Musings from the ever-changing, ever-amazing and occasionally ever-baffling Fort McMurray, Alberta.

Wednesday, April 16, 2014

Consent Required - Written Consent for Vaccination in Alberta

I am a strong believer in vaccinations.

As a parent (and pet owner) I have always believed that vaccines are powerful ways to protect those in our care from the diseases that once destroyed and claimed lives. As a parent I am an equally strong believer in informed vaccination, and in the necessity of being in charge of our children’s health care, such as giving consent for medical procedures, including vaccination. I believe this a crucial part of protecting the health of our children, and as parents and caregivers we must be responsible for our children’s health care.

Over the years I have both consented, and refused consent, for school-hosted vaccinations and medical tests for the Intrepid Junior Blogger. She is fully vaccinated for all the usual diseases of childhood, but in Grade One when they were doing routine tuberculosis testing of all Grade One children in the school I refused consent after a conversation with my physician and doing research that indicated that such routine testing for tuberculosis in areas where it is not endemic is of little value. I signed the form public health sent home through the school “consent refused”, and the Public Health Nurse called and I explained my reasoning.
In Grade Five when the IJB came home with another form I once again refused consent. This time they were vaccinating for Hepatitis B, but I had already decided she would be vaccinated for both Hepatitis A and B and since this was not offered through the school vaccination program I opted to have her vaccinated privately. I also rejected consent for vaccination against HPV after a long discussion with our physician who indicated they felt there was no harm in waiting until she was older and more mature to do this vaccination, and so it has been during her career in school, with most suggested vaccinations gaining my consent but some being refused for one reason or another. With each refusal came a phone call from the Public Health Nurse and we discussed my reasoning, and that was always the end of it, which is just as it should be.

Regrettably recently in our community this was not what happened to a young boy. When the vaccination consent form went home it was not returned by the boy’s parents, his mother, father, or stepmother as they had determined he too would be vaccinated for both Hepatitis A and B and thus they did not provide written consent for his vaccination. And there the story should end, except that in this case the boy was vaccinated on vaccination day without consent, and, despite him explaining to the nurse that he had recently had a needle, the vaccination went ahead.
No harm was done, at least in the physical sense as the dual vaccinations has proved to do him no injury – but harm was done in the sense that he was vaccinated without the consent of his parents. His parents have handled it remarkably calmly, while I would have likely reacted slightly differently.

I would have gone ballistic.
Regardless of how one feels about vaccinations I suspect we can all agree that consent is a fundamental part of medical treatment, particularly when it comes to our children. There can be myriad reasons we may refuse consent, and to vaccinate a child without proof of consent is deeply worrisome to me. What if the child has a medical condition, eg an allergy to a component of the vaccine (and I have witnessed vaccine-induced anaphylaxis in animals, and it is not something to underestimate as it can pose an immediate risk to life)? What if the child has an illness and a physician has determined that vaccination poses a risk? What if the child has a psychological fear of vaccination and their parent has chosen to vaccinate them privately as opposed to a herd setting (which incidentally is what we have done since the IJB was tiny and after a serious bout of anemia and subsequent medical intervention was left with a severe phobia of needles)? What if a parent has rejected vaccination for other reasons?

Now, in the above case a claim has been made that oral consent was given to vaccinate, and so it has become one word against another. In my belief, though, vaccinations should never be administered without written consent. This should be the only acceptable form of consent in our school system, and it should be required prior to vaccinations being administered. This written consent could come from a parent or whatever adult is acting as a parent of the child, or "in loco parentis" to quote the legal term, as there are cases when parental consent cannot be obtained and so the adult(s) responsible for the child's care should be allowed to provide this consent.
I firmly believe in vaccination. I also firmly believe in consent, and in consent that is unequivocal. Allowing oral consent to suffice leaves too many loopholes for those who may not understand the question or to what they are giving consent. It can end in the kind of incident that occurred to a local family, and it is, in my view, unacceptable.

In May one of the parents in the case I describe will join with MLA Don Scott to present a petition asking the provincial government to amend the law in such a way that only written consent will be accepted as consent for vaccination. This petition is now being circulated in our community, and as a mother and a concerned community member I will not only sign the petition but lend my support to this cause and encourage others to sign as well. I am including a list of locations where you too can sign the petition to demand that only written consent be accepted as consent for school vaccination programs.
What I know is this: If the IJB had been vaccinated without my express written consent I would have been outraged, as while I firmly believe in vaccination the concept and ideal of consent is a crucial part of the health care process. I had always assumed that without my written consent no medical procedure could be performed on my child (unless in an emergency situation, when lifesaving measures need to be implemented). I firmly believe that unless you have written consent in hand the appropriate action is to not vaccinate, because there may be reasons for not vaccinating that are not only sound but vital to understand prior to administering a vaccine.

I not only lend my support to this petition but to the demand that ONLY written consent be accepted for vaccination of children in Alberta. Now that I understand oral consent is deemed acceptable I must advocate to change this, because it matters and because I believe it allows incidents like the one I share today to occur - and while this one ended without serious health repercussion this may not always be the case.
I worked in veterinary clinics for a decade, and you may wonder why vet clinics are so adherent to the policy of consent forms. Unless the vet is standing in front of you almost any medical procedure done on your pet will involve a consent form, signed and dated, because almost every veterinary clinic has a horror story of oral consent gone wrong, and procedures being done when an owner has not given proper consent (a good number of lawsuits and malpractice claims in veterinary clinics centre on exactly this scenario, and I have seen many play out). If veterinary clinics require written consent for any procedure done in the absence of the owner of the animal then does it not make sound common sense that the same should be true of any procedure for children done in the absence of parents and caregivers, including vaccination?

I believe in vaccination, you see. And I also believe in consent, which is why I write this post today, and share the story with all of you. These are the locations where you can sign the petition asking the Government of Alberta to change the law to require written consent from parents or those acting as parents for vaccination of children. I can guarantee this - my signature will be found on this petition, and my email to the Minister of Health has already been drafted - and if you feel as I do I encourage you to do the same.

- Superstore Pharmacy (Downtown)
- Just Kidding Boys & Girls Clothing (Downtown)
- The Eye Place (Peter Pond Mall)
- Peter Pond Dental Clinic (Peter Pond Mall)
- One posted upstairs and one posted downstairs on Sportchek community board, right before you walk in (Peter Pond Mall)
- Back on Track Wellness (Timberlea)
- Shoppers Drug Mart Front Desk and Pharmacy (Thickwood Medical Centre)
- Dave Hill's Pharmacy (Thickwood)
- Family Foods (Gregoire)

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