From vaccinations to treatments for chronic illnesses and conditions, when — and in what cases — should minors be able to decide what’s best for their own health?
It started with a Reddit post at the end of 2018. Ethan Lindenberger was reaching out to the internet for advice on how to get vaccinated now that he was an adult.
“My parents are kind of stupid and don’t believe in vaccines,” he wrote, before going on to explain he’d had countless arguments with them on the topic over the years to no avail.
Now that he was finally 18, he wanted to take matters into his own hands.
Reddit came through. Lindenberger was able to get vaccinated, but he didn’t stop there. In March 2019, he appeared before Congress to share his story and speak against the groups he claims are responsible for spreading misinformation and fear about vaccines to people like his mother.
Lindenberger isn’t alone in wanting to go against his parents’ wishes when it comes to vaccines.
While most medical practitioners and government officials are united in support of vaccinations, the states seem to be torn on how to deal with minors who want to go against their parents’ wishes to skip those vaccinations.
Some states, such as California and Delaware, have laws in place that allow children as young as 12 to receive treatment without parental consent when it comes to things like vaccinations and reproductive healthcare.
Other states, such as Alaska and Idaho, allow medical practitioners to determine if a minor is capable of making these decisions for themselves in the event the parent or guardian goes against medical advice.
But the vast majority of states still leave these choices entirely in the hands of the parents, with medical ethicists divided on when, and how, children should be given the right to override their parent’s medical decisions.
One of the arguments against granting children this ultimate freedom is the damage it could potentially do to the family unit. It’s an issue that Dr. Cora Breuner, MPH, spokesperson for the American Academy of Pediatrics (AAP) and member of the division of adolescent medicine at Seattle Children’s Hospital, takes to heart.
“As a pediatrician, the important thing to me is the family,” Breuner told Healthline. “I think the thing we are losing sight of in all this is that families have their own values they are trying to impart on their kids.”
But that doesn’t mean Breuner thinks those values should always be blindly supported by the medical community. “I am a pediatrician and I believe in universal vaccines,” she said. “But I also believe in supporting the family.”
She worries that allowing children to override their parents when it comes to vaccinations, a topic some parents can feel extremely passionate about, runs the risk of damaging the family unit.
“The problem I see with allowing kids to make their own decisions with this is that the family model is how they survive. It’s something they rely on. And while it is a quick fix for this situation to give them that freedom, we need to be mindful of the fact that we are potentially creating another problem within their family unit.”
The New England Journal of Medicine recently broached this topic, focusing on the concept of vaccination over parental objection.
They determined that “adolescents need not be harmed by parental decisions that are based on misinformation or disinformation. Allowing adolescents to consent to vaccination despite persistent parental resistant facilitates access to a medically recommended and evidence based treatment.”
But when it comes to allowing adolescents that consent, where should the line be drawn? If we determine kids are capable of making their own vaccine decisions, should they then be allowed to make other medical decisions as well?
“In some instances, kids 12 and above are developmentally ready to make their own medical decisions, like for vaccines or receiving recommended healthcare treatments where there are harmful consequences if they do not receive them,” she told Healthline.
But developmental readiness doesn’t necessarily apply to going against medical advice, she explains, pointing out that not all kids are able to process and decide what’s best for their health.
For example, chronically ill children, or those needing treatments for things like cancer, might refuse treatment based on how a treatment makes them feel now, without considering the long-term consequences of those decisions.
“This is very, very gray. Which makes it difficult to make a blanket statement for an age for all medical decisions,” Levin explained.
In her view, however, a lot comes down to medical advice, particularly if a parent wants to go against medical advice. In those cases, she thinks the child should have a say in accepting medically recommended treatments that are in their best interest and well-being: receiving vaccines, medication, or doctor-recommended counseling.
Levin explains that in the mental health field, there are a lot of instances where medication or counseling may be recommended, only to be denied by parents who don’t believe in treating mental health conditions with either. When the child would like to pursue those options, she’d like to see them have that ability.
But on the flip side, she doesn’t want to see children refusing treatment that’s both in line with medical advice and supported by the parent.
“My professional opinion is that at [age] 12 and above, kids should have the ability to override parent decisions only in circumstances where a parent’s refusal is against medical advice.”
Most parents probably don’t want to think about their children having the ability to go against them when it comes to medical decisions. But at age 18, most kids will be given that opportunity anyway.
So, parents have the choice of remaining firm or working with their children to slowly involve them in their medical care.
It’s that gradual process that Dr. Alyssa Burgart, a board-certified anesthesiologist specializing in pediatric anesthesiology, supports.
Having a joint appointment in the Stanford Center for Biomedical Ethics and serving as the co-chair of the LPCH Ethics Committee and as member of the SHC Ethics Committee, she believes that even at very young ages we should be listening to the opinions children express in terms of their own medical care.
“To me, a child saying ‘I don’t want a shot’ is a really important opinion,” Burgart told Healthline. “It doesn’t mean it’s an opinion you alter your own decision-making based on, but it does mean that anything we do to children from toddler age up that’s against their will can be very traumatizing. So from that perspective, a child’s opinion matters.”
She says that as an anesthesiologist, she’s always taking those opinions into consideration when determining how and when to anesthetize a child.
“And not all decisions are the same. Life-saving medical treatment versus things that can be delayed over time, that changes the decision,” Burgart added.
But when it comes to these big decisions as the child gets older, Burgart says that instead of letting the argument come to a head, with the parent on one side and the child on the other, adolescents and teens should slowly be given more involvement and control over their medical decisions.
“What I observe in working with children of many ages and their parents is there is slowly a switch over time, where parents go from being the ones making decisions, where the child is generally distracted and doesn’t have any questions, to moving into a stage where the kids really are having more direct conversations with their practitioners, and parents become the support person,” Burgart said.
Allowing for that shift is something recommended by the AAP, which considers this part of the informed consent process as adolescents get older.