By Dr. Laura Kicklighter
The case “A Minor Problem” asks when, if ever, teens should be able to access medical care without parental consent.
Parental decision-making is an example of “justified paternalism” – a legitimate exercise of parental authority. In this model, parents are assumed to be acting in their children’s best interests and are empowered to make medical decisions that reflect their own values.
Although paternalism may be justified for young children, it becomes ambiguous when applied to teenagers, who may be able to make informed decisions on their own. In bioethics, a person’s “decisional capacity” is determined by assessing their ability to make an informed choice; an adolescent could possess the ability to make informed choices even though they are a minor.
What happens when a parent and a teenager disagree about the child’s best interests? Teenagers sometimes know their interests better than their parents do, and parents’ decisions aren’t always in the child’s best interests. Adolescents also can have different values than their parents’.
Many states make exceptions to parental consent for reproductive health care, treatment for sexually transmitted infections, and mental health. The rationale centers on public health interests and the importance of trust between doctor and patient.
Does allowing teens access to the Covid-19 vaccine also meet these criteria? Covid is clearly a compelling public health concern, yet According to the American Academy of Pediatrics, only around 60% of children between 12-17 have received both doses of the Covid-19 vaccine. Although people in this age group are less likely to become seriously ill from Covid-19, they are far more likely to be in situations like schools where the disease is easily spread; a 60% vaccination rate is not significant enough to limit this spread.
In circumstances where teens seek access to care that their parents reject, doctors must choose between competing duties to parents, the individual patient, and public health. Should parental consent always be required? If teens can access some medical care on their own, where do we draw the line?
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This case can be found here. Ethics Bowl has open meetings on Thursdays at 7:00. Contact Kicklighter@lynchburg.edu.