How should doctors like me approach teens like Ethan Lindenberger, who asked to be vaccinated against his mother's wishes?
Should we refuse a teenager the right to protect himself from a preventable disease or respect the authority of the parents for raising their child as they see fit?
As a physician who cared for critically ill children for more than 30 years at Phoenix Children's Hospital in Arizona, I've taken care of several young children who were not vaccinated and who developed measles, leading to advanced medical care.
Despite parents seeing their child stricken with a preventable disease, they all stood their ground and still refused to vaccinate. There was no recourse on our part to change their mind or intervene. Parental values and their best interest regarding their children trumped the evidence of the outcome of their decisions.
Is parental consent required?
In declining vaccinations for their child, many parents believe that vaccinations could cause ill effects that could compromise their child. They want to protect their child against all odds. It is that single interest in protecting the child from harm that comes into question.
The parents have good intent. But their action — or inaction — could be construed based solely on their own bias, with little regard for the danger they are putting their child in. When parenting brings harm to a child such as abuse or neglect, society and the law intervene to protect the child.
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Not vaccinating a child and later having that child die of a preventable disease is harm.
The law already allows adolescents to receive medical care without parental consent if it relates to the reproductive system. That means a patient younger than 18 can seek treatment for a sexually transmitted disease, can request testing for HIV and a prescription for birth control.
But when do teens reach maturity to make their own decisions regarding every aspect of their health?
How we should define a 'mature minor'
That's a grayer area.
Teenagers who realize that vaccines had not been offered them as a child may become resilient to parental demands and beliefs. They may see firsthand the destruction of life by preventable disease and seek self-protection, ensuring that they will have a meaningful life. If so, they do so without parental consent and trust that physicians to whom they turn for help will support them when they ask for a vaccine.
Physicians are duty and oath bound to serve those who come to them for help, to prevent harm from happening and to be virtuous in their care. Physicians engage in not only taking care of patients but engage in caring for and caring about them.
A teen who understands the ramifications of illnesses, especially those that are preventable, can be considered a "mature minor." In American law, albeit not recognized in all states, the Mature-Minor Doctrine says that an unemancipated minor patient may have the maturity to choose or reject a health care treatment, sometimes without the knowledge or agreement of their parents, and should be allowed to do so.
We entitle teenagers to self-worth and a right to be autonomous in their medical decisions as long as the decisions do not lead to personal harm. Teenagers can be mature minors if they understand the consequences, risks and benefits of their decisions.
In my opinion, they need no parental consent.
David Beyda, MD, is chair and professor of the Department of Bioethics and Medical Humanism at the University of Arizona College of Medicine — Phoenix. He is the former division chief of Critical Care Medicine at Phoenix Children's Hospital, where he also served as chairman of the hospital's Bioethics Committee. This column first appeared in The Arizona Republic.
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This article originally appeared on Arizona Republic: Doctor: Teens who want vaccines shouldn't need parental consent