Medical professionals weigh in on minors’ right to consent to immunizations
Tuesday, December 17, 2019
As outbreaks of preventable diseases, namely measles, have become relatively commonplace in recent years, some physicians are supporting laws that would give adolescents the right to choose to be vaccinated over parental objections before the age of 18.
In an article published in the New England Journal of Medicine (NEJM) last July, two health policy professors, along with Seattle-based pediatrician Douglas Opal,elaborated on why they believe states should enact laws that expand access to vaccines and the right to consent to vaccination for minors at least 12 to 14 years of age.
“We argue for the expansion of the rights of adolescents to make their own decisions to be vaccinated against serious and potentially life-threatening diseases without requiring parental consent and involvement,” stated a separate alliance, including State University of New York professor of pediatrics Dana Shaw of in a viewpoint piece published by the Journal of American Medical Association (JAMA).
The issue of conflicting viewpoints on vaccines between parents and teens hit the national media when Ohio high school senior Ethan Lindenberger shared his experience of trying to get vaccinated despite his mother’s objections in his testimony before a Senate committee last March.
According to the NEJM group, laws granting adolescents the authority to agree to vaccination without parental permission would allow them to catch up on any missed childhood vaccines. More importantly, it could improve rates of vaccination against diseases such as measles, although they concede it wouldn’t address all problems with vaccine uptake and access.
How many adolescents would benefit from such laws isn’t clear. For example, a 2016 Pew Research survey showed only 10% of adults in the U.S. said the risks of the MMR vaccine against measles, mumps and rubella outweigh the benefits.
States would need to make substantive changes to laws governing medical consent for minors. Currently, the vast majority don’t permit vaccination without parental permission with the exception of hepatitis B and HPV vaccines, which fall into the sensitive or stigmatized healthcare services category in some states. This allows adolescents to independently access medical care related to reproductive health, drug and alcohol abuse, and prevention of sexually transmitted infections (STIs).
The HPV vaccine, which offers protection against the virus human papillomavirus known to cause several types of cancer and the most common sexually transmitted infection in the U.S., has come under fire according to Claudia Borzutzky, a physician in the adolescent medicine clinic at Children’s Hospital Los Angeles in a NewScientist article.
“We don’t have the same resistance to hepatitis B as we do with other vaccines, which is mysterious to me because all our vaccines have the same efficacy. People forget it’s an STI,” she notes.
For minors wanting to get vaccinated, Borzutzky recommends researching the rights they have under law in their state through public health departments as well as turning to a school nurse or social worker at a clinic for guidance. These professionals may also be enlisted to help convince parents to support their child’s decision, which she sees as the best strategy.
“We would always rather engage parents and have them on board for any healthcare we provide a young person, as long as the parent is going to be supportive,” she says. “There are parents who will come around on vaccines, but it’s not always in one visit. It may be over months or years.”
Similarly, Cora Breuner, a pediatrician at Seattle Children's Hospital and the chair of the American Academy of Pediatrics' committee on adolescence, prefers engaging in dialogue with parents about the need for vaccines.
Creating a rift that divides families is not the goal, she says in an NBC News article. To that end, the AAP has no formal position on new bills that allow teens to get the HPV vaccine on their own, but acknowledges that parents should generally be recognized as the best people to make medical decisions for children and teens.
“As a pediatrician, my complete moral compass, is that the family has the right to determine the medical welfare of their children,” she said. “Education, persuasion, gentle and compassionate understanding of other opinions is the way to go.”
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