Should parental vaccination decision-making ever be overridden by the state?

Should parental vaccination decision-making ever be overridden by the state?

I was reading a paper to research another post, and this paper sparked the idea for this post

It's extremely rare that parental decision-making is ever questioned in our culture - be it in healthcare decisions or otherwise. That's for good reason. Parents want the absolute best for their children in all aspects of their life. They want to give their children every advantage they can so their children grow up happy, successful and productive. All of that is dependent on the child's health throughout their life. Therefore it won't surprise you that few things are more important to parents than the health and wellbeing of their children.So, as I've said before, respecting a parent`s decision(s) as a healthcare professional is respecting the wellbeing of the child or children. It also recognizes that, although the physician is the primary source of medical guidance, the parent is also a key stakeholder in making healthcare decisions for their child. For this reason, the American Academy of Pediatrics stated that if, after repeated discussion, parents continue to reject vaccination for their children, their decision should be respected.

However, unfortunately conflict can arise between a physician's medical opinion and parental wishes, and the case of six year old Oisin Kiszko highlights this reality. Oshin had brain cancer, and his physicians believed he should receive chemotherapy and other curative treatment. His parents, however, believed the potential side effects and long term health consequences of the treatment outweighed the benefits. They wanted him to receive only palliative care. In March 2016, Western Australia`s Family Court ruled that Oshin should be given chemotherapy. Sadly, after another two court cases, palliative care was supported by the court as his chance for a cure decreased. 

Now, in the majority of cases, such conflicts do not escalate to the point of court. That said, it is also important to acknowledge that there do exist such extreme cases. In cases where there are outbreaks, epidemics, or pandemics of disease that has the potential to be life-threatening, the child is at risk of serious long term harm. In such cases; parental decision making may be overridden. That said, the COVID 19 pandemic is probably the most recent example of personal freedoms being restricted for public health. By extension, parental freedoms were restricted. As the pandemic unfolded, physical distancing and social restrictions were introduced and for this period, college children and students were to rely on resources to learn remotely through the Internet, television, or radio. 

Not only this, but all cinemas, theatres, casinos, betting shops, bingo halls, gyms, leisure centres, swimming pools, exercise and dance studios are required to close. In Ireland, travel within the local county was permitted under only exceptional circumstances, such as for caring for vulnerable family members, farming etc. International travel bans as well as curfews applied, and for those who were unlucky enough to contract the SARS-CoV2 virus; even more freedom was restricted as they were required to self-isolate for 10 days after the onset of symptoms; plus three days after the symptoms resolve. So playdates for younger children were stopped, family dinners, outings and so on were banned. Some parents could not see their adult children in person. The point is that in some contexts, parental freedom can be limited to some degree, if not doing so could place the child or children at serious risk. 

In the context of COVID-19; this certainly applies. Of course, as with all viruses, SARS-CoV2 evolves over time, and so its symptoms will change to different degrees too. With that in mind, here is a current list of COVID 19 symptoms according to the website of the CDC. They range from milder symptoms such as chills, coughing, fatigue, to more severe ones such as trouble breathing, chest pain, confusion, to the notorious Severe Acute Respiratory Syndrome (SARS) , which is where the virus gets its name. Some patients even experience long-term symptoms from the virus, called Long COVID or Post COVID conditions. It can include a range of persistent health conditions lasting months to even years which can make it debilitating.This set of conditions can include nausea, fatigue particularly after physical or mental exertion, malaise, among many others. Most crucially, unvaccinated individuals have a disproportionately higher risk of developing Long COVID, with children being especially vulnerable. With this context, a case could be made for why parental refusal of COVID 19 vaccination could be overridden. 

An article on the covevrsation.com describes how it is also important not to excessively focus on the child's well being at the complete expense of parental autonomy. At times, choices that do not harm the child can be accepted despite being substandard. This involves the delicate act of striking a balance between parental autonomy and the child's well being. In addition, this may build further trust between the healthcare provider and parent. This makes future difficult decisions slightly easier as a base of trust has been established. What is clear from this is that any approach should be based in empathy between the physician parent and child. 

Conclusion

Parents are key decision makers for healthcare decisions for their children; as they know their children best, and how various treatments may impact them. That said, as with everything, there are exceptions that may mean parental decisions may need to be overridden for the overall wellbeing of the child. In such cases, physicians still try to remain respectful of parental rights  by informing them fully about the consequences of the choice and will strive to come to a resolution that acknowledges the importance of everyone involved. Only after this may autonomy be overridden. Thanks for reading!

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References;

1. Impact of COVID-19 on the lives and mental health of children and adolescents - PMC
2. When parents disagree with doctors on a child's treatment, who should have the final say? (theconversation.com)
3. CONFIRMED: Local lockdown imposed on Offaly, Laois and Kildare
4. Advice for the public (who.int)
5. Symptoms of COVID-19 | CDC
6. Long COVID or Post-COVID Conditions | CDC