Public Health Law Map - Beta 5 - Medical and Public Health Law Site

eligion or conscience. Thus, he cannot claim freedom from compulsory
vaccination for the child more than for himself on religious grounds. The
right to practice religion freely does not include liberty to expose the
community or the child to communicable disease or the latter to ill health or
death.
Despite the clear language of the U.S. Supreme Court, nearly all state immunization
laws provide an exemption for persons with religious objections to immunization.
This creates a large loophole because the Constitution will not allow laws that favor
one religion over another. Christian Scientists are exempt if they choose to be, but so
are individuals who have their own unique religious beliefs. If a state provides a
religious exemption, the state may not question the validity of the religious beliefs of
those who invoke the exception.
State compulsory immunization laws contain these exemptions because few
legislators understand the public health and safety implications of immunization. No
states exempt religious groups from child abuse laws or other criminal laws intended
to protect either children or the general public. Physicians should make a concerted
effort to educate their legislators to the risks of allowing children to remain
unimmunized.
3. Consent for Immunizations
All states require that children be immunized for certain diseases before entering
school. Since school attendance is mandatory, the law makes immunization
mandatory. Philosophically, it is absurd to speak of informed consent to a mandatory
treatment. Nonetheless, physicians are expected to obtain informed consent for these
immunizations. There is only one acceptable way to obtain this consent: using the
federally promulgated vaccine information pamphlets. [Goldsmith MF. Vaccine
information pamphlets here but some physicians react strongly. JAMA.
1992;267:2005– 2007.] These are often referred to as the Important Information
Forms because of their introductory header. They are available from the vaccine
distributors, state health departments, and the CDC. The forms have a section to
document the consent, including the manufacturer and lot number for the biological,
and the date of the immunization. Although not part of the mandatory information, it
is also useful to record the name of the person administering the immunization.
It is imperative that every patient or person authorizing the immunization (parent or
guardian) be given the information in the federal form and a copy to keep. The
consent can be further documented in a more conventional immunization record such
as those provided by the World Health Organization. These formal immunization
records are useful to show that the child’s immunization status is current.
4. Medical Exemptions
All state immunization laws contain an exemption for individuals with medical
contraindications to immunization. It is beyond the scope of this book to list all
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