Sunday, October 21, 2007

RELIGIOUS FREEDOM AND THE CLAIMING OF VACCINATION EXEMPTIONS

Over the last few months when I have been, for the most part absent from the bloggosphere, I probably could have predicted that Paul Offit would be involved in the timing of my return.

There’s been a lot said recently about the claiming of religious exemptions to avoid vaccination of children. Perhaps it’s due to an upsurge of interest in the vaccine issue in the wake of Jenny McCarthy’s recent media appearances. In any event, the Associated Press recently distributed an article entitled “Parents Use Religion to Avoid Vaccines,” which sparked quite a discussion on the web. As I join in the discussion, let me emphasize that what I have to say is not a scientific discourse, but rather examines the legal/ethical/moral/religious issues.

The AP writer, a fellow named Steve LeBlanc, tells us that:
Twenty-eight states, including Florida, Massachusetts and New York, allow parents to opt out for medical or religious reasons only. Twenty other states, among them California, Pennsylvania, Texas and Ohio, also allow parents to cite personal or philosophical reasons. Mississippi and West Virginia allow exemptions for medical reasons only.
The article examines a recent increase in the claiming of religious exemptions ⎯ the numbers actually doubling or tripling in some states. Instead of asking why religious people might actually have objections, Mr. LeBlanc apparently spoke to only one parent, a woman who acknowledged that she is not particularly religious and characterized her claim of a religious exemption as “misleading.” So the writer apparently extrapolated that all or most parents who claim an exemption must likewise be misleading the states.
Some of these parents say they are being forced to lie because of the way the vaccination laws are written in their states.
And of course, whenever the media talks about vaccination policy, they always go to the same source for a quote: our old buddy, Dr. Paul Offit, who holds at least one vaccine patent.
“Do I think that religious exemptions have become the default? Absolutely,” said Dr. Paul Offit, head of infectious diseases at Children's Hospital in Philadelphia and one of the harshest critics of the anti-vaccine movement. He said the resistance to vaccines is “an irrational, fear-based decision.”
Based on the constant bragging of the CDCC as to increasing vaccination rates, I think labeling the choice of a religious exemption as the “default” is a shining example of Doc Offit’s customary resort to hyperbole. And the reference to an “anti-vaccination movement” tells me that Mr. LeBlanc buys into Offit’s paranoid “us versus them” worldview (see my discussion of his book, The Cutter Incident).

Paul Offit is not the only Doctor O to weigh in on the issue. The medical blogger, Orac, has also had his say. Orac and I first started sparring a few years back, and we managed to develop what I would classify as a civil and cordial relationship. I can even say that I agree with him on many issues. Vaccination policy and the possible role of vaccination in the triggering of the current autism epidemic, however, are issues on which our views are sharply different.

In a recent post, Orac leads into the AP article by writing:
I’ve written before how this misplaced deference has resulted in a spate of laws that allow parents easily to declare a religious exemption and refuse to have their children vaccinated⎯all legally. In the last couple of months, news has come out that indicates that the problem of parents taking advantage of “religious exemptions to avoid vaccinating their children has grown worse than previously thought. . .
Orac, who does not seem to be very religious himself (apart from a near-religious devotion to what he deems to be good science), makes clear that he believes most claims of religious exemptions are nothing more than sham:
While some parents ⎯ Christian Scientists and certain fundamentalists, for example ⎯ have genuine religious objections to medicine, it is clear that others are simply distrustful of shots.
. . .

In other words, the fear-mongering over vaccines of antivaccinationists, coupled with religious exemption laws in many states, are making it possible for more and more parents simply to lie in order to claim a religious exemption to which they are not (morally, at least) entitled . . .
. . .

Although I’m dismayed at such behavior and the undue deference to religious ideas that allow such laws to make it easy for parents to lie, I can sort of understand why some parents, mislead by antivaccination misinformation, might decide that they have no choice but to lie to “save their children.” Sort of understand, but not condone.
The AP article quotes Doc Offit attempting to sound reasonable:
Offit said he knows of no state that enforces any penalty for parents who falsely claim a religious exemption.

“I think that wouldn’t be worth it because that’s just such an emotional issue for people. Our country was founded on the notion of religious freedom,” he said.
Perhaps Offit has not heard the same stories I’ve heard out of New York, regarding parents who cannot back up their claim of religious exemption with some sort of official documentation from a recognized church. I’m not familiar with the rules in New York, and I invite any corrections on this point, but parents in that state tell me that their children are not allowed in school without that documentation. Sounds like a penalty to me.

Steve LeBlanc, Paul Offit, Orac, and apparently the State of New York all assume that a deeply held religious belief requires some sort of specific church decree to validate the conviction. Pardon my less-than-religious language, but there is only one word that adequately describes that viewpoint: bullshit!!!!

Again, let me emphasize for the sake of clarity that I am not discussing the scientific merits of any particular viewpoint. As I have written on numerous occasions, I consider the science on these questions to be far from conclusive. The question here is not scientific validity; it is individual conscience.

With the exception of a few sects that have an institutional distrust of modern medicine, most denominations do not take a formal theological stand one way or the other on whether vaccination is good or evil per se. To be sure, groups who are part of particular denominations may make generalized statements about the subject as a commentary on public policy. Recent statements issued by the Women’s Division of the United Methodist Church decrying the use of thimerosal in vaccines stand as one example. I’m sure those who disagree with me can cite examples of church-related organizations calling for increased efforts to vaccinate particular populations. Again, these are more in the nature of public policy commentaries, perhaps guided by broad theological principles. As far as I know, no major mainstream denomination has declared that either vaccinating or not vaccinating a child qualifies as a sin.

As a believing member of a mainstream christian denomination, I am guided by broad principles of what is right and what is wrong. Those principles tell me that I should avoid doing harm to innocent children. If I am personally convinced that the health benefit of a vaccine outweighs the potential risk, I must have my child vaccinated as a moral imperative. On the other hand, if I am personally convinced that the risk to my child is high, an equally strong moral imperative commands that I refrain from vaccination.

The problem with enforcement of mandates is not so much that it is an “emotional issue,” but rather that it is impossible to actually see within the heart of any individual.

Not surprisingly, Orac believes that mainstream scientific opinion trumps religious freedom:
Undue respect for religious beliefs that clash with the scientifically demonstrated ability of vaccines to prevent disease safely enables parents who are either antivaccinationist or who have been mislead by antivaccinationist fearmongering a relatively easy method to bypass vaccination laws and an easy avenue for physicians peddling non-evidence-based attacks on vaccination to help them do so.
In an addendum to his post, though, Orac starts to make sense, although his rationale is probably far different from mine:
Either non-medical exemptions should be allowed for any reason, religious, pseudoscientific, or whatever, or they should not be permitted at all. Why should religious objections to vaccination be privileged above any other objection, such as philosophical or plain “I just don't want to”? There’s no rational reason why they should.
There’s a broader issue here than just religious freedom. The real debate should be whether a government has to right to dictate a specific medical procedure or health-related practice. There are certainly “antivaccinationists” who believe that vaccines, by their nature, are doing more harm than good to the human immune system. But there are also undoubtedly many parents who may accept the need for vaccination in principle, but who question whether the enormous number of shots on the current schedule present an unacceptable risk. For example, the parent of a young girl may accept the need to vaccinate for measles, but not for HPV. If a parent chooses to wait until a child has reached an age where the risk of contracting Hepatitus B becomes more palpable, should that child be denied school enrollment prior to that immunization?

There are no easy answers in this debate. Assuming solely for the sake of argument that there is validity to the “herd immunity” theory (which is taken in some quarters as, if you’ll pardon the expression, an article of faith), then a parent is not only making the choice for his/her own child, but for other children as well. It is a delicate balancing process lies at the heart of every societal debate we have about the limits of freedom and self-determination.

Unfortunately, we do not have all the information we need to make an informed decision as a society. We have no idea what cumulative impact the huge number of scheduled vaccines are having on the immune system of any given child. And we’re only starting to figure out that some children may be particularly susceptible to damage from particular vaccines or components.

Until we know more, there is very little we can settle by debating the real question. In the meantime, we must err on the side of freedom from governmental interference, and leave the everyday choices to individual conscience. And we can pray that the choices we make for our children ⎯ whether those choices are to vaccinate or to not vaccinate ⎯ are wise.

2 Comments:

Anonymous Alice Boudreaux said...

This comment has been removed by a blog administrator.

10/22/07, 4:37 PM  
Blogger Brett said...

Wade,

It's good to see you back and blogging. (The fact that I am responding to this post nearly 2 months after it was posted gives you an idea of how much blogging I've been doing lately!) Glad to hear that all is well.

On the subject of vaccinations, I too had started to put together some thoughts on the whole messy issue, but just couldn't force my way through. Good thing, too, 'cause you did a much better job of it than I would have.

Though I don't quite accept that vaccines (or, more properly thimerosol) have a causative role with autism, I do scratch my head sometimes at the number - and types - of vaccines that everyone has to get these days. And, unfortunately, most people have no idea what they are getting, they are just following the 'herd'.

You hit the nail on the head when you say "It is a delicate balancing process lies at the heart of every societal debate we have about the limits of freedom and self-determination." Where does the individual end and the society begin?

12/20/07, 9:57 PM  

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