It surely does not feel good to do less for a patient than our rigorous and demanding scientific standards demand. However, we constantly make choices involving how much to do. We fret over how extensive an evaluation to do for what usually turns out to be a common, self-limited problem and not the potentially disastrous "zebra" we – and the parents – fear. We administer a 10-day course of antibiotics for an infection that some may treat for 3 weeks. Providing care for unvaccinated children does not differ fundamentally from other actions where we intervene less than some might claim is "optimal."
Many factors influence our decisions to limit treatment: family resources, our own resources (time/effort), and family beliefs and preferences (say, to avoid ionizing radiation or use watchful waiting in a child with fever and middle-ear effusion). The troubling question is whether withholding care violates an ethical imperative. In the case of vaccine refusal, it’s more gray than certain.
Dr. Frader is the A Todd Davis Professor of General Academic Pediatrics and professor of medical humanities and bioethics at Children’s Memorial Hospital and Northwestern University, Chicago. Dr. Frader said he had no relevant financial disclosures.