A pediatrician faces the dilemma of whether to turn away unvaccinated children from practice because of growing anti-vaccination sentiment. The American Academy of Pediatrics changed the recommendation in 2016, allowing families who refuse vaccinations against diseases like measles after repeated attempts to be kicked out. About 40% of pediatricians choose to discharge such families rather than provide substandard care without vaccines. Ethical arguments for discharge include the moral obligation of parents to protect others and vaccination as a social contract. Arguments on both sides were heard in the New England Journal of Medicine in January, with Dr. Sean O'Leary advocated accepting unvaccinated patients. An example is the practice of Larchmont Pediatrics, where after refusing a vaccine at 3 months of age, they send an official discharge letter. The Academy of Pediatrics recommends vaccination against 18 diseases, as opposed to the CDC, which lists 11. Some doctors emphasize that they are punishing parents, not children.[1][2][3]