Are dentists obligated to treat children without vaccinations? This is a question that the risk management staff of The Dentists Insurance Company (TDIC) is hearing with increasing frequency. They explored the ethical and legal considerations in the August issue of the Journal of the California Dental Association.
Measles was declared eliminated from the U.S. in 2000, but measles outbreaks are making headlines nearly 20 years later. As of August 1, nearly 1,170 cases of measles were reported in 30 states, and dentists are rightly concerned about disease transmission to young and immunocompromised patients.
"These factors can place dentists in a precarious position," TDIC Risk Management staff wrote (CDA Journal, August 2019, Vol. 47:8, pp. 533-534). "Should they -- and can they -- refuse to treat unvaccinated patients?"
TDIC staff consulted Arthur Curley from the law firm of Bradley, Curley, Barrabee & Kowalski. Dentists have no legal obligation to treat or retain patients without vaccines as they are not a protected class under federal or California law, Curley stated. The American Academy of Pediatrics also issued a report stating that clinicians can dismiss families who refuse vaccines, he added.
"Bottom line, so long as there is no other protected classification in which the patient falls, and the doctor gives adequate notice and an opportunity to find other dentists, a dentist may dismiss unvaccinated patients," Curley said.
However, dentists must follow a traditional dismissal process for patients without vaccines, he noted. This includes being available for emergency treatment until the patient finds alternative care.
While there are no legal issues for refusing unvaccinated patients, there are still ethical ones, TDIC cautioned.
"What is interesting about this debate is that the unvaccinated patient is the one at risk, not those other patients who are vaccinated," Curley said.
Dental practices can screen patients for measles and other communicable diseases by asking about their vaccination status and recent international travel. Practice owners should also consult local dental societies and occupational safety divisions for state-specific information.
"While it is the ultimate goal of every dental professional to protect the oral health of all patients, choosing whether to treat unvaccinated patients is a personal decision," TDIC staff wrote. "Finding a balance between legal and ethical obligations can be challenging, but protecting your patients, your practice, and yourself should be a guiding force."
