1. The Where & How of Reaching Adolescents: Adolescent Vaccination & Consent Abigail English, JD Center for Adolescent Health & the Law english@cahl.org 41 st National Immunization Conference Centers for Disease Control and Prevention Kansas City – March 6, 2007

2. Center for Adolescent Health & the Law Overview  Basic legal framework for consent  Fundamentals of parental consent  State minor consent laws  Minor consent & vaccination  Federal law & consent for vaccination

3. Center for Adolescent Health & the Law Consent - The Legal Framework  Complex patchwork  State & federal law  Constitution, statutes, court decisions

4. Center for Adolescent Health & the Law Who Is An Adolescent?  No single fixed age range or “official” definition  Ages 11-21 Some adolescents are minors <18 Some adolescents are adults > 18  Critical distinction for consent Minors often need parent consent Adults can give their own consent

5. Center for Adolescent Health & the Law State Law & Consent for Minors’ Health Care  Basic rule = parental consent required  Alternatives to parental consent – unclear whether all apply to vaccination Legal guardians Related caretakers Foster parents Court Social worker or probation officer  Minor consent

6. Center for Adolescent Health & the Law Parent Consent & Minor Consent  Parent consent Usually necessary and appropriate for vaccination of children & adolescents Often does not serve as a barrier even for adolescents  Minor consent May be needed as an option when requiring parent consent would be a serious obstacle  Minors who are being seen on their own for sensitive services & would not come back with a parent to receive vaccine  Minors who lack parental support and are acting independently for other health care

7. Center for Adolescent Health & the Law Minor Consent Laws in 50 States & DC  All states have minor consent laws  Many laws in place for 2 or 3 decades  Some laws based on minor’s status  Some laws based on services minor is seeking  A few laws allow treatment without consent

8. Center for Adolescent Health & the Law Minor Consent Laws Based on Status  “Emancipated minor”  Married minor  Minor in the armed services  “Mature minor”  Minor living apart from parents  High school graduate  Minor over a certain age  Pregnant minor  Incarcerated minor

9. Center for Adolescent Health & the Law Minor Consent Laws Based on Services  Pregnancy related care  Contraceptive or family planning services  STD/VD prevention, diagnosis, & treatment  Reportable disease prevention, diagnosis, & treatment  HIV/AIDS testing & treatment  Drug or alcohol counseling & treatment  Outpatient mental health services  Examination & treatment for sexual assault

10. Center for Adolescent Health & the Law Relevance to Vaccinations – Minor Status  Minor may be able to consent based on status  Special importance for populations of youth who lack parental support

11. Center for Adolescent Health & the Law Relevance to Vaccinations – Type of Service  Minor may be able to consent based on type of service  All states allow minors to consent for diagnosis or treatment of “sexually transmitted” or “venereal” disease  At least 12 states allow minors to consent for care related to reportable disease

12. Center for Adolescent Health & the Law “Prevention”  Some state laws allowing minors to consent for care related to a sexually transmitted, venereal, or reportable disease expressly include “prevention” along with “diagnosis” and “treatment”  One state expressly allows minors to consent for HepB vaccine  Extent to which laws regarding diagnosis & treatment have been interpreted to include prevention not fully known

13. Center for Adolescent Health & the Law Federal Law & Consent for Immunizations  Federal law does not explicitly require parental consent for immunizations  National Childhood Vaccine Injury Act (NCVIA) requires provision of Vaccine Information Statements (VIS) prior to each dose

14. Center for Adolescent Health & the Law Vaccine Information Statements  Required by NCVIA  Must be given prior to each dose of a vaccine To parent or legal representative of child to whom vaccine will be administered To any adult to whom vaccine will be administered

15. Center for Adolescent Health & the Law Legal Representative for Receipt of VIS  “a parent or an individual who qualifies as a legal guardian under state law” (42 USC §300aa-33)  “a parent or any other individual who is qualified to consent to the immunization of a minor child or incompetent adult” ( CDC, “Instructions for the Use of Vaccine Information Statements”)

16. Center for Adolescent Health & the Law When Can Minors Consent for Vaccination?  Specific analysis required  State  Age of minor  Capacity to give informed consent  Legal status  Condition for which immunization is sought