Dr Edward Farnan
A young patient's father refused to consent to his daughter's vaccination.
A GP called the MDU advice line after receiving a letter from the father of a three-year old girl who was a patient at the practice. The father, who was registered elsewhere, said that he and the child's mother had separated acrimoniously, but that he was still in regular contact with his daughter.
He explained that he was aware that his daughter was due to have her pre-school vaccinations, and that he was opposed to the idea and didn't want his daughter to have these without his consent. He said that he had parental responsibility for the child, and enclosed a copy of the child's birth certificate, on which he was named.
The GP told the MDU adviser that the child's appointment for the vaccination was the following week, and asked how he should proceed.
The adviser first discussed parental responsibility. Mothers and married fathers have parental responsibility, as do unmarried fathers of children registered since 15 April 2002 in Northern Ireland, since 1 December 2003 in England and Wales and since 4 May 2006 in Scotland, as long as the father is named on the child's birth certificate. Parental responsibility can be restricted by a court order.
In most situations, all that is required for a doctor to proceed to treat a child is the consent of one person with parental responsibility (or indeed the consent of the child, if he or she is sufficiently mature). This is in keeping with the Children Act 1989 which states, 'Where more than one person has parental responsibility for a child, each of them may act alone and without the other (or others) in meeting that responsibility.' Another excellent source of guidance is chapter 2 of Public Health England's The Green Book, which covers consent matters relating to immunisation.
However, there are some circumstances in which the consent of both parents is required. The courts have held that there is 'a small group of important decisions made on behalf of a child which, in the absence of agreement of those with parental responsibility, ought not to be carried out or arranged by one parent carer.'i
It may surprise doctors to know that the courts have said that 'hotly contested issues of immunisation are to be added to that 'small group of important decisions.''ii
On that basis, the GP was advised that the child should not receive the planned pre-school vaccinations until the position was clarified further. In the first instance, since the child's mother did want the vaccination to proceed, it was suggested that the GP check with her if the father's parental responsibility had been restricted by a court - it had not.
That being the case, the MDU advice was that the GP should try to avoid becoming the mediator in a family dispute. Instead, it was suggested that he may wish to explain the position to both parents; namely that since he was aware of the difference of opinion, he would not be able to vaccinate the child until this was resolved and both parents agreed, or if he was ordered by a court to do so.
The parents consulted with their respective solicitors. The patient's father withdrew his objection, having been advised by his solicitor that a court would be likely in this case to order that the vaccination go ahead in accordance with the child's best interests. The child received her pre-school vaccinations a few weeks later.
Dr Edward Farnan
MB BCh BAO LLM FRCGP DGM DCH DRCOG
Dr Farnan graduated from Queen's University, Belfast, in 1995 and completed his GP training in Northern Ireland, practising as a principal in general practice in Armagh for 11 years. He also sat on a research ethics committee, and had a particular interest in clinical governance.
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