Do children in Ontario need to provide informed consent to get the COVID-19 vaccine?

TORONTO — It’s not uncommon to see a teary eye or hear a child wail when they get a shot—but it is rare to see a health practitioner refuse to vaccinate a child because they would not provide consent.

Children between the ages of five and 11 became eligible to get their first paediatric dose of the COVID-19 vaccine in Ontario on Nov. 23, just days after Health Canada approved it.

Parents were told they could book appointments for their kids using the provincial portal or their local public health units. They could also get the shot at select pharmacies or through their family doctor.

In order to get the vaccine, parents of children in this age group must provide consent, either before or at the time of the appointment. However, the provincial website also says that children and youth must also provide informed consent to get the shot, which means the individual must understand what the vaccine involves, why they are getting it and what the risks and benefits are.

The province goes on to say that if an individual is unable to provide that informed consent, they will need consent from someone who can make the decision on their behalf.

“Parents or substitute decision makers of children aged five to 11 will, for the most part, have to provide consent on behalf of the child at the time of the appointment before their children can receive a vaccine,” the website says.

In Ontario, there is no minimum age of consent under the Health Care Consent Act, meaning that as long as a person is deemed capable of making an informed decision about their health, they have the right to do so.

“In order to give informed consent, the person giving the consent has to be able to understand the reason for the intervention, the benefits and risks of the disease,” said Associate Medical Officer of Health Dr. Vinita Dubey.

“And so, while in Ontario, there is no age of consent in the Health Care Consent Act … developmentally most children under 12 are not able, or as we say in medicine capable, to provide their own consent, which is why it falls to the parent or guardian.”

Dubey said that most of the time the reason why a child doesn’t want a vaccine is because of needle fear or anxiety. She urged parents to discuss the vaccine with their child prior to going to a clinic.

Children and youth over the age of 12 in Ontario can get the COVID-19 vaccine without parental consent, although Dubey said that regardless of age, if an individual is determined not to be able to provide informed consent they would need a guardian or caregiver to do so.

CAN A CHILD GET A COVID-19 VACCINE WITHOUT PARENTAL CONSENT?

Experts say that a child can get the COVID-19 vaccine without their parents’ permission, but that it would be extremely rare as the child would have to prove they are mentally capable of making the decision.

Dubey said that in this scenario, a physician would do an assessment to determine if the child has a complete understanding of what they are agreeing too. The process would likely be “a bit more intense” than what would be required of an adult, she said.

“It’s one of the reasons why, at our Toronto Public Health Clinics for example, we’re requiring parental consent because our nurses don’t necessarily have that expertise to do that kind of assessment. But you know, in a family doctor’s office, for example, perhaps even some pharmacists might be able to determine that.”

Dr. Adam Kassam, president of the Ontario Medical Association, admits that a child wanting to get a vaccine without parental consent is a “very challenging situation” but could be determined by a family doctor or someone with a pre-established relationship with the child.

“If a child is considered a mature minor, they can make an informed decision about care without a parent agreement,” he said. “We see this also happen in other circumstances that are not vaccine related. So, for example, in teen pregnancy, in conversations about abortion, for example, these are obviously intimate and important conversations to have but those are similar conversations that have happened within the private provider of patient relationships.”

Individuals between the ages of 12 and 18 – the age group in which a youth is officially considered an adult – are allowed to get the COVID-19 vaccine without parental consent, something that Kassam says is usual in terms of vaccinations. However, those doses are typically provided in school settings or at a family doctor’s office, not at a clinic or pharmacy.

CAN A CHILD REFUSE A VACCINE IF THEIR PARENTS WANT THEM TO GET IT?

The same rules apply for children that do not want to get the shot. However, for the most part, if a child shows up with their parents to a clinic, there is implied consent.

Anna Banerji, infectious disease expert with the University of Toronto’s Dalla Lana School of Public Health, says that it’s not uncommon for kids to be worried or afraid of getting a vaccine, but if parents give permission, health practitioners usually give the shot.

“In most situations, we find a way to get give the kid the needle,” she told CTV News Toronto. “I vaccinate refugee children and if they need it for school and the parents want the kids to get it, you know, someone sits there, holds the kid’s legs and arms and we just give it.”

“It’s rare that that the kid says no, that the clinician refuses. At that point you find a solution.”

Banerji goes on to say that she is doubtful that a five-year-old child would be able to comprehend what a vaccine is, as well as the benefits or risks involved. However, she adds that an older child aged 10 or 11 could be able to prove they have an understanding of the process.

According to Kassam, if a parent brings a child to a clinic to get the vaccine, it’s assumed they will get the vaccine.

“If the parent and family comes to a doctor’s office or to a vaccine clinic, and they’re very much set on getting the vaccine, you’ve already had your informed consent by virtue of them coming in and making the trip.”

Consent then continues as the health practitioner asks the family the usual questions about the vaccine and allergies prior to giving the shot.

Kassam says that in some cases, if a child is really resistant, the parent may take them home and try another day.

Health experts say that regardless of age, it’s important that everyone understand why they are getting medical treatment. For kids, this would involve parents sitting them down beforehand and explaining what the vaccine is and why they are going to get it.

“We have links to other resources as well to help parents have those conversations prepare their child, and really to address the child’s specific fear,” Dubey said. “Because when the child says I don’t want it, it’s really important to understand why.”

“The preparation is really important. We really do want parents to involve their children. We want children to involve their parents. I think that having a good clinic experience can often be prepared for.”

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