There’s a new twist to the ongoing vaccine debate: Doctors are increasingly “firing” patients whose refuse to vaccinate their children, according to a new report from The Wall Street Journal.

One office in Michigan, for example, made the decision to stop treating vaccine-refusers because they could expose children — some of whom are too young for some shots — to diseases:

In one case, an unvaccinated child came in with a high fever and Dr. [Allan] LaReau feared the patient might have meningitis, a contagious, potentially deadly infection of the brain and spinal cord for which a vaccine commonly is given. “I lost a lot more sleep than I usually do” worrying about the situation, he said.

“You feel badly about losing a nice family from the practice,” added Dr. LaReau, but families who refused to vaccinate their kids were told that “this is going to be a difficult relationship without this core part of pediatrics.” Some families chose to go elsewhere while others agreed to have their kids inoculated.

Dr. LaReau’s office isn’t alone: 30 percent of Connecticut pediatricians who participated in a 2011 study reported asking a patient to leave their practice after refusing vaccines, while 21 percent of Midwestern pediatricians interviewed in a second survey did the same. Earlier surveys from 2001 and 2006 showed that only 6 percent of doctors “routinely” stopped working with vaccine-resistant families, with 16 percent “sometimes” dismissing them.

The controversy tugs at the heart of both medicine and parenting: Who has the right to decide what is best for both a child and the community? And if there is a disagreement, what is the proper recourse?

The American Academy of Pediatrics (AAP) does not recommend firing patients; rather, it asks doctors to keep seeing children — and stressing the importance of vaccines — unless there’s a significant health risk. But some doctors may be pushed to the brink of making such a decision:

As patients have become savvier and more willing to challenge doctors, physicians have become increasingly reluctant to deal with uncooperative patients, said Arthur Caplan, a bioethics professor at the University of Pennsylvania. In addition, doctors may feel financial pressure to see more patients and so have less time to contend with recalcitrant ones.

The rise of parents doing their own vaccine research — in large part due to the wealth of information that can be found on the Web — has caused some to refuse inoculations for reasons ranging from fears about autism (despite no scientific link between the vaccinations and the disorder) to concerns about the sheer number of vaccines children are exposed to. While there are some doctors, including Dr. Robert Sears, who advocate an alternative vaccine schedule, doctors willing to alter or disregard scheduled vaccines can be few and far between.

Take the case of Pamela Felice, profiled in the Journal:

Ms. Felice received a letter from her pediatrician a few years ago stating that because the family chose not to vaccinate, it needed to find another doctor. She called four or five other practices but none would agree to an appointment after she told them she was opposed to vaccines. The family ended up with an elderly family doctor who said he had “seen it all” and was willing to treat the children if they got sick, Ms. Felice said.

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