, Philipose NM, Sanford JP, editors. The Children’s Vaccine Initiative: Achieving the Vision. Washington (DC): National Academies Press (US); 1993. B, National Vaccine Injury Compensation Program. Available from: https://www.ncbi.nlm.nih.gov/books/NBK236419/
- CDC. (2024). Current VISs. Vaccines & Immunizations. https://www.cdc.gov/vaccines/hcp/current-vis/index.html
- Alkam D, Jenjaroenpun P, Wongsurawat T, Udaondo Z, Patumcharoenpol P, Robeson M, Haselow D, Mason W, Nookaew I, Ussery D, Jun SR. Genomic characterization of mumps viruses from a large-scale mumps outbreak in Arkansas, 2016. Infect Genet Evol. 2019 Nov;75:103965. doi: 10.1016/j.meegid.2019.103965. Epub 2019 Jul 15. PMID: 31319177; PMCID: PMC6832845.
- CDC. (2012). Pertussis Epidemic — Washington. Www.cdc.gov. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6128a1.htm
- HRSA. (2023). Data & Statistics. https://www.hrsa.gov/sites/default/files/hrsa/vicp/vicp-stats-11-01-23.pdf
- AMA. (n.d.). Terminating a Patient-Physician Relationship. Www.code-medical-ethics.ama-assn.org. https://code-medical-ethics.ama-assn.org/ethics-opinions/terminating-patient-physician-relationship
