From the advice line

05 February 2019

Dr James Lucas, medicolegal consultant at Medical Protection, shares a recent case where a member sought advice regarding consent for childhood immunisation.

Mrs D, a practice manager, telephoned Medical Protection’s medicolegal advice line to discuss a difficult situation. The parents of AF, a 5-month-old girl, were in the process of divorce. AF’s father wrote a letter to the practice, explaining that he had recently changed his views about childhood immunisation, owing to reports about long term complications which he had read on the internet. He indicated that the practice did not have his consent to administer any more vaccines to AF.

Mrs D contacted AF’s mother, who said that she was a strong advocate of the childhood immunisation programme. AF’s mother explained to Mrs D that she planned to bring her daughter to the practice as per the immunisation programme and she expected the practice to administer the appropriate vaccinations, notwithstanding her estranged husband’s objections, in the best interests of AF and in accordance with her rights as a mother.

Mrs D was unclear how to proceed in circumstances where the parents were in disagreement about immunisation.

Expert Advice

Mrs D spoke to Dr C, an expert medicolegal consultant with a background in general practice.

Dr C explained that AF’s mother and father were the legal guardians of the child. This meant that both had a right to be involved in decisions affecting the welfare of the child including decisions about health. Where the patient is under 16 years, a parent(s) or legal guardian(s) will usually be asked to give consent for medical treatment on the patient’s behalf.

Dr C referred to the Health Service Executive (HSE) National Consent Policy, which explains that the consent of one parent will normally provide sufficient authority in respect of any health or social care intervention in relation to a child.1 However, there are exceptions to this general rule, including those circumstances where a parent/legal guardian refuses medical treatment on behalf of a child. Dr C advised that the National Consent Policy makes specific reference to the type of situation described by Mrs D, as in where the parents disagree between themselves about the provision of healthcare to their child. In these cases, the parents should be advised that they have a responsibility to discuss the matter and reach an agreement between themselves as quickly as possible, with the assistance of the HSE advocacy services and a third party mediator if required. If agreement is not possible then the service should generally not be provided unless it is deemed by the healthcare professional to be necessary to safeguard the child’s best interests. In such circumstances, legal advice should be sought as to whether an application to court is required.

Dr C advised Mrs D to consider, as a preliminary step, inviting AF’s father to meet the clinical team at the practice, in order to talk through his concerns about childhood immunisation.

With Mrs D’s agreement, Dr C opened a case file in anticipation of her requiring further advice and support with the dilemma. Mrs D wrote to Medical Protection the following week to explain that AF’s father had met with a GP and practice nurse, and, having been advised of the benefits and risks of immunisation, had consented to the administration of vaccines to the child.

1. National Consent Advisory Group, National Consent Policy. Health Service Executive. 2017, Version 1.2.