New AAP Policy on Patient Dismissal for Vaccine Refusal May “Erode Solidarity” Among Pediatricians

Syringe and vial
Syringe and vial
Others have argued that dismissal is ethically problematic because it can deprive children of comprehensive pediatric care and undermine public health.

A shift in guidance from the American Academy of Pediatrics (AAP) regarding the dismissal by clinicians of families who refuse vaccines may “erode professional solidarity” and place an increased burden on those practices willing to care for them, argues a new opinion piece published in JAMA Pediatrics.

The AAP recently issued a clinical report that stated it is an “acceptable option for pediatric care clinicians to dismiss families who refuse vaccines,” representing a clear shift from their previous guidance, in which they had advised practitioners to “endeavor not to discharge” patients based solely on parental refusal to allow their child to be vaccinated.

This is a controversial issue and while pediatricians are clearly divided on this question, the majority do not dismiss families from their practice for refusing vaccines. The authors of the opinion article point out that while the earlier guidance promoted a unified response to vaccine refusal, the new report says that dismissal is an acceptable option.

“The AAP has sanctioned a practice that may be unfair to the many clinicians who do not dismiss these families,” they write, because in addition to imposing burdens on their colleagues, clinicians who dismiss families for this reason might be showing an “insufficient commitment to the efforts of their profession to promote health for all children.”

Pediatricians have a duty to make reasonable contributions to efforts to promote vaccination within their communities, and thus, it is important to keep families that refused childhood immunizations within their practice so that they can revisit the topic with them. 

Related Articles

“More generally,” concluded the authors, “Clinicians who dismiss vaccine-refusing families seem to focus excessively on the interests of their own practice at the expense of their responsibilities to contribute to collective public health efforts.”


Deem MJ, Navin MC, Lantos JD. Considering whether the dismissal of vaccine-refusing families is fair to other clinicians [published online April 30, 2018]. JAMA Pediatr. doi: 10.1001/jamapediatrics.2018.0259.