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Carl von Clausewitz was a Prussian general and military theorist who famously said: “War is a mere continuation of politics by other means,” (“Der Krieg ist eine bloße Fortsetzung der Politik mit anderen Mitteln”). I leave the full parsing of its meaning to other military strategists. But, the quote serves as a useful segue to discuss how divorced parents sometimes use the medico-legal playing field to continue their battles. 

The Kagens were divorced in 2012. They were awarded joint legal and physical custody. As defined by their divorce judgment, neither parent was allowed to make major medical decisions relating to the children without consulting the other.  

Mom discontinued the daughters’ vaccinations when they were 3 and 5 years old respectively – long before the couple’s divorce. She asserted she maintained religious objections. She contended Dad shared those concerns. (Dad claimed he was blindsided by his ex-wife’s religious reformation and was unaware his kids had not received updated vaccines until 5 years later.) 

Over Mom’s objections, Dad secured four vaccinations for their eldest daughter in February, 2013.  Mom then filed a motion with the circuit court to prevent any further unilateral action by the father.  

The lower court excluded statements from government agencies supporting the benefits of vaccinations. These statements were submitted by the father to buttress his position. One these documents were excluded, the circuit court concluded that without supporting evidence, a change in course of conduct by Mom was not in the children’s best interests.  

Michigan appellate court overruled. 

Mom’s documents were deemed by the court to be inherently untrustworthy.  Mom submitted a Wikipedia article detailing a list of vaccine ingredients. The court ruled that anyone can update or edit a Wikipedia article. Mom submitted an article entitled, “Should Mickey and Minnie Mouse Be Vaccinated?” from Dr. Brownstein’s Holistic Medicine Blog.  The court held that a blog by its very nature is not akin to a formal and official statement presented by a government agency. An article from a doctor unconnected to any scientific study does not share the characteristics of trustworthiness necessary to be admitted. The court reached a similar conclusion for the article – “On Gardasil.” Other articles were similarly rejected. 

What did pass the court’s filter? The father’s information from the CDC, FDA, and NIH’s National Center for Complementary and Alternative Medicine.  The mother’s information from the National Vaccine Program Office and the CDC was also allowed. While warning readers of the potential risks associated with vaccinations, it revealed that severe and even moderate risks are rare and far outweighed by vaccine benefits. A letter from the children’s pediatrician recommended vaccinating the children and clearly enumerated which vaccinations the eldest daughter had yet to receive and were recommended specifically for her. The mother never argued that the children had ever experienced an allergic reaction to a vaccine. No evidence indicated that either child had a compromised immune system or a history of seizures which might have cautioned against the administration of vaccinations.  

The court ruled Dad could control the vaccination schedule. 

Sometimes divorced parents have legitimate philosophical differences on how to care for their children. Sometimes those philosophical differences contribute to their divorce. In this particular case, if the children had received vaccines according to the recommended schedule through the age of three, they would likely have already received baseline protection against the dangerous childhood diseases. A simpler path before bringing in lawyers and spending oodles of money might have been to obtain blood antibody titers demonstrating immunity. That, of course, is the desired outcome of vaccinations. This would not have addressed the issue of influenza vaccines (which did not appear to be the issue being litigated). And it would not have addressed the issues of Gardasil or meningococcus – which typically are addressed late teens.  

Maybe the battle over a medical issue was beside the point. 

Anyway, as a physician, be careful about getting sucked into the drama of divorced parents. Sometimes, it’s unavoidable. But, it’s a vortex that can create a fair amount of collateral damage. 

Kagen v. Kagen, 2015 WL 4254993 (Mich.App., Jul. 14, 2015)

What do you think? Share your comments below. 

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