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The Ethics of Letting the Adolescent Patient, Instead of the Parent, Decide About Vaccinations

April 27, 2022

At every visit, I talk about vaccines. Even when vaccines aren’t due, I talk about the next ones that are due and make a statement that I recommend those vaccines. I do this because I want to make sure that the family hears a strong recommendation about vaccines. I have had countless experiences in which I ask whether everyone above the age of 5 is vaccinated against SARS-CoV-2 and a parent will say that they are not vaccinated, because their doctor did not say anything, and so they assumed that the doctor did not want them to get vaccinated. I don’t want that to happen, and so I make it a point to say something positive about vaccines at every patient encounter.

I have also had encounters in which the parent might want to get their child vaccinated against influenza or SARS-CoV-2 but either the child volunteers that “Shots hurt! I don’t want one!” or the parent asks the child, “Do you want a shot today?” I am always astounded when the parent goes against their inclination and turns to me and says, “They don’t want a shot today. So we won’t get it.”

For someone who considers every vaccine a small victory, that is obviously disappointing.

If I am frustrated when a parent listens to the child who doesn’t want a vaccine, I am acknowledging my bias that the parent should make the decision, even if the child doesn’t agree, because the parent is the decision-maker.

What if the parent doesn’t want the vaccine, but the child does? Although this occurs less frequently than the reverse, it does happen. Can I advocate for the parent to be the decision-maker only when I think that the parent is right? Should I advocate for the adolescent who wants to get the SARS-CoV-2 vaccine, even if their parent disagrees?

This week, Pediatrics is early releasing a thoughtful Pediatrics Perspectives by Dr. Lainie Friedman Ross, a bioethicist from the University of Chicago, entitled, “State vs Adolescent Override for Parental Refusals to Vaccinate against COVID-19” (10.1542/peds.2022-056369). She tackles this very issue. Should adolescents be able to consent for vaccines when their parents don’t?

Dr. Ross argues the pros and cons of 3 different approaches:

  • Recognizing the autonomy of adolescents to make their own health care decisions.
  • Understanding that requiring parental consent may not be in the best interest of the adolescent, as it could lead to delays in diagnosis and management that could be detrimental. She notes that there is precedent for this, as most states allow adolescents to make decisions about mental, sexual, and reproductive health.
  • Mandating vaccinations at the state level.

Please read this thoughtful Pediatrics Perspectives. The points that Dr. Ross makes are ones that are relevant to multiple health care encounters with older youth and adolescents, not just those involving vaccination discussions.

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