‘You do it all then – you’re the boss’, said the dad to his ten-year-old daughter, as they struggled to don her swimming hat. Yesterday marked week four of swimming lessons for one of my children; it was also the day the UK government recommended a single-dose COVID vaccine for 12-15-years-olds in England. The science of the decision and some ethical concerns are covered elsewhere. Here I want to ask what are the considerations for Christians and Christian parents? Who is the ‘boss’ when it comes to deciding whether to have the vaccine or not? As a Christian, a parent of a twelve-year-old, and a paediatrician, there seems much to ponder.
Consent and competence
It’s been announced that whilst parental consent will be sought, when the child and parent have different views, the child can give consent themselves if they are considered competent. This mirrors the process for the Human Papilloma Virus (HPV) vaccine, which is offered to children aged 12-13 years as part of the NHS vaccination programme.
Most of us are familiar with the term ‘Gillick Competence’ where children under 16 can consent ‘if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment“’. In practice, allowing a child to overrule their parents’ wishes is a significant step and one not accepted lightly by healthcare professionals. It could be argued that in the education setting, such caution is not displayed so readily, with access to contraception without parental consent commonplace. Research published in Vaccine in September last year outlines some concerns with the HPV vaccine consent process, concluding that ‘concerns were expressed that self-consent procedures could undermine trust between schools and parents. Furthermore, although self-consent might be considered a positive step for some, concerns were raised that it could put an unfair burden on young people and may have a negative impact on family relationships.’
The ability to give consent is always directly related to the quality of the information provided, even before competence is considered. Consenting when the proposer is sure of the risks and benefits of the intervention is one thing. But to ask a child to weigh up the risks and the benefits of such a decision, when even the experts are still grappling with it, is another thing altogether. Furthermore, the nature of the conversation means that peer pressure will inevitably play a huge role in whether a child decides to self-consent.
Finally, in this case, children are effectively being asked to consent to a medical intervention that does not directly benefit them. Whether it will reduce school closures or impact community transmission is uncertain. Granted, the Chief Medical Officers have had a difficult decision to make. However, the lack of evidence of health benefit surely means allowing children to consent for such ‘treatment’ is placing an even heavier burden on them. The narrative this winter risks heading towards ‘we have to close schools again, and that’s because not enough children received the vaccine’. Whilst this isn’t the place to debate the science around this, it would be a misrepresentation of the facts, to put it mildly. Psychological coercion has been used throughout the pandemic, and we have another example here.
The consent issue raises the question – who is best placed to assess the decision-making competency of our children? Many would suggest our children are best-placed, and the younger they can choose, the better. The clear agenda in the West is towards allowing choice at a younger age, putting the burden of decision making onto children. This ranges from what clothes they wear all the way through to what gender they identify as. Whilst we, of course, want our growing children to gradually share and ultimately take on decision-making for themselves, the burden of making such decisions at such an age is significant. Especially when the maturity of a twelve-year-old varies so widely depending on a variety of biological and psychosocial factors.
Others would argue that the government should be boss and make the decisions. In schools, the State has decided what children as young as five need to know about relationships and sex and when. We have become more used to State intervention these past 18-months, being ready to sacrifice freedoms at the heart of our private lives on the say-so of the State. Whilst this isn’t an instance of government mandate, vaccine passports have sailed close to the wind, and mandatory vaccine for healthcare workers in some cases has already followed, and is likely to be extended more widely among public servants. Again, whilst Christians will come to different conclusions on this, ongoing theological reflection on the longer-term implications of Big State mandates is vital.
So, are parents best placed to make this decision on behalf of their children? Sometimes we might think not. As a paediatrician, I am (to say the least) pro-vaccine and have frequent conversations seeking to persuade parents to vaccinate their children, countering misinformation and fear, haunted by seeing children die both at home and abroad of vaccine-preventable diseases. I am constantly assessing children who are impacted to a greater-or-lesser extent by their parents, for good and for ill. But despite this, upholding the natural and pre-political rights of parents to make decisions for their children is vital. I, therefore, defend to the hilt the right of parents to choose whether to vaccinate their children. Parents are best placed to judge the ability of their child to make healthcare decisions, and any intervention by the State to disrupt this should surely only be done in the most extreme of circumstances. Legal rights, as given by the State, are inherently unstable. What the State can give, it can also take away. It is important we recognise where the wind is blowing in our culture with the atomisation of the family, the veneration of the wisdom of youth with children being seen as ‘the boss’ when it comes to their diet, clothes, access to social media and so on. The child swimming yesterday evening may have ended up with wet hair – a negligible consequence when a child takes control too soon. But in some cases, it really does matter when we step in, and parents need the wisdom to know which is which and the courage to know when to take a stand.
Finally, this is not a primary issue, and Christians will inevitably differ in their conclusions. Whatever position you come to, this is a fantastic opportunity to have or continue the conversation with your teen(s). You might consider with them the science and how these decisions have been made; the impact of peer pressure and media influence and how they can be beginning to make decisions for themselves; what it means to ‘love your neighbour’ in the wider context of COVID-19; whether it is just for the UK to commit three million vaccines to 12-15-year-olds for minimal benefit when so many in the developing world who would benefit are denied access by dint of their country of birth or social status. Rather than a wedge that divides, let’s allow these conversations to strengthen relationships with our children, recognising the responsibility and authority God has delegated to parents to care for them.
A recent CMF file looks in detail at the faith and ethical issues surrounding vaccines and vaccination.