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Old 15-10-2008, 11:05 PM   #29
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Default The Issue of Consent

This article from the Sunday Herald puts a whole new spin on it.

GP gives cervical cancer vaccine to 13 year-old ... against parents' wishes
Health board launches investigations after mother's complaint
By Helen McArdle

A SCOTTISH HEALTH board has launched an investigation after a 13-year-old schoolgirl was given the cervical cancer vaccine despite the doctor being aware her parents had withheld consent.

The girl's parents had decided to delay immunisation against the human papilloma virus (HPV) because their daughter, Abigail, is diabetic.

Although they had agreed to other vaccines in the past - including MMR, polio and TB - they felt there was not yet sufficient evidence of the safety of the cervical cancer vaccine on people with chronic illnesses. Since the virus is transmitted via sexual activity, they believed there was no pressing need to vaccinate their daughter at 13.

The girl's mother, Debbie Jones, told the Sunday Herald: "It's not as though I think the vaccination is a horrible thing, but I just figure what's the harm in a bit of extra time? We don't need to vaccinate her yet. So I thought, let's just leave it for now and we can make up our minds about it later."

However, during the first round of the three-step vaccination programme at Stromness Academy in Orkney last month, Abigail - along with other classmates whose parents had consented to the jab - was taken from class to join the line-up of those being inoculated. While the other girls were treated by the nurse, Abigail was taken aside by the doctor, who asked her if she knew that she was the only girl whose parents had withheld consent. After a brief conversation she was given the vaccine.

Jones said: "When Abigail told me what happened, I asked her, Did you really want it done?' and she said, No'. And I asked her if she had said that she didn't want it done, and she said that the doctor didn't really ask her if she wanted it done, that she didn't get the opportunity to say yes or no.

"Part of me thinks, why is it being done in schools when they don't seem to have much control over the programme?

"I'm sure the doctor was only concerned about the best and really believes in the vaccine. My daughter's not terribly assertive, she doesn't like to rock the boat. She's fun and she's happy, but she basically submits to authority."

Jones contacted NHS Orkney on Thursday to express her concern. The health board confirmed to the Sunday Herald that it had received a complaint from a member of the public and was launching an inquiry to find out what went wrong.

The board said: "We take this complaint extremely seriously and will be investigating further as a matter of urgency.

"If there are lessons to be learned from the investigation they will be incorporated into the vaccination programme in Orkney. The health of young people in Orkney is of paramount importance to NHS Orkney."

The incident highlights some of the potential pitfalls in using external medical staff to carry out the inoculations, standard practice in vaccination programmes. The person administering the vaccine was not aware of Abigail's medical history. Although her parents are reluctant to make a direct link, within 10 days of receiving the jab Abigail suffered only her second seizure since being diagnosed with diabetes six years ago. Her blood sugar levels were normal at the time.

The incident also raises questions around the issue of consent. While parents are asked to complete consent forms if their daughter is under 16, a girl below that age is entitled to request to have the vaccine even if her parents declined it.

A spokeswoman for the General Medical Council said the issue must be resolved on a case-by-case basis: "It is not a matter of once they reach 16 they are capable of giving consent and if they are not, they can't.

"If a girl under 16 wanted the vaccine, even though her parents had not given their consent, the doctor would not be acting inappropriately if they administered it, having first explained the potential outcomes of whatever path of treatment they choose, whether that's to accept or refuse it."

GMC guidelines state: "When treating children and young people, doctors must also consider parents and people close to them, but their patient must be the doctor's first concern Children and young people are individuals with rights that should be respected. This means listening to them and taking into account what they have to say about things that affect them. It also means respecting their decisions and confidentiality."

The Scottish Government launched the national immunisation programme against HPV in schools last month, targeting girls in the 12-13 age group. Older girls will be treated as part of a later "catch-up" initiative. The HPV virus is transmitted via sexual contact so it was deemed the most "cost-effective" strategy to vaccinate before the majority will become sexually active, and in a school environment where the optimum number could be treated.

However, Jackie Fletcher of JABS, a support group for parents who believe their children have been adversely affected by vaccines, expressed misgivings about the setting.

"This is something which should be taken out of the school situation because, firstly, are the right questions being asked of the girls and will they own up to whatever they need to own up to if they're in a queue of other girls? So it's not like a measles or a polio jab, because there are sexual behaviour activities which need to be discussed."

A statement on behalf of the Scottish Government said the leaflet distributed to schoolgirls "clearly states that it is every person's right to opt out of having the vaccine, if they wish to do so".

In other words, they will TALK your child INTO IT if they CAN. Can your child stand up to the "logical" arguments and persuasive tactics of authority figures? Peer pressure will be used to gain traction.
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