Adolescent Consent for Human Papillomavirus Vaccine: Ethical, Legal, and Practical Considerations.
Adolescent Consent for Human Papillomavirus Vaccine: Ethical, Legal, and Practical Considerations.
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DOI：
10.1016/j.jpeds.2021.01.026
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
English A
中科院分区：
文献类型：
--
作者：
Zimet GD;Silverman RD;Bednarczyk RA;English A
我们解决有关青少年自我同意HPV疫苗接种的伦理，法律和实践问题。人乳头瘤病毒疫苗接种覆盖率继续远远落后于80%系列完成的国家目标。结构和行为干预提高了疫苗接种率，但态度、行为和获取障碍仍然存在。增加获取和提高疫苗接种覆盖率的一个潜在方法是允许青少年自己同意接种HPV疫苗。我们认为青少年的自我同意是合乎道德的，但在许多州有法律障碍需要克服。在自我同意合法的司法管辖区，由于卫生保健提供者和青少年对该政策缺乏认识，仍然可能存在障碍。实施自我同意的其他障碍包括反疫苗活动人士和家长权利活动人士的抵制，即使在法律上支持自我同意，提供者也不愿同意接种疫苗，以及对保密的威胁。如果青少年在发给父母的益处说明中出现了自己同意的HPV疫苗接种情况，或者父母通过国家免疫信息系统获得了青少年的疫苗接种记录，保密性就会受到损害。在COVID-19大流行导致HPV疫苗接种大幅下降的背景下，可能有更多理由考虑自我同意。围绕未来COVID-19疫苗的不确定性和不信任气氛突出表明，任何疫苗政策变化都需要在明确沟通和符合伦理原则的情况下进行。
We address ethical, legal, and practical issues related to adolescent self-consent for HPV vaccination. HPV vaccination coverage continues to lag well-behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from anti-vaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent’s self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent’s vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles.
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26.1
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