It’s time we objected to conscientious objectors

HOW far are you prepared to go to engage with so-called “conscientious objectors” to childhood immunisation?

Provide written information? Gentle discussion? Robust debate? Ban the family from your practice?

Everyone has a line they will not cross. The line for informed consent gets very blurry when it comes to the proxy consent provided by parents on behalf of their children.

As GPs we are convinced of the merits of immunisation against the vaccine-preventable infectious diseases that were so feared by previous generations who did not have the benefit of effective treatments or prevention.

I hesitate to even mention groups such as the Australian (Anti-)Vaccination Network for fear of giving them more attention than they deserve, but given this is a filtered readership I feel I can mention the harm they are doing to public health with their misinformation campaign aimed at scaring parents away from immunisation.

The balanced carrot-and-stick approach has worked well in encouraging high rates of immunisation in Australia until now. We doctors have played our part with time-consuming record and reminder systems, and immunisation PIP incentives.

Parents have been encouraged through various government incentives to have their children fully immunised before starting school.

However, from 1 July the system changes. The PIP incentive for doctors has been scrapped and parents will need to document that they have fully vaccinated their child in order to receive the Family Tax Benefit Part A Supplement of $726.35 per child.

If parents want to claim the money, they have to demonstrate that their child is fully immunised, or have their doctor complete documentation that they are a conscientious objector.

Recently we saw the release of new guidelines on how not to get into a heated unproductive debate on vaccination with a “total refuser”.

This will prove to be a time-consuming and frustrating challenge if we are to truly judge whether someone is conscientious or simply misinformed.

GPs have been advised not to get into a game of “scientific ping pong” with parents who have strange and unfounded views on immunisation.

One of my colleagues told me last week that she intends to be a conscientious objector to conscientious objectors. I must say the idea appeals to me.

When parents request that she fills in the government form indicating the child is exempt on the basis of parents being conscientious objectors, she will politely indicate that is against her principles and advice, and will refuse to provide the documentation.

Of course this means that patients will go to another clinic or miss out on the financial incentive.

We are asked to provide documentation for all sorts of benefits to patients, from Centrelink disability forms to fitness-to-drive certificates, WorkCover assessments to disability insurance reports and Medical certificates for time off work. 

On each specific occasion we have to assess the case on its merit and decide if we are ethically comfortable with providing that documentation.

I take my colleague’s point. Clinical contraindications are perfectly valid. But just because a patient decides they will refuse immunisation against the overwhelming weight of evidence for its benefits, doesn’t mean we have to get caught up in facilitating their financial incentive.

So the experts say don’t argue with parents who refuse vaccination. Right then. As long as they don’t argue with us about refusing to provide a Conscientious Objection Form.

Conscientious Objectors to Conscientious Objectors, unite!