Physician dismissal of vaccine refusers: A legal and ethical analysis

While vaccines represent one of the most effective health interventions of the twenti-eth-century, most vaccine-suppressed infec-tious diseases are merely contained within a defined geographical area for as long as preventative measures can interrupt effective transmission. A difficulty faced by public health authorities is that, once outbreaks become rare, parents of minor children who are meant to commence their scheduled vaccines may question whether vaccination is necessary. This hesitancy can be compound-ed, or transformed into vaccine refusal, by social circles and vaccine-negative social media campaigns. As a result, some parents refuse some or all vaccines for their chil-dren. Indeed, vaccine hesitancy and refusal have increased in the last decade. Some physicians have responded by dismissing refusers and their families from their prac-tice. While dismissal data is not readily available for most jurisdictions, dismissal of patients is a serious and growing concern. As such, this article offers an analysis of the legal and ethical implications of physician dismissal of patients for vaccine refusal, focus-ing on Canada, but drawing on evidence and authorities from the United Kingdom and the United States where appropriate. It concludes that, while physician dismissal of vaccine re-fusers is occasionally supportable, it is gener-ally ethically and legally problematic. It closes with suggestions for physicians for managing vaccine refusal in the clinical setting.