Vaccination over Parental Objection — Should Adolescents Be Allowed to Consent to Receiving Vaccines?

New England Journal of Medicine
July 11, 2019 Vol. 381 No. 2
http://www.nejm.org/toc/nejm/medical-journal

 

Perspective
Vaccination over Parental Objection — Should Adolescents Be Allowed to Consent to Receiving Vaccines?
Ross D. Silverman, J.D., M.P.H., Douglas J. Opel, M.D., M.P.H., and Saad B. Omer, M.B., B.S., M.P.H., Ph.D.
…Such cases raise the question of whether adolescent minors should be able to consent to vaccinations without parental permission. For minors to be able to choose to be vaccinated over parental objections, most states would need to make substantive changes to laws governing medical consent. Since children are generally considered nonautonomous under U.S. law, treatment of a child in a medical setting requires parental permission, typically until a child reaches 18 years of age. Parents are generally given broad discretion in making decisions on behalf of their children, in part because they know their child best, are positioned to weigh competing family interests, and are permitted to raise their child as they choose. Such discretion doesn’t mean that adolescents have no role in decisions that affect them, however. Out of respect for adolescents’ developing autonomy, clinicians routinely explore their understanding of health-related issues, solicit their agreement on care plans, navigate discordance between parental and adolescent preferences, and protect adolescents’ confidentiality interests.2
Both ethical principles and state laws also support independent decision making by adolescents in cases in which failing to grant adolescents autonomy could foreseeably result in substantial risk to the minor or to public health. For instance, all states have laws permitting minors to make independent, confidential clinical decisions regarding certain sensitive or stigmatized health care services, such as those related to sexual health, reproduction, mental health, and substance use disorders. Roughly 20% of jurisdictions require adolescents to be at least 12 or 14 years of age to make such decisions; others don’t designate a minimum age of consent.3 A court may also grant an older adolescent (typically 16 years or older) legal emancipation or deem the adolescent to be a “mature minor” who is able to make certain decisions independently.
Most states, however, don’t authorize adolescents to independently consent to vaccination…