According to two of Australia’s leading medical ethicists, there is no solid ethical argument why medical professionals should not vaccinate children aged 12 and over who want protection against COVID-19, even if their parents do not consent to the procedure.
Professor John Massie, Professor of Paediatrics at the University of Melbourne and a leading childhood bioethicist, said Preview+ in an exclusive podcast that at the heart of the problem was the child’s ability to make a decision in his or her own best interests.
“We assume adults have the ability to make decisions that are in their own best interests,” he said. “And then we have to work hard to prove that they don’t if they make a bad decision for themselves.
“In children it’s reversed – we assume children don’t have the ability to make decisions on their own.
“Most people would think that 16-year-olds can make most decisions on their own, then under 16-year-olds for virtually everything, kids would need a parent’s consent to start a procedure.”
The underlying ethical principle that should guide vaccinators when assessing a child’s capacity was the ‘doctrine of the mature minor’, Prof Massie said.
“The mature minor is a doctrine that is situated in the context of the procedure or intervention that is proposed. There will be a whole range of things that a young person could decide for themselves.
“If they have the ability to understand the nature of the disease, for example, the procedure, the side effects and the risks, they should be able to give consent for it to happen.”
The key was for the vaccine provider to assess each child’s ability to do so on an individual basis.
“Clearly the onus is on the provider to assess capacity and register it.”
In one outlook for the MJAProfessor Massie and his co-authors provide a chart of the kinds of things a clinician might want to consider when assessing a young person who is seeking a COVID-19 vaccine.
Professor Paul Komesaroff, professor of medicine at Monash University and executive director of the NGO Global Reconciliation, told InSight+ that the concept of vaccinating a child against their parents’ wishes was “uncontroversial” and “nothing new. “.
“[The mature minor doctrine] is a principle that involves judgment in individual cases,” he said.
“The choice, certainly in [judging] The Gillick competence comes down to the doctor making an assessment of the child on the basis of this privileged relationship that a health professional has with the young person.
“[Massie and colleagues] to offer a set of very conservative and, I suppose, practically useful guidelines for clinicians in all settings.
“They have made every effort not to state an extreme, exaggerated or even unfamiliar position. They make connections with existing legal and ethical frameworks to establish the principle that vaccination of young people aged 12 and over follows the same principles as other forms of medical treatment.
While the ethics of vaccinating children against their parents’ wishes are clear, the legal protections for vaccinators in a situation where parents may object remain “very complicated”, according to Professor Massie.
“The australian vaccination manual says there are various state rules, but if it’s not clear, the vaccine provider should rely on the mature minor doctrine,” he said.
“In some states, such as Queensland and Victoria, it is clear that the 12 to 15 year old group should be able to get vaccinated on their own.
“In South Australia, Western Australia and New South Wales you need parental consent, but in New South Wales it’s messy depending on who you ask.”
Prof Massie said it was not the role of the vaccine supplier to be “adversarial” with parents.
“We try to preserve parental involvement in care and treatment decisions – after all parents are the natural decision-makers for their children,” he said. Preview+.
“But they don’t have absolute authority or absolute sovereignty over their children. They are limited in their decision-making by their own ability to make a decision, which is ideally in the best interests of their child, or at least not detrimental to the interests of their children.
“The budding autonomy of the child must then be taken into account.
“You could build a record here that says the child makes that value judgment on their own about whether vaccines are good.
“So the weighting is on the child who has the capacity to make that decision.”
In another article published online first at MJAauthors from the Murdoch Children’s Research Institute and the University of Melbourne detailed the potential indirect impacts of the COVID‐19 pandemic on children.
“We identified 11 areas of impact, divided into three broad categories,” wrote the authors, led by Professor Sharon Goldfeld.
- Poorer mental health
- Poor health and child development
- Lower grades in school
Family level factors:
- Poor parental mental health
- Declining family income and job losses
- Increase in domestic stress
- Increased abuse and neglect
- Poor maternal and neonatal health.
Service Level Factors:
- School closures
- Reduced access to health care
- Increased use of technology for learning, connection and health care
Goldfeld and his colleagues have proposed five “potential policy areas” for policymakers to consider:
- Fighting financial instability with financial supplements for parents
- Expanding the role of schools in closing learning gaps and wellbeing
- Rethinking healthcare delivery to address reduced access
- Focus on prevention and early intervention in mental health
- Use digital solutions to address inequitable service delivery
“History shows us that children who already experience adversity lose the most, with the potential to worsen health inequities,” Goldfeld and his colleagues concluded. “Now is the time not just to mend the past, but to start reimagining the future for a more equitable Australia for children.”