Negotiation should resolve HPV vaccine consent conflict
MedWire News: UK researchers suggest that a negotiation process between all parties is the best way to determine whether to perform human papillomavirus (HPV) vaccination on school-aged girls when their and their parents' views conflict.
The current arrangement, involving parental consent forms, causes difficulties because forms are "subject to loss and confusion," they write in the Journal of Medical Ethics.
Furthermore, while the study results showed that some stakeholders have concerns about damaging relationships between parents and schools by going against parental wishes, many responders recognized that the Gillick guidelines could deem a girl competent to consent to vaccination without parental consent.
Gillick competency (legally recognized in England, Wales, Canada, Australia, and New Zealand) says that someone under the age of 16 years can give consent if they can demonstrate a capacity to sufficiently understand the proposed intervention, note the authors.
Fiona Wood and colleagues from Cardiff University reviewed the views of key stakeholders involved in the development and implementation of the 2008 UK HPV vaccination program in schools for all girls aged 12-13 years. In particular, the team explored how the process of consent for the vaccine should proceed if conflict exists between parents and their daughter.
Wood and co-investigators interviewed 14 professionals involved in the vaccination program's development and 11 professionals involved in its implementation (including school nurses and head teachers).
Overall, three responders - all involved in the development rather than implementation of the vaccine program - believed that the Gillick guidelines removed all dilemma with regard to parents not providing consent, but their daughters consenting to the vaccination.
A further four responders believed that while Gillick was helpful, parents should be informed that their daughter had given consent and their agreement should be sought where necessary.
One responder - a head teacher - felt that the relationship between parents and the school could be damaged if the vaccine was administered against parental preference.
However, nearly all responders made reference to difficulties establishing parental consent for a school-based program. These included children forgetting to take their form home, not returning it to school, and parental ambivalence.
Responders also raised concerns about how to establish Gillick competency in a school setting, in the absence of parental consent.
"Those administering the vaccine need to be confidence in their local guidance on how to manage difficult situations and will need to ensure that they are able to assess competence in adolescents, should this be required, or be able to refer the girl to somebody who can make that decision," say Wood et al.
"Conflicting consent for this vaccine, and others like it, needs to be a negotiated process between parents, adolescents and the vaccinators," they conclude.
By Sarah Guy