We should always be concerned when we hear that any patient has been ordered to have medical treatment against their wishes. Respecting a patient’s autonomy is a fundamental principle of medical ethics; it is like freedom of speech or the right to a fair trial and should only be breached in the most extreme circumstances. These principles still stand even when the patient in question is only 15 and the medical treatment in question is something as effective and important as the MMR vaccination – and so headlines such as ‘Judge orders sisters to have MMR jab against their wishes’ should make us sit up and start asking questions.
Only that is not what the judge ordered.
Despite the widespread reporting that a court order had been issued, in fact the judge said that she would ‘make a declaration that it is in the interests of both L and M to receive the MMR vaccination’. I’m reliably informed by legal types that this is very different to an order which must be obeyed, but a judgement in principle, and as such it has not breached anyone’s autonomy.
The case involves two sisters, aged 11 and 15, whose divorced parents, having been united not to fully vaccinate them against MMR when they were infants, now face a sharp disagreement about whether or not to catch up on the vaccines they missed. The girls share their mother’s views and do not want to receive the vaccine and so the father took the issue to a family court where the judge was asked to consider what was in their best interests. The declaration, however, is more like a recommendation – the wise council of an arbitrator – than a legally-binding command. What is concerning is that sloppy reporting has failed to notice the difference.
This matters greatly, because the damage is done as soon as these issues are misreported. The reputation of medical ethics is tarnished when it is seen to have over-stepped the mark; young people wary of seeing their doctor for fear of not being listened to will have had their image of patronising, authoritarian doctors reinforced by hearing these headlines, and may be prevented from seeking help; and vaccine conspiracy theorists will have their passions stoked by being given the false impression of the state imposing its will with scant disregard for alternative health beliefs.
The headline-makers may not feel that ‘Judge recommends sisters have MMR jab’ has quite the eye-catching quality they are looking for – but if we are to avoid the ripples of harm that can arise from such misinformation then we must get this reporting right, or at the very least robustly correct its errors.