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The rules of evidence: A court’s decision on vaccinations

posted on Mon, Jun 20 2016 11:33 am by Colleen Healy

Despite the abundance of reliable evidence supporting the safety and efficacy of vaccines, many voices continue to propagate misinformation about vaccines. Whether from public figures or figures made public by their stance on vaccines, there is no shortage of “evidence” opposing vaccination, both for those inclined to go looking for it and for conscientious parents attempting to navigate the issue for the first time. On top of the messy informational environment, numerous studies document the many psychological and social factors that affect parental decision-making about vaccination. The CDC has cautioned that even if statewide vaccination rates are high, “geographic pockets of low vaccination coverage and high exemption levels can place children at risk for vaccine-preventable diseases.”  

State legislatures and health departments have taken a variety of steps aimed at shaping the legal environment in which vaccination decisions are made, ranging from repealing and/or limiting the availability of nonmedical exemptions, to decreasing the ease with which exemptions may be obtained, to mandating education of parents choosing to decline vaccination.

Courts have typically garnered public attention when confronted with legal (rather than factual) issues associated with vaccine policy, such as constitutional challenges to mandatory vaccination. Distinctly different issues arise, however, when a child’s parents argue with each other – rather than with the state – about whether or not to vaccinate their child. In these cases, where courts evaluate the best interests of a particular child rather than determining the reach and limits of the law, courts may find themselves wading into the messy informational and social environment described above to resolve a factual dispute about the efficacy and safety of vaccines. While certainly no one is immune to bias, judicial decision-making offers a unique lens to the vaccination debate since a judge’s decision must account for the rules of evidence.

In 2015, the Michigan Court of Appeals faced precisely this issue. The case arose after a lower court considered documentary evidence submitted by both parents regarding vaccination and concluded that the father, who favored vaccination, had not adequately demonstrated that vaccination was in the children’s best interests. The appeals court reversed the decision after rejecting the mother’s contradictory evidence, concluding it was almost entirely inadmissible because it came from unreliable sources.

The mother’s inadmissible evidence included reports and articles from websites such as Wikipedia.com (advertised as a site that anyone can edit) and Snopes.com (“the definitive Internet reference source for urban legends, folklore, myths, rumors, and misinformation” according to the description on website’s homepage), as well as articles and blog posts that failed to show the authors’ personal involvement in, or specific references to, scientific studies. In contrast, the father’s evidence in support of vaccination came from the CDC and other government websites. His evidence was deemed admissible because it carried “indicia of reliability,” including preparation by experts, basis in scientific studies, and dissemination by public officials invoking a special duty of accuracy. The appeals court also admitted evidence submitted by the mother from vaccines.gov and the CDC showing possible side effects of vaccination, but the court concluded these sources “reveal that severe and even moderate risks are rare and far outweighed by vaccine benefits.”

After reviewing and rejecting inadmissible evidence, the court found that vaccination was in the children’s best interests and ordered that they be brought into compliance with their pediatrician’s vaccination recommendations. More broadly, the court confirmed in legal language what public health experts have said for years: “A review of the parties’ [admissible] evidence clearly supports that vaccination of children is in their best interests, unless the child’s medical condition contraindicates vaccination.”

This post was developed by Colleen Healy, Staff Attorney, at the Network for Public Health Law – Mid-States Region at the University of Michigan School of Public Health.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.

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