Ethical Perspectives on the News
September 12, 2o10
A colleague recently emailed me. Her daughter, just turned 12, had come back from school bearing an information leaflet about HPV vaccination with the Glaxo Cervarix vaccine, and a consent form for the parent to sign.
The consent form nodded inelegantly to Gillick, asserting that ‘[t]he decision to consent or refuse is legally [the girl’s], as long as she understands the issues in giving consent.’ There was no indication given, in the consent form or the accompanying literature, as to whether and if so how that understanding would be tested. The reality is that it won’t be tested at all.
If parental consent is refused, the parent is instructed to identify the ‘Reason consent refused’, and is told to turn over the page ‘for additional space to give us your reason for your decision.’
The request for a reason for refusal is perhaps a well-meaning attempt to ensure that medically misguided reasons for refusal can be addressed. If, for instance, a parent refuses because she thinks that there is a significant chance of anaphylactic shock, further discussion about the magnitude of that risk relative to the chance of HPV-related disease is warranted. Fair enough. But the request won’t be read that way by parents. They will think that there is a legal obligation to provide a reason, and since the explanatory leaflet suggests strongly that there is every reason to have the vaccine, and none not to, the effect will be to force reluctant parents to sign up because they can’t articulate a reason for not signing.
The case for some sort of HPV vaccination is overwhelming. But the strength of that case should not allow the normal safeguards for ensuring appropriate consent to be ignored.
The NHS has decided that it will pay only for Cervarix. But Cervarix is not the only vaccine. Many other countries have opted instead for Gardasil, produced by Sanofi-Pasteur and Merck. This is not the place to argue the relative merits of Cervarix and Gardasil. It is enough to say that there is a good case for saying that Gardasil is a better vaccine that Cervarix. (See, for instance, here and here). The UK seems to have opted for Cervarix because it is cheap. Shouldn’t any proper process of pre-vaccination counselling for Cervarix include a mention of its main competitor? Parents or girls themselves, having the full facts, might opt to pay themselves for Gardasil. There is no mention in the explanatory leaflet of any alternative to Cervarix. The clear impression is that if you want to avoid cervical cancer you will have Cervarix.