Ross and Aspinwall 10 contend that there should be a distinction between medical neglect and state intervention, arguing that vaccine refusal constitutes the former but does not warrant the latter. Furthermore, even if vaccine refusal amounts to medical neglect, it is not clear that this finding requires state intervention. 7 A few states codify that vaccine refusal regardless of reason, 8 or solely for sincere religious beliefs, 9 does not constitute medical neglect. For instance, some maintain that CPS screens out reports solely based on failure to vaccinate, 6 and Michigan has an explicit policy to this effect. A finding of medical neglect can trigger court action that may result in the temporary or permanent loss of custody or parental decision-making authority.Īlthough the application of medical neglect to parental vaccine refusal has some salience-a child is exposed to some potential risk of harm by a parental act of omission-it is not clear whether it is salient to CPS or meets the legal threshold for neglect. CPS must determine whether a report requires an investigation and, if so, whether investigation findings meet the relevant legal standards. Pediatric providers (and other mandatory reporters) have an obligation to report suspected child abuse or neglect to CPS. Both child neglect and child abuse (parental acts of commission that result in harm to the child) constitute child maltreatment. 5 Medical neglect is a subset of child neglect, which refers to parental acts of omission in the care of their child not exclusive to health care. New York’s law is paradigmatic: a neglected child is one whose “condition has been impaired or is in imminent danger of becoming impaired” because the parent has failed “to exercise a minimum degree of care in supplying the child with adequate” health care. 4Īlthough child welfare laws vary by state, the legal concept of medical neglect has a common denominator. 3 One strategy recently promoted is to treat vaccine refusal as neglect and report parents to child protective services (CPS) or another comparable agency. With increasing numbers of parents exempting their child from required school-entry vaccines 1 and few evidence-based interventions to address vaccine hesitancy, 2 pediatric providers are struggling with how to respond to parental vaccine refusal. Parental refusal of childhood vaccines is a contentious issue in pediatrics and public health. Each state should clarify whether, under its laws, vaccine refusal constitutes medical neglect. Some states have a legal precedent for considering parental vaccine refusal as medical neglect, but this is based on a small number of cases. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute neglect or considered it neglect only in the absence of a sincere religious objection to vaccination.Ĭonclusions. Most courts (7 of 9) considered vaccine refusal to constitute neglect. Our search yielded 9 cases from 5 states. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication. We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a neglect proceeding. To examine the relation of vaccine refusal and medical neglect under child welfare laws.
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