Parental Consent as a Barrier to HPV Vaccination: Should Adolescents Call the Shots?
Both individual and system-level barriers contribute to the low rates of HPV vaccination among adolescents.
Individual-level factors as well as system-level barriers contribute to the low rates of human papillomavirus (HPV) vaccination. Investigators reporting in the Journal of Medical Ethics suggest that allowing adolescents to consent to the HPV vaccine without parental approval is ethically justifiable and should help in improving vaccine rates and reducing the risk for HPV among the population at large.
The need for parental consent represents one of the most substantial system-level barriers to increasing HPV vaccination rates among minors. According to investigators, similar ethical measures justifying the right of adolescents to consent to sexual and reproductive care "also justify permitting minors to consent to HPV vaccination." Although parents are typically the decision-makers in their child's healthcare, certain sensitive health subjects are harder to approach because of many adolescents' reluctance to discuss these issues with their family. Sexual health is one such example, in which physicians can help teenagers and young adults learn about measures that will prevent unplanned pregnancy, HIV infection, and HPV.
Many states vary in regard to whether the HPV vaccine is an acceptable exclusion from standard parental consent laws. Governor Jerry Brown of California signed a state law in 2011 allowing adolescents to consent to medical services that help prevent the spread of sexually transmitted infections. Healthcare professionals believe this law should be enacted in most, if not all, states. Ultimately, this may help minimize delays in vaccination and reduce the overall incidence of cervical, oropharyngeal, and anal cancers.
Although this proposed legislature may increase the risk of reducing parents' trust for their child's physician, this risk is not unique to the HPV vaccine. The cornerstone of modern bioethics is the respect for patient autonomy; however, many adolescents fall into a grey area with regard to whether they are capable of making sound and carefully thought out medical decisions.
Despite the foreseeable challenges in allowing consent for the HPV vaccine among adolescent patients, physicians are encouraged to prioritize open communication and trust with patients, which may help patients "come to the provider for indicated medical care — including, and perhaps especially, for sensitive issues."
Agrawal S, Morain SR. Who calls the shots? The ethics of adolescent self-consent for HPV vaccination [published online February 24, 2018]. J Med Ethics. doi: 10.1136/medethics-2017-104694