AMA May Endorse ‘Mature-Minor’ Vaccination Decisions

Outbreaks of measles in the USA is bringing renewed attention to the fact that adolescents in 39 states must have their parents’ permission to get vaccinated. 

But, there are 18 states that have made allowances for “mature-minors” to make their own vaccination decisions. 

Unlike adult patients, decisions for pediatric patients usually involve a three-way relationship among the minor patient, the patient’s guardian, and the physician. 

“Many children go unvaccinated as anti-vaccine related messages and advertisements target parents with misinformation,” said AMA Board Member S. Bobby Mukkamala, MD, in an AMA statement on June 10, 2019. 

“The prevalence of unvaccinated pediatric patients is troubling to physicians.” 

“Allowing ‘mature-minors’ to provide informed consent to vaccinations will ensure these patients can access this type of preventive care,” said Dr. Mukkamala. 

To help realize this suggestion, various AMA delegates adopted a new policy to support ‘state policies allowing minors to override their parent’s refusal for vaccinations.’ 

And, ‘to encourage state legislatures to establish comprehensive vaccine and minor consent policies.” 

During April 2019, the AMA developed a draft ‘Model Legislation for “Mature Minor' Consent to Vaccinations.’ 

The states of Alabama, Alaska, Arkansas, Delaware, Idaho, Illinois, Kansas, Louisiana, Maine, Massachusetts, Montana, Nevada, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and West Virginia have already made allowances for “mature-minors” healthcare decisions. 

According to a study published in the journal Pediatrics in 2013, this “mature minor doctrine,” can present a legal and ethical dilemma to the treating physician.

Somewhat of a grey area, it outlines certain other “status-based and condition-based exceptions” aside from more long-standing minor rights in fields such as abortion, access to contraceptives, and treatments for mental illness, sexually transmitted diseases or substance abuse. 

For example, in Washington people 13 and older can consent to inpatient mental health treatment and outpatient substance abuse treatment. 

According to the AMA reference committee, the April 2019 recommendations will be voted on during the AMA June meeting.