Most children and youth currently eligible for COVID-19 vaccines will be able to consent to those vaccines on their own in Simcoe-Muskoka, according to the local health unit.
With school-based vaccine clinics starting up in September, the question of consent has been raised again. While the local medical officer of health wants parents and children to talk about the COVID vaccine together, consent is left to the person who will be getting the shot.
The Simcoe Muskoka District Health Unit confirmed a COVID-19 vaccine will only be provided if informed consent is received from the person to be vaccinated, and that includes those born in 2009 or earlier if they have the capacity to make the decision.
Under Ontario law, consent for health care is based on mental competency, not age.
“It’s been a long-standing practice of public health, in keeping with legislation, that people who receive immunization need to be mentally competent in order to give their consent,” Dr. Charles Gardner, medical officer of health for the Simcoe Muskoka District Health Unit, said during a recent media briefing. “Age is actually not a requirement, it’s the ability to understand that’s the requirement.”
The Health Care Consent Act states a person has the capacity to make the decision regarding any medical treatment or admission to a care facility if they are able to understand the information that is relevant, and if they are able to appreciate the reasonably foreseeable consequences of a decision, or lack of decision.
In this case, they must understand what the vaccination involves, why it is being recommended, and the risks and benefits of accepting or refusing to be vaccinated.
This concept is referred to as “informed consent.”
“They have to be able to understand what it is they’re considering receiving,” said Gardner. “They have to understand immunization and what’s involved and why it would be recommended and understand the risks and benefits before accepting it or not accepting it.”
The health unit confirmed it will be up to the nurse immunizer who is providing the vaccine to a student to assess and ask questions to determine informed consent.
“If the nurse identifies red flags that the student is unable to answer, they would discuss with the nurse co-ordinator and discuss calling the parent/guardian if needed,” wrote the health unit in an emailed statement.
The Health Care Consent Act also puts the onus on the health practitioner to determine whether a person is capable of conformed consent based on the definitions and requirements of the act.
The practitioner must be of the opinion that the person to receive the treatment is capable and has given consent, or they can decide the person is incapable and a substitute decision-maker must then give (or not give) consent.
“We would encourage parents to encourage their children to be immunized and we encourage children to talk with their parents about it,” said Gardner. “But the decision actually rests with children who are deemed to be competent to make that decision to understand the decision that they’re making.”
Based on vaccination data provided by the health unit, 62 per cent of youth aged 12 to 17 years old from Simcoe-Muskoka region have been fully vaccinated. It's estimated there are about 38,985 youth in that age range living in the region, and another approximately 2,400 children in Simcoe-Muskoka who are 11 turning 12 this year (born in 2009).
The Health Care Consent Act states the following elements are required for consent to treatment:
- The consent must relate to the treatment
- The consent must be informed
- The consent must be given voluntarily
- The consent must not be obtained through misrepresentation or fraud
The Act also requires health-care practitioners to give the following information in order to properly inform consent:
- The nature of the treatment
- The expected benefits of the treatment
- The material risks of the treatment
- The material side effects of the treatment
- Alternative courses of action
- The likely consequences of not having the treatment
