How do healthcare workers talk to teenagers about the COVID-19 vaccine?
Although it is legal for minors 12 and older to receive the vaccine without parental consent in Canada, healthcare experts say they focus on informing rather than influencing a teenager's decisions Photo by The Canadian Press  Article content Since the end of May, most provinces have allowed children aged 12 and older to receive the COVID-19 vaccine, eliciting mixed reactions from parents and doctors alike. For parents, it represents a crucial fork in the pandemic road  whether to allow their children to be vaccinated. For doctors, it means navigating talks about the vaccine with teenagers whose parents are either hesitant or, in rare cases, refuse to let their children receive the vaccine. We apologize, but this video has failed to load. tap here to see other videos from our team. Back to video Legally, minors in Canada dont need an adults consent to receive a vaccine as long as they can show that they are mature enough to make decisions about their own healthcare, several experts have told the National Post. Its about the individual regardless of their age being able to understand and appreciate the decision thats before them, said Dolly Menna-Dack, a clinical bioethicist at Holland Bloorview Kids Rehabilitation Hospital in Toronto. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content The legislation, known in the U.S. and Canada as the mature minor doctrine, has been in place in Canada long before the COVID-19 pandemic; It was recognized by the Supreme Court of Canada in 2009. Yet when Peel Region updated its vaccination guidance on May 20 to clarify that minors aged 12 and older dont need parental permission, it was met with a wave of angry comments online. More On This Topic Watch'Kids transmit less doesn't mean they don't transmit': Don't downplay COVID risks to kids, doctors say COVID shots for children are coming. Why we need them to end the pandemic I dont know who gave the authority for CHILDREN 12+ to consent on their own to get vaccinated, but I will be in touch with a lawyer in the morning to discuss the legality of this initiative and exactly who to include on this class action law-suite! This is insane, tweeted Twitter user Maurice Zabanah. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Im 29 and I dont even understand the benefits or risks of this vaccine (oh right, because clinical trials are still being done), tweeted another. Dr. Cora Constantinescu, who supports a vaccine confidence clinic that trains healthcare workers how to combat vaccine hesitancy in adults and children in Alberta, said that she encounters public backlash every time she has spoken on the issue. Its a sensitive topic, she said. Constantinescu stressed that she and her colleagues, despite some public skepticism, do not try to influence teenagers to take the vaccine without parental consent. Rather, they play the role of educators, supporters and, when possible, encourage adolescents to include an adult, be it a parent or otherwise when deciding to take the vaccine. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content We want parents to be involved and be part of the decision-making process all the time and we encourage kids to actually communicate it to their parents, she said. But at the end of the day  if the teen understands the consequences of the treatment, is able to deliberate the information and has come to a very reasoned decision, then they have the capacity to make the decision, she explained. Federally, there is no age limit at which a child required parental consent to make decisions on aspects of their healthcare. The only province to set one is Quebec, where children younger than 14 require the consent of the parent or guardian to make treatment decisions. Which means that in most provinces, children as young as 12 are legally permitted to receive the vaccine without the consent of their parents or guardians. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Our youth are so connected and so highly informed that we are sometimes surprised Healthcare providers are also not legally obliged to ask a young patient if they have told an adult about their decisions to receive the vaccine. We want to make sure that the barriers (to accessing the vaccine) are very low, said Dr. Lennox Huang, chief medical officer and vice-president of medical and academic affairs at the Hospital for Sick Children. However, they are trained to take a more nuanced approach with a youth who has come to the clinic alone, versus a teenager who is accompanied by an adult. In the case of the latter, Menna-Dack explained, were able to see that that conversation (about the vaccine) has occurred and the interaction will involve the people who are present in the room, she said. For teens who come alone, it becomes the healthcare providers responsibility to take those crucial introductory steps to assess how well the teen is supported and informed. For one, it would mean asking questions to better understand the teens background and whether there may be an adult involved in the teens decision-making process. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Really, the healthcare provider would be looking to ask questions like Are there people you have spoken to or would you like to speak to, can we offer you information about how to start that conversation with adults or caring adults in your life, she explained. This first conversation, she said, allows the healthcare provider to intuit what the young person understands about the decision theyre making, and if, in some cases, there may be a reason why guardian or parental involvement is not possible. The healthcare provider, in those cases, when possible, could act as a mediator and support their young patient in efforts to communicate with their guardian or parent about the vaccine. That can be truly an important piece to uncover during this process, Menna-Dack said. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content While there may be efforts to involve an adult in the discussion, the healthcare providers obligation, at the end of the day, rests with the young patient and ensuring that they themselves are informed and capable of understanding the benefits and risks of the vaccine, Huang said. We want parents to be involved and be part of the decision making process all the time For Huang, that responsibility has extended beyond the hospital. Over the past few weeks, he and other Ontario public health officials and healthcare experts have visited schools and held town halls to talk to parents and students about the COVID-19 vaccine. Digital and printed materials on the vaccine have also been handed out to Canadians either through email or at the clinics. This means that by the time teens visit the clinic, theyre already familiar with the ins and outs of the vaccine, simplifying the conversation between doctor and patient. So our conversation is oftentimes very easy, he said. Its straightforward.  Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Deciding whether the teen in question is capable of informed consent is, contrary to public belief, not dependent on their age, Menna-Dack said. Rather its their emerging autonomy  the individualss life experiences, mental maturity and context that determine just how capable they are of making their own healthcare decisions. A teen, for example, may have more experience interacting with the healthcare system, she posited, which could impact their familiarity with making medical decisions. Someone also can be affected by their maturity, and by their cognitive abilities, she said. One way a healthcare worker could assess a youths capacity is by testing their knowledge of the vaccine and its effects: What does the vaccine do, what are the potential side effects, what do you see as the benefits and risks of getting the vaccine, Menna-Dack listed as some examples of questions youth could be asked about the vaccine. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content We also would want to be ensuring that the young person knows where to get help,, she said, should they experience any mild or severe side effects from the dose. The doctor-patient conversation, she says, is not that much different from that a healthcare worker assessing whether an adult is sufficiently knowledgeable about the vaccine. It's clear that sometimes more information may be needed Teens, Huang said, also tend to ask very similar questions about the vaccine as adults. Will this affect my fertility, Huang listed as some of the most common questions he has heard from adolescent patients, similar to those voiced by adults. Some adolescent women, Dr. Alene Toulany, an adolescent medicine specialist at SickKids, found, voiced specific concerns about how the vaccine may affect their periods. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Our youth are so connected and so highly informed that we are sometimes surprised, she said, in that they have oftentimes done far more research than an adult would have, or thought about things that we wouldnt have expected or wouldnt have thought of ourselves. Furthermore, although it is legal for teenagers to not include parents in their decisions about the vaccine, Toulany and Huang said they are yet to come across one who has done so. We have not heard that happening, Huang said. Whats more common, he said, is encountering young patients whose parents are vaccine-hesitant rather than averse  which in turns reinforces the preference for a family approach, he said. If it reaches a certain point where youre seeing outright conflict and disagreement in the setting of a clinic, then thats going to be a scenario where we say (to the family), It seems like you need to have a longer in-depth conversation, Huang said, stressing that it would be inappropriate in such situations to let someone to take the vaccine. Its clear that sometimes more information may be needed, he said. And there may be a very complex family dynamic that needs to be worked through.  Share this article in your social network        Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Shopping essentials Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. 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