Case Study #4: Refusing Pediatric Vaccinations

Phoenix, a 24-month-old boy, is brought in by his mother for his annual well-child physical examination. The provider notices that the child has yet to receive vaccination against measles, mumps, and rubella (MMR) and reminds his mother of the need to have her son immunized. The mother is hesitant and states that she has heard of the links between MMR and autism. Citing several recent cases of measles in the community, the physician stresses the need for the MMR vaccine to protect the young child, because they may be in the midst of a measles outbreak. He tells her that mortality rates range between 1 and 3 of every 1000 cases and that acute encephalitis, which may cause permanent brain damage, occurs in about 1 of every 1000 cases. The mother counters that her chiropractor has discussed the issue of vaccination with her, including the topic of vaccination safety. In addition, the chiropractor discussed immune function and noted that treatments such as spinal manipulation and nutritional supplements, although not an alternative to vaccination, may optimize her son’s natural immune function. The provider is frustrated and tells her that he is not comfortable with continuing care for Phoenix if she chooses not to listen to his professional advice. The provider wonders what he could have done differently to avoid this impasse.

1. What is the Advanced Practice Nurse’s ethical duty in the above scenario

2. What is the ethical duty of the parents when thinking about the “best interests” of the child

3. Should the Advanced Practice Nurse continue the patient-parent relationship and why?

4. What information does the Advanced Practice Nurse need to give the parents for them to make an informed decision?