High Court forces children to have MMR – What happens when parents disagree.

Being a parent runs you through a hundred emotions every day. So does not being a parent. But you have the added pleasure of worrying for someone who has almost no ability to think safely for themselves. They are walking disaster zones for years.

What really pisses me off is other parents who are unable to separate fact from feeling. Well, overwhelming scientific consensus from a fear of their own ignorance. Anti-vaccine (anti-vaxxers, as they’re often referred to) are high on this list for me.

It may come as little surprise that my wife and I follow the best available evidence when it comes to our children’s health. Both my children are vaccinated against everything they should be, for their respective ages. But not all parents are born equal. Some chose the path less walked. Some find reason to mistrust science, scientist, doctors, the government or whoever they’ve decided to mistrust, for whatever reason or reasons. They justify their mistrust with “evidence” and anecdote, often disproven, often wrong. They don’t just do this at their own risk, but at the risk of their children and mine.

I read this piece on the BBC website with some interest, “High Court orders two sisters must receive MMR vaccine”

It’s a sad case of two parents, now divorced, unable to reach a decision as to the welfare of their children. While this isn’t the first time the courts in the UK have ruled on such cases, they still remain rare enough to be newsworthy.

Facebook groups like the Vaccination Information Network (VINE) have reported this as a travesty. Of children being forced to do something they don’t want to do. That in someway their liberties are being infringed upon. But that’s not really what’s going on here. What is going on is two parents disagree over some aspect of their children’s care and have been unable to reach an amicable solution. Just for arguments sake, let’s make it about eating fruit.

The mother thinks that fruit is bad for you. That it contains dangerous ingredients. Eating fruit will cause untold damage to her children. The children agree with their mother. The father believes the opposite. He believes that eating fruit is good for your long term health and isn’t to be feared.

The court has to decide of the best available evidence. Well, the best available evidence is that fruit is good for you. That as part of a healthy lifestyle you should eat fruit. But just to make sure that all arguments are given an equal hearing, the court hears from the children. The children share similar, unscientific, non evidenced based views as their mother. The court rules that the children should eat fruit and find the children don’t posses the ability to make this decision for themselves.

Sounds a bit ridiculous when you make it fruit, but vaccines are about as safe.

Here’s the thing. They’re children. The court has to rule based on this. The mother is an adult and receives the freedom of choice, however stupid, that she wants for herself. The children were given even opportunity by the court to offer reasonable objections to being vaccinated. They weren’t able to. They could only offer the typical anti-vax nonsense that their mother has probably fed them. As a child, claiming that the ingredients in the MMR vaccine aren’t all included on the labelling and that the vaccines are dangerous based on dishonest research, forces the court to believe that the children are unable to make an informed decision. That they are unable to evaluate the evidence available.

This was a family court, not an emancipation of minors hearing! Hearing from the children has confused people that this is any more than a parental decision that a court has had to rule on because they couldn’t reach their own decision. In this case, they are the children and the parents are the parents.

For me, it’s as ridiculous as the courts having to rule on eating fruit. The science, frankly, is done. There is no controversy, just sadly misinformed people. Yes, children have adverse reactions to vaccines but some people have allergic reactions to fruit.

Of course the example breaks down a bit when you consider the benefits of vaccines to the wider community, like heard immunity, but ho-hum.

4 Responses

  1. Jonathan says:

    Your comment was a pleasure to read. Both clarifying and edifying. So don’t think I’m picking a fight if I want to explore this science question a little more…

    Whether I chose an example from early medical science or pre-science is open to debate. But let’s agree that my example was from a pre-scientific era. The 1960’s, on the other hand, would not be considered pre-scientific by our current understanding of the word. And yet what was then “modern medicine” brought us the horror of Thalidomide babies. These were babies born with birth defects when their mothers took Thalidomide for morning sickness during their first trimester of pregnancy. So what went wrong?

    Well it is easy in hind sight to say the drug was not sufficiently tested. But then that is the fear of those who are suspicious of vaccines today, is it not?

    Did doctors prescribe Thalidomide to pregnant women knowing it had a high chance of causing birth defects? Of course not. And indeed many initially doubted the connection. After all, Thalidomide had been tested in the lab. Many doctors of the era even doubted that medicine could affect anything in the growing fetus beyond the placental barrier. As silly as that sounds today, such a concept was essentially rooted in science, or at least the scientific understanding of the time. As it turns out, the testing was insufficient. But think about the implications of that. It was tested. It was found to be safe. Then when it was provably NOT safe, the testing was deemed inadequate. That’s enough to make some parents skittish about believing something is safe just because a doctor tells them so.

    So let me be clear what I am not saying. I am not saying common vaccines are dangerous. And when I said our current science will be viewed in 200 years as something “close to voodoo”, I chose clumsy wording. I did not literally mean that we will think it was unscientific. Rather we will have such greater understanding of the underlying mechanisms in play that our current treatments and theories will be laughably crude. Like when Bones on Star Trek complains about the era of crude surgery where human beings were stitched like garments. We think of brain surgery as advanced. In 200 years, they will revile in horror that we split open skulls and poked around in there all willy-nilly.

    The scientific method is obviously beneficial to human advancement, but we should not allow this fact to lead us into thinking that current science is infallible or invariably safe. Thalidomide is one simple example of the failure of medical science. It is a failure we learned from, obviously, but one that at the time was pretty well un-thinkable. People trusted their doctors. After all, it was medical science!

    But let me choose a more modern example. Surely the 1990’s are part of the modern scientific era. And during this time many doctors delivered babies by Cesarean section because it was seen as safer than natural childbirth. Done properly, it led to fewer complications. It still is preferred in many medical circles, but not all. Because it seems as we gain a greater understanding of our microbiome (a concept that itself wasn’t even taken seriously until the late 1990’s), we learn that C-sections may limit the germs an infant is exposed to. And as it turns out these germs play a huge role in allergies and other forms of resistance later in life. So now some current thinking is that passing through the birth canal is actually healthier for the baby than being plucked from its mother’s belly. But imagine asking a doctor in 1990, “Will giving birth by C-section, affect the health of my baby?” No, the doctor would assure you. It would not. “Everything we know about this form of delivery tells us it is perfectly safe.” And he could be right about the science while being wrong about the facts.

    And to me this is an important point about science that really does not get enough emphasis. We may be very good at knowing what we know through science. But science is more stingy in what it tells us about what we don’t know. Or don’t yet know.

    And that is why I always have some sympathy for folks who don’t trust medicine just because they are told it is safe. That’s not saying we should ignore what science teaches us. But it does mean we should be a little hesitant in thinking “no known harmful effects” is the same thing as “no harmful effects”.

  2. Jonathan says:

    This is a fair consideration of something I find very complicated. When we allow government or society to determine what is best for children over the objection of the parents, we get into a really weird area.

    It seems like it is a no brainer to let “science” be our guide. Except when you make an honest appraisal of science you are left with a history not of enlightenment as much as of decreasing ignorance. 21st century medicine is not infallible. Suppose we had a parent that didm’t want his child leeched or bled 200 years ago? Would we want the best medical science of the time to trump the parents own feelings?

    We can point to the safety and general effectiveness of vaccines as a way to defend forcing parents to get their children vaccinated, but that does not settle the matter philosophically. Must we always allow medical science to dictate how parents raise their kids? Consider that new vaccines are riskier than older vaccines. Consider that no vaccine is perfectly safe. Consider that newer vaccines are less effective than older vaccines. Consider that no vaccine is perfectly effective. There is clearly margin of error in medical science in general and in vaccinations specifically. Should parents be allowed to weigh the impact of each new vaccine separately in the interest of their own children?

    We can say that a community must have the right to force its citizens to act in the common good. That is, for example, why driving drunk is illegal. You may have the right to put your own life in danger, but drunk driving impacts others. So we’d like to fall back on the notion of the community deciding who should do what for the common good. But here again, an honest appraisal of the wisdom of communities as opposed to the wisdom of individuals should make us take pause. In many historical periods, it would be “obvious” that we should force everyone to go to church for the common good. In certain societies, one could even have made the case that giving up one’s child for sacrifice to appease the gods was for the greater good. So free thinkers must be suspicious of any line of reasoning that puts the common wisdom at the helm of their parenting decisions in place of the individual liberty to make one’s own choices and to make choices for ones own offspring. I mean right now in Russia they are debating a law that will remove children from the homes of homosexuals because of the “obvious” threat they pose to the fabric of society. Can we rely on society to determine the norms we must raise our children by?

    So in the end the problem is that the “common good” is a weak reason to force parents to do something against their will. The weight of scientific evidence is of course a stronger argument, but since what passes as science now will be deemed something close to voodoo in a century or two, we shouldn’t get too smug about that either. Best medical practices have a way of being seen as less helpful and more harmful as the science progresses.

    You can make a solid case that vaccinations should be required. But trying to find a really bullet-proof philosophical foundation for that requirement is trickier. And as an atheist in a society that is often eager to tell me what I should believe, I am always suspicious of rule by social norm.

    Please note that all I have done here is discuss my discomfort with the foundation of mandatory vaccinations. I have not tried to claim the policy is necessarily wrong or that vaccinations on the whole are bad.

    In a recent study, doctors were more willing to advise patients to get a flu vaccine that had a small risk of paralysis than they were to actually choose the vaccine for themselves. It seems that the benefit of the vaccine obviously outweighed the tiny risk of harm when the doctor was thinking in clinical terms, but this advantage evaporated when it was their own bodies they were risking. The study concluded that doctors don’t make as sound medical judgements for themselves as they do for their patients. Another interpretation could be that medical science discounts actual risk by viewing humans as statistics.

    • David says:

      This is a fair consideration of something I find very complicated. When we allow government or society to determine what is best for children over the objection of the parents, we get into a really weird area.

      It seems like it is a no brainer to let “science” be our guide. Except when you make an honest appraisal of science you are left with a history not of enlightenment as much as of decreasing ignorance. 21st century medicine is not infallible. Suppose we had a parent that didm’t want his child leeched or bled 200 years ago? Would we want the best medical science of the time to trump the parents own feelings?

      We can point to the safety and general effectiveness of vaccines as a way to defend forcing parents to get their children vaccinated, but that does not settle the matter philosophically. Must we always allow medical science to dictate how parents raise their kids? Consider that new vaccines are riskier than older vaccines. Consider that no vaccine is perfectly safe. Consider that newer vaccines are less effective than older vaccines. Consider that no vaccine is perfectly effective. There is clearly margin of error in medical science in general and in vaccinations specifically. Should parents be allowed to weigh the impact of each new vaccine separately in the interest of their own children?

      We can say that a community must have the right to force its citizens to act in the common good. That is, for example, why driving drunk is illegal. You may have the right to put your own life in danger, but drunk driving impacts others. So we’d like to fall back on the notion of the community deciding who should do what for the common good. But here again, an honest appraisal of the wisdom of communities as opposed to the wisdom of individuals should make us take pause. In many historical periods, it would be “obvious” that we should force everyone to go to church for the common good. In certain societies, one could even have made the case that giving up one’s child for sacrifice to appease the gods was for the greater good. So free thinkers must be suspicious of any line of reasoning that puts the common wisdom at the helm of their parenting decisions in place of the individual liberty to make one’s own choices and to make choices for ones own offspring. I mean right now in Russia they are debating a law that will remove children from the homes of homosexuals because of the “obvious” threat they pose to the fabric of society. Can we rely on society to determine the norms we must raise our children by?

      So in the end the problem is that the “common good” is a weak reason to force parents to do something against their will. The weight of scientific evidence is of course a stronger argument, but since what passes as science now will be deemed something close to voodoo in a century or two, we shouldn’t get too smug about that either. Best medical practices have a way of being seen as less helpful and more harmful as the science progresses.

      You can make a solid case that vaccinations should be required. But trying to find a really bullet-proof philosophical foundation for that requirement is trickier. And as an atheist in a society that is often eager to tell me what I should believe, I am always suspicious of rule by social norm.

      Please note that all I have done here is discuss my discomfort with the foundation of mandatory vaccinations. I have not tried to claim the policy is necessarily wrong or that vaccinations on the whole are bad.

      In a recent study, doctors were more willing to advise patients to get a flu vaccine that had a small risk of paralysis than they were to actually choose the vaccine for themselves. It seems that the benefit of the vaccine obviously outweighed the tiny risk of harm when the doctor was thinking in clinical terms, but this advantage evaporated when it was their own bodies they were risking. The study concluded that doctors don’t make as sound medical judgements for themselves as they do for their patients. Another interpretation could be that medical science discounts actual risk by viewing humans as statistics.

      Hey Jonathan. Thank you for taking the time to offer a balanced and thoughtful comment. I’d like to address a couple of points you’ve made.

      First of all, I also find the idea of courts forcing parents to make their children have vaccines a little morally ambiguous. It is worth noting that this was a subtlety different case. This is just the sad side effect of disagreement. It’s also exactly what the courts are designed to deal with. When two parents have such opposing views an arbiter has to make the tough decision. Important to remember that the parents are the ones who brought this before the court and not the other way around. They chose, through an inability to compromise, to allow this court action. By doing so they also removed any element of choice their children would have had before hand. The courts have to abide by the best available evidence (although this clearly doesn’t away happen) when making their decisions. This includes judging the ability for the children to make a competent argument on their behalf. The irony would have been, considering we are both atheists, that a religious exemption may have forced the courts hand. The children being aged only 11 and 15 were more inclined to offer only their mothers objections as their own. This meant the court were bound to ignore their individual pleas and rely on the best available evidence. The legal term for this is ‘Gillick competence’.

      Now “best available evidence” is the real sticking point that you and I probably have and is probably the leading point from the reasonably waffling paragraph above.

      You use a couple of examples that I disagree with a little. You said, “Suppose we had a parent that didn’t want his child leeched or bled 200 years ago? Would we want the best medical science of the time to trump the parents own feelings?” You also said that, “what passes as science now will be deemed something close to voodoo in a century or two”. I think my answer to both these points lead into each other, so I’ll cover them

      I think you’ve made a small error in your deductive process. 200 years ago was pre-scientific and practitioners of medical modalities of the day were doing the best they could, with what they had. Observation and individual trial and error were the only way to practice medicine. Large studies with rigorous controls, scrutinised by peer review, just weren’t part of the process of practicing medicine. It is unfair to draw a comparison from pre-scientific times to scientific times. While is feels a bit counter intuitive you can’t use the term “best available evidence” to apply to the pre-scientific era. Why? Because the words don’t have the same mean as the do today. The “best available evidence” 200 years ago wasn’t scientific.

      Your point regarding how science will be viewed in a century or two falls down because of this. We have 5,000 years of prescientific medical practices. Stumbling from one observed placebo effect into the odd actual observed treatment, then more trial and error and lots of deaths. An over simplification, sure, but we know that vaccines are massively efficacious and have the data to support it. The same can’t be said for blood letting. But that’s only one part. We can’t extrapolate into the future very well. While we can’t say what’s ahead, we can say it’ll be scientific. Humanity may well cure all cancers and find a way supplementing our immune systems on a genetic level to remove the need for vaccines. But these will all be scientific in nature, based on the work that’s gone before.

      Another factor is the legal system itself. It’s not a point I want to dwell on because it isn’t hugely relevant to either your point or mine. The court had the opportunity to rule the MMR vaccine as no longer being controversial. No other vaccines are in this category. This is important for two reasons. Firstly, cases like this are likely to come about again. Secondly, with all other vaccines, where one parent opposes medical opinion and the other assents, the assenting parent by law takes precedents. This means no court and no tabloid drama.

      I think I’ve written enough!

  3. I thought this was quite interesting. It would have been helpful if the court had made the point that the MMR vaccine is no longer controversial.

    http://peterenglish.blogspot.co.uk/2013/10/mmr-and-courts-missed-opportunity.html

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