This article about COVID-19 vaccine parental consent was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), who is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy, and the law.
Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also a member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease. She is also a member of the Vaccines Working Group on Ethics and Policy.
On May 10, 2021, the FDA authorized Pfizer’s mRNA vaccine against COVID-19 for emergency use in teens aged 12-15. Even before that, the vaccine was authorized in teens 16 and up. This raises a question that has been coming up occasionally – if teens in this age group want to get the COVID-19 vaccine, but their parents object, can they do it without parental consent? The short answer is that it depends.
The starting point is that laws allowing minors to consent to medical procedures generally, and vaccines specifically, vary across states. In a recent and important effort, teen Kelly Danielpour from Los Angeles put together minor consent laws across the United States, state by state.
In some states, minors may already be able to consent to get vaccinated without parental permission. That is, for example, the case in Alabama. In other states, like California, teens cannot consent to medical procedures generally, though there are some exceptions (for example, in the vaccine context, teens over 12 can get HPV or hepatitis B vaccines).
Some other states do not have a statute allowing minors to consent but may have judicial doctrines – known as mature minor doctrines – which allow minors to consent to certain medical procedures. Often, these doctrines require case-by-case assessment by doctors, who may or may not be willing to do what the minor wants.
If you are in a state that does not have a law allowing a minor to consent, the teen’s options may be limited. One option is to reach out to children’s law organizations and see if they would help one argue for a judicial mature minor doctrine.
It may also be appropriate for children’s rights groups to mobilize to argue for access to vaccines for teens.
In an article in the New England Journal of Medicine, scholars Ross Silverman, Douglas Opel, and Saad Omer argued for allowing teens to consent to vaccines. In a lengthy article published in the Connecticut Law Review, Prof. Lois Weithorn (who specializes in children’s rights and minor consent) and I also made a case for allowing minors to consent to routine childhood vaccines.
We based that on the extensive data showing that the risks of childhood vaccines are low, their benefits high, and on data on minor’s ability to consent. We recommended states adopt a model law allowing minors to consent to vaccines from the age of 14 and up, and allowing judicial consideration of permitting vaccines without parental consent to children 12-13.
COVID-19 vaccine parental consent
That said, parental consent considerations for the COVID-19 vaccine are not quite the same, for two reasons:
- The risks of COVID-19 appear to decrease with age, absent certain medical conditions, so teens are at lower risk from older people.
- COVID-19 vaccines are new, and there is limited data for their safety in, especially, younger teens – we have a very positive clinical trial, but it has less than 3,000 teens. This raises the question of whether we want to allow teens to get these vaccines without parental consent.
On the other hand is the reality that although the risks of COVID-19 are lower in younger people, they do exist – children have died, been hospitalized, and left with long-term harm by the disease.
And although the data has been limited in the trial for younger people, at the point of writing over 600,000 people under 18 have been fully vaccinated against COVID-19 in the United States, and over two million have had at least one dose of a COVID-19 vaccine, with no real safety signals appearing.
Further, teens’ lives have been thoroughly disrupted by COVID-19 – vaccinating may allow them to safely resume much of their old lives. Under these circumstances, there is at least a strong case for allowing teens to vaccinate against COVID-19 without parental consent.
As the last wrinkle, teens – and young adults on their parent’s medical insurance – should be aware that there is at least a chance that even in states that allow teens to consent to vaccines, information about their choice to vaccinate may be available to their parents through insurance billing.
The specifics will vary too much to generalize, but since confidentiality has impacted teens’ choice to use healthcare in another context, it’s worth alerting people to the issue. Teens that have the legal right to choose to vaccinate may want to check with a provider what the clinic says on that, and whether there will be records reaching their parents, or use a mass vaccination site or health department.
I am frankly unsure whether pharmacies inform insurance carriers of vaccines, and whether it’s noted in programs, and would be happy to learn more about it, but confidentiality is something to check.
In short, whether teens can vaccinate without parental consent varies by state, and in states without friendly laws, options may be limited (though there are potential options to check).
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