Consent for Adolescent Vaccination: Issues and Current Practices

Abstract

To identify and describe implementation of state-level informed consent requirements for adolescent immunizations, current state regulations on informed consent and immunization services for children and adolescents were identified through the LEXIS-NEXIS legal data base. Regulations were coded for informed consent characteristics, consent exemptions, and current immunization requirements. State immunization program directors, project managers, and state hepatitis coordinators were surveyed to catalogue how regulations were implemented and document new policies or regulations under consideration. Parental consent for immunizations is standard practice in 43 states. Most states (n = 34) require separate consent for each injection when more than one injection is required to complete a vaccination, but only for a limited number of medical procedures. Nine states allow adolescents to self-consent for hepatitis B vaccination in sexually transmitted disease clinics and family planning clinics as part of the exemption for minors' receipt of sexual health services. Most states require consent for vaccination services provided to adolescents. Parental consent requirements are a potential barrier to vaccinating adolescents in some settings.

Human papillomavirus and cervical cancer behavioral surveillance in the US

“…47 Furthermore, parents may be unaware of all adolescent vaccinations because some, such as hepatitis B, may be administered without parental consent. 48 Collectively, these findings suggest that there is no gold standard against which to measure self-reported vaccine use and that self-reports concerning the HPV vaccine may suffer from measurement error, especially from parents reporting about their adolescents. Therefore, validity studies evaluating adolescents' self-reports of HPV vaccine use in healthcare settings with strong medical record and auxiliary data systems are needed to understand the magnitude and direction of biases attributable to under-reporting or over-reporting and to adjust national prevalence estimates.…”

Informed consent in vaccination in India: Medicolegal aspects

“…Most states require consent for vaccination services provided to adolescents. 13 As mentioned earlier, there is no Federal law making informed consent mandatory before vaccination.…”

Legal Basis of Consent for Health Care and Vaccination for Adolescents

“…However, vaccination generally would be covered under laws that more generally address consent for health care and, on the basis of statutes and/or court decisions, every state requires minors to have parental consent for most health care, including vaccination. 2, 13 When the parent is not available or does not have custody, depending on the specifics of an individual state's laws and the minor's particular circumstances, consent for health care generally may almost always be given by a legal guardian or a court and may sometimes be given by related caretakers, foster parents, social workers, or probation officers, who have the appropriate authority. This would likely also be true for vaccination.…”

“…With respect to vaccination, consent laws in a majority of states have been interpreted as requiring consent for each injection when more than 1 injection is required to complete a vaccination series. 13 The question of when adolescents may give consent for their own vaccination depends on an analysis of several factors: the age and capacity of the adolescent, the state in which the adolescent is seeking care, the legal status of the adolescent, the type of health care, and the disease for which vaccination is being administered. These factors are addressed in the minor consent laws, which are contained in 2 types of statutes in every state: laws that allow minors to give consent on the basis of their status ( Table 1) and those that allow minors to give consent on the basis of the services they are seeking (Table 2).…”

“…1 Both types of minor consent laws may be used to determine if an adolescent minor may consent for vaccination. 13 Minors who are generally allowed to consent for their own health care on the basis of their status (eg, age, emancipation, marriage, living apart from parents) would likely be able to consent for their own vaccinations unless a specific law explicitly precluded them from doing so. The concept of the mature minor, which was developed in court decisions and is widely accepted by legal scholars and courts, 2 enables certain older minors who have the capacity to give informed consent to do so for care that is within the mainstream of medical practice, not high risk, and provided in a nonnegligent manner.…”