should doctors help teens get vaccinated behind their anti-vaxx parents' backs?

a 12-year-old boy secretly seeking something his parents had always denied him recently visited dr. eric cadesky.he wanted his baby shots.satisfied the pre-teen possessed the maturity to make his own medical decisions, cadesky was happy to oblige.the boy’s parents had chosen not to vaccinate their son after being exposed to “fear-based” anti-vaxx propaganda, said cadesky, a family physician and president of doctors of bc. however, in b.c., as in most every other part of the country, a minor under the age of 18 who is deemed capable can make a decision to be immunized without his or her parents’ knowledge or consent.now, in the face of declining immunization rates and a rise in the “vaccine hesitant,” the question being asked is, do doctors have a legal and ethical obligation to ask unvaccinated youth if they would prefer to be inoculated?as timothy caulfield recently told the canadian medical association journal, “as a thought experiment, you could imagine a teen saying, ‘you knew i wasn’t vaccinated. you knew i was competent to make that decision. how come you didn’t tell me about it?”numerous medical groups have produced advice to doctors on how to work with vaccine-hesitant parents, a growing segment of the population the world health organization recently called out as one of the top 10 threats to public health globally.much of that advice boils down to this: be non-judgmental. validate concerns. be reassuring. build trust.in the wake of the vancouver measles outbreak, dr. theresa tam, canada’s chief public health officer, urged “my fellow health-care provider colleagues” to answer the questions of concerned parents. “we must support parents as they tease apart fact from fiction,” tam said. an article in this month’s issue of the canadian family physician, meanwhile, also offers tips on swaying parents, including taking a presumptive approach (“today we are going to give your child the recommended vaccines to keep the child healthy” instead of, “what do you want to do about the shots?”)however, no mention was made of when doctors should talk to unvaccinated teens themselves.according to caulfield, “the teen’s consent is both necessary, and sufficient.”an 18-year-old ohio teen made headlines earlier this month after he publicly and famously thwarted his anti-vaxx mother and had himself immunized. “i grew up understanding my mother’s beliefs that vaccines are dangerous,” ethan lindenberger told a senate hearing examining the recent surge in measles. when he approached his mother, brandishing articles from the centers for disease control and prevention confirming vaccines don’t cause autism, she responded, “that’s what they want you to think.”

lindenbeger is part of a new generation, the children of anti-vaxxers, questioning the conspiracies and faulty rhetoric they grew up with.cadesky said his own 12-year-old patient, who has now started on the catch-up schedule for vaccination, had been exposed to “misinformation” and decided to seek out more trustworthy sources. “he had heard about the current (measles) outbreak and had spoken to a number of reliable sources and he had come in to further that discussion,” cadesky said.“when people are in a small community, when they’re being exposed to an echo chamber and they’re being bombarded by fear-based propaganda, then it’s easy to understand why they would choose something that is not in the best interests of their children,” cadesky said.several adolescents have attended cadesky’s clinic seeking mmr immunizations and more, which prompted him to post a tweet last month rhetorically asking, “what else didn’t my parents protect me against?” he encourages teens to bring parents into the discussion, partly to address their own fears, “which are very real, based on the very scary images and stories” circulated by those opposed to vaccines.however, he also respects a capable youth’s decision not to involve the parents. “as always, if someone is autonomous, then it’s their decision in terms of what information they share, and with whom,” unless someone else could be affected, such as in the case of a sexually transmitted infection.cadesky said it’s important doctors keep an open door.caulfield said health-care providers need to go further, and not wait for unvaccinated youth to initiate the discussion.“from an ethical and legal perspective, if they are a competent teenager, then they are the ones you should be having the conversations with,” said caulfield, a professor of health law and policy at the university of alberta.“we don’t even need to couch it in, ‘well, this is a way to get more people vaccinated.’ i would say there is an obligation to revisit this topic with a patient who has become competent.”the law in most provinces allows mature minors to make decisions about their own care. in ontario, a minor is considered capable of providing consent if he or she has the maturity and intelligence to make a decision about treatment and can appreciate the “reasonably foreseeable consequences” of their decision.the mature minor doctrine plays out on a case-by-case basis. so, a minor may be competent to make decisions about vaccines, but maybe not open-heart surgery.still, given vaccines are considered safe, and given that discussions around vaccinations would be relatively straightforward, “i think it’s entirely possible a 13-, 14- or 15-year old would be competent on their own to consent” to the shots, caulfield said.adolescents “all have to rebel in one way or another, and it would be pretty cool if they chose to rebel by getting immunized,” said dr. joan robinson, a pediatric infectious disease specialist at the university of alberta. “i guess the question that’s being asked is, should we put the idea into their heads?”for her part, robinson thinks it would be a rare adolescent “who actually is going to pursue immunization on their own.” teens hardly ever go to the doctor to begin with, unless for some acute illness, “so there wouldn’t be a lot of opportunities for the discussion.”instead, she believes schools should be educating kids about the history of vaccines and how to interpret what they’re reading and hearing in the media. “a sad story about a child who appeared to be normal and now they have some horrible problem, that is way more convincing than reading about medical evidence.”diseases such as measles, mumps, rubella, and chicken pox can affect teens if vaccines are missed as a young child. other vaccines the public health agency of canada recommends for teens include hepatitis b, meningococcal, a tetanus/diphtheria/pertussis booster, the hpv (human papillomavirus) vaccine and a seasonal flu shot.email: skirkey@postmedia.com | twitter: sharon_kirkey‏