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‘A clear line.’ When parents want mask exemptions for kids, doctors face ethical choice

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Posted at 7:10 PM, Aug 12, 2021
and last updated 2021-08-12 19:15:08-04

LEXINGTON, KY. (LEX 18) — As the politicized debate around masks continues, some medical professionals are getting requests from parents to get their children an exemption from having to wear a face covering — but the cases where an exemption is legitimately called for are rare.

Kentucky Gov. Andy Beshear announced a mask mandate for all schools in the state on Tuesday, and on Thursday the Kentucky Board of Education also issued an emergency mask regulation for public schools statewide.

Dr. Beth Hawse, a pediatrician with Commonwealth Pediatrics in Lexington, has gotten calls from parents of young children hoping to get an exemption. But of thousands of patients at Hawse’s practice, only four or five qualify for a mask exemption. The parents of those kids have known for a while that their child would have difficulties and already had plans in place, Hawse said.

The American Academy of Pediatrics advises healthcare providers being asked for mask exemptions by a patient to convey that masks are safe for “nearly all children 2 years of age or older, including the vast majority of children with underlying health conditions, with rare exception.”

The guidelines from the the American Academy of Pediatrics and the CDC call for exemptions only for children who are unable to voluntarily remove the mask either because of a physical or developmental disability, Hawse said.

In Fayette County Public Schools, medical exemptions have to be submitted to the school or a department head in writing and on the official letterhead of a physician, pediatrician or psychologist’s office and signed by a medical professional.

Hawse has been pushed by some parents to give a mask exemption for their child.

“My job as a pediatrician and as a physician is to do what’s right for my patient and first do no harm,” Hawse said. “So it’s a pretty easy answer, that they are safer in a mask than without.”

For some doctors it may be hard to say no.

“I’m sure it is more difficult when you are with people that you have both a personal and professional relationship, and we all hate to make people mad,” Hawse said. “Generally pediatricians are pretty nice people and we don’t like to make people upset … but sometimes what they’re asking is harmful to their child, who is our patient. So that’s a clear line that we just don’t cross.”

If a licensed healthcare provider is caught giving fraudulent medical exemptions for masks, they could face a number of repercussions. The person involved could be forced to take an ethics class, be admonished or warned, reprimanded, suspended or have their medical license revoked altogether, said Michael S. Rodman, executive director of the Kentucky Medical Licensure Board.

For Hawse, there are other consequences that matter more.

“I want to be able to sleep at night … I don’t want to give someone a mask exemption and then that child is sick and I feel responsible for that,” Hawse said. “I have a moral and ethical obligation and I want to follow that. To me, it might not make somebody happy with what I’m saying, but it’s not a difficult decision.”

Masks make children safer, Hawse said, and the key to getting children to deal with wearing a mask is to practice at home.

“I would remind people, as I am reminding my patients, that they really should be wearing those when they are in the grocery with you, if they’re running errands with you if they’re indoors, because they’ve not had the opportunity to be vaccinated yet,” Hawse said. “And it’s something they need to learn anyway. That’s a skill just like any other skill, like learning to tie your shoes … and it may take time.”

Additionally, children’s anxiety around masks usually comes from their parents’ anxiety around masks, Hawse said. When parents normalize masks, children follow their example.

“The way you present things to your child affects that level of anxiety,” Hawse said. “If you’re super anxious about them wearing a mask, they’re going to be anxious … you as a parent are sort of their bedrock of stability.”

There’s years of data that show masks do not harm children emotionally or physically, Hawse said.

“Pre-COVID days, there’s a reason that they manufactured masks that are for kids … and that’s because kids who are immunosuppressed, kids who are on transplant lists for heart, lung, liver, kidney transplants, kids who are born with rare diseases where their immune systems not developed, kids with cystic fibrosis, kids with cancer — they have all worn masks when they’re out and about to protect themselves,” Hawse said.

Hawse acknowledges no one likes wearing masks, but said that they are part of the reality we’re all living in.

“Part of parenting and raising healthy, happy kids is teaching them that when life throws you curveballs — because all life is, really, is one curveball after another — you have to learn to cope and to deal with it and to move on,” Hawse said. “You may not like it, but it is what it is, and we’re all going to have to do this together.”