Ethics of helping a minor get vaccinated?
July 22, 2021 12:44 AM   Subscribe

I (double vaxxed) will shortly be flying cross-country to visit family, some of whom aren't vaxxed. Because Reasons, I believe my 13yo nephew is planning to ask me to help him get vaxxed because his parents won't. Help?

I'm so confused about the ethics of this situation. Can you help me think it through? Some data points:
-- This is in Hawaii, an all-day plane trip from where I live.
-- I haven't been able to tell if the J&J vaccine is available in this area right now. And I definitely can't stay there long enough to be there for Nephew to get 2 doses.
-- If it matters, the parents are left-wing anti-vaxxers. More like "we don't put foreign substances in our pure bodies" than "Soros wants to inject me with 5G."
-- Their children (the others are all under 12 so ineligible for the vaccine right now) have never had any vaccinations at all. Mom (my sibling) got the usual vaccinations growing up. Dad never had any.
-- I don't massively care about potentially blowing up my relationship with Mom and Dad. I do care a lot about potentially blowing up the relationship between Nephew and his parents, at a time when he is young enough to still have to reside in their household for many years to come. Especially because I live so far away that I can't meaningfully be there to assist him on any kind of regular basis.
-- I don't massively care about filling out forms and lying by saying I'm the parent. Perhaps I should care more about this?

I feel like the correct thing to do is to say to Nephew, "I can't do this for you but I can be with you while we have a convo with Mom and Dad and explain why you want to be vaccinated." But also...I believe in science. I have watched friends get Covid. I have watched one friend of mine come thisclose to dying of Covid.

Is there any possible way that taking this kid for his first vaccine would be the correct thing to do?
posted by anonymous to Human Relations (67 answers total) 3 users marked this as a favorite
You are not the legal parent of your nephew. He is underage. You have no say in whether he gets vaccinated or not, regardless of his parents' views, rightly or wrongly. He is still an underage child. What are you thinking?
posted by Marie Mon Dieu at 12:53 AM on July 22, 2021 [24 favorites]

Is there any possible way that taking this kid for his first vaccine would be the correct thing to do?

No. This is the parent's decision, not yours regardless of what you believe to be right or wrong. You can sit down with the nephew and family and try to discuss this as a family, but under no circumstances should you take it upon yourself to interfere with their decision.
posted by wile e at 12:54 AM on July 22, 2021 [6 favorites]

Minors are able to be vaccinated without parental consent in some states, though sometimes only for specific vaccines. I suspect 13 is too young to be covered by these laws, though, but you never know.

In other words, if the state of Hawaii says it's his choice, it's his choice and you can facilitate access (and arguably have an ethical obligation to do so).
posted by hoyland at 1:04 AM on July 22, 2021 [60 favorites]

I honestly think legally and ethically are two different things here . Ethically helping a 13 year old who wants to be vaccinated be vaccinated feels like the right thing to me but legally you could get yourself into who knows what kind of trouble. This vaccine does have side effects strong enough that it will likely be noticed. Also when someone is vaccinated it does go into their vaccine database record and that's not a secret! And in fact required by many institutions like schools. So I highly highly doubt that this will stay secret until he is able to get vaccinated on his own.
posted by AlexiaSky at 1:10 AM on July 22, 2021 [30 favorites]

You won't be able to do J&J because I believe only Pfizer is approved for this age group.

I think you're right that talking to his parents is the way to go. Probably best to stay out of the pro/con vaccine argument and focus on shouldn't he have the right to choose for himself.
posted by slidell at 1:14 AM on July 22, 2021 [15 favorites]

Is there any possible way that taking this kid for his first vaccine would be the correct thing to do?

Weird answers on the Green today; yes, taking your teen nephew to get possibly life-saving medical care that his religious/new age extremist parents are denying him is absolutely the right thing to do. Would people be telling you to ask his parents before calling 911 if he was seriously injured when his parents were Christian Scientists who would refuse treatment? If he was lgbt and wanted to reach out to you for support if his parents were fundamentalist homophobes? If he was starting to be sexually active and wanted to know about birth control or condoms? Refusing humane medical treatment like vaccines is a form of abuse, you should not feel bad in the slightest about having 0 compunctions about forging paperwork to get your nephew access to care. You will have to be careful about timing your visits to the two-week window and may not even want to tell the parents you’re in town for one of the trips. There may be some logistical issues to work out to make this less of a possible legal risk for you, too. But yes, get this kid his vaccine. Kids in those kinds of situations— dependent and basically owned by spiritually abusive families who put them in danger— need all the adult advocates they can get until they’re old enough to get free of the house. While you’re at it, check into the age and ways he can independently get his regular vaccine cycle, too, which has been semi-famously done by minors in anti-vaxxer households.
posted by moonlight on vermont at 1:44 AM on July 22, 2021 [157 favorites]

I’ve been reading about how to be a cool uncle. Apparently my duties encompass being willing to bend the rules a little.

I can’t speak to the legal issues, but If I were in your shoes with my nephews, I’d be tempted to say we were heading off to the comics shop to look at Dungeons and Dragons modules, and then, wow, look at that, we spontaneously decided when we were out to get vaccinated against a deadly pandemic!

I can’t decide if it is the right thing to do. I just mean i can empathize and can see the argument in favor of it. And it would be consistent with your duties as a cool aunt or uncle.
posted by johngoren at 1:57 AM on July 22, 2021 [5 favorites]

I’ve made a practice of always being on the side of kids I know, even if it means not being on the side of the parents. This usually looks like helping them sneak a little candy or something, but I would absolutely help a youngster get an abortion. This feels similar to me. Good got that kid knowing who’s on their side.
posted by spindrifter at 3:02 AM on July 22, 2021 [18 favorites]

In my mind, it is ethical to help your nephew get vaccinated, not just against covid but against all the childhood diseases he may have missed. The challenge is that the law often prioritizes parental authority over teens' bodily autonomy. That is, unless the law allows self-consent or waiver of consent, you are going to be hard-pressed to find someone willing to risk their license/risk being sued.

VaxTeen is a really good resource here. It's a teen-to-teen site with a breakdown of consent laws by state, as well as a ton of information on how to talk with anti-vax parents.
posted by basalganglia at 3:34 AM on July 22, 2021 [62 favorites]

Comparing this situation with treatment for serious injury or receiving an abortion doesn't make sense. A healthy 13-year old with no underlying conditions is incredibly safe from Covid.

In the US, there have been 67 covid deaths of 5-14 year olds, out of a population of 41,075,169 (0.0002%). For context, 4,990 5-14 year olds died of any cause, so covid caused 1.3% of deaths. In the UK, there have been 22 deaths of 10-19 year olds (obvs a closer age group), out of a population of 7,528,144 (0.0003%). 1109 deaths of 10-19 year olds occurred, so Covid caused 2% of deaths. Source. Hospitalisation is also incredibly rare.

Where I live (UK), the latest scientific advice is that, absent underlying conditions in the child or family, a 13-year old should not receive any covid vaccine. They say: "the minimal health benefits of offering universal COVID-19 vaccination to children do not outweigh the potential risks. Almost all children and young people are at very low risk from COVID-19. Symptoms, when seen, are typically mild".

You should weigh the tiny covid risk to this child against the extremely-high risk of seriously damaging their relationship with their parents.

It's important not to project adults' legitimate covid anxiety onto an age group who face a totally different balance of risks.

The health risk to the child of not having received their normal baby/early-childhood vaccinations is almost certainly far higher than the risk from not receiving the covid vaccine, and you didn't do anything to get them those vaccinations.

Finally, I definitely don't think you should make healthcare choices for someone else's child on the basis of wanting to be seen as the cool aunt/uncle.
posted by Klipspringer at 3:40 AM on July 22, 2021 [45 favorites]

1. Pfizer is the only COVID vaccine approved for the 12-18 category right now.
2. As mentioned above, states have different guidelines for minor seeking medical care. Some state delineate by type of service being sought (contraception, abortion, mental health, communicable diseases). And some states do not. No idea what Hawaii’s is.
3. If Hawaii’s laws allow the kid to get vaccinated on their own, then I think that would be wonderful to help your nephew get vaccinated.
4. If Hawaii’s laws do not, then discussing with parents, not about the goodness or badness of a vaccine, but about Kid’s desires is absolutely a good thing to do. If kid is 12, they are going to be running into a lot more of these conversations soon anyway.
posted by raccoon409 at 3:53 AM on July 22, 2021 [11 favorites]

I'm a huge believer in vaccines and participated in creating health campaigns for the HPV vaccine rollout in teens. I also have had to make the decision to take my infant daughter off life support against the beliefs of my husband's family (he was in agreement with me.) Our family has lined up for every vaccine available and my teen is double-vaxxed.

Vaccinating a healthy child is extremely different than condoms (which have no negative health impact of which I'm aware) or a lifesaving procedure...but even in the case of a lifesaving procedure, parents do have rights, and we can argue about those rights, but they remain.

I cannot imagine the horror that would have ensued had my suffering daughter with no swallow reflex been forced to continue on a ventilator while our family fought us, whether under the belief of being a "cool uncle" or not. While I am 100% pro-vax, these questions are very complicated and that's why there are laws and courts to address them.

You don't have the legal right to take this child to get vaxxed according to a quick search on Hawaii's laws. To me, that should be a full stop. Also, unless you forge documents as suggested horribly above, you won't be able to accomplish your goals.

That you think the J&J vaccine is available for 13 year olds shows you're not ready to make this decision. The only vaccine approved for 13 year olds in the US and Canada is Pfizer, and although it's rare, there is a side effect particularly prevalent in adolescents which is myocarditis. It would be important to both monitor and support a 13 year old after the vaccine because they might, like my teen, have some anxiety that would present as chest pain.

You can't fly in, get them jabbed, and walk away even if it would be ethical to do so, which it is not.

However, I do think there are things you can do. You can gently talk to the parents. You could, if it's legal, take your nephew to see his doctor and he can ask his doctor to advocate for him. His doctor will also be up on the legal aspects and might be able to vaccinate him at either an age threshold or if the rules change.
posted by warriorqueen at 4:12 AM on July 22, 2021 [43 favorites]

Thank you for mentioning VaxTeen, basalganglia. Came to mention it.

Stuck around to say that I'm stunned at some of these responses. For the record, a 13 year old is "incredibly safe from Covid," but there's the rub with parsing health information. They can still contract, transmit, suffer from, and die from this virus. I'm not one to parse a desire for a vaccination against all of that into a statistical claim of safety. Populations of 13 year olds are "incredibly safe from Covid," and every 13 year old in that population is right and proper to want to distance themselves from the likelihood of being an exemplar breakthrough case, or point of transmission in their family and friend group, or any other possible worry that isn't captured by a population statistics.

I'm an epidemiologist/toxicologist, I work in vaccine development, I I would absolutely drive a vaccination-seeking 13 year old to get vaccinated against his parents' wishes. The consequences that would possibly come to my from those parents are much, much preferable to me than the consequences of telling my young relative "no" to this request.
posted by late afternoon dreaming hotel at 4:13 AM on July 22, 2021 [95 favorites]

I don't work in law in any capacity, but couldn't you be charged with kidnapping if the parents really wanted to pursue a consequence when they find out? And it will be when. Whether blurted out in a stressful teen moment or some situation that requires documents and paperwork, this is not going to stay a secret for long -- so just steel yourself for the fallout in whatever form it is going to take if this is your decision.
posted by archimago at 4:26 AM on July 22, 2021 [1 favorite]

An observation: this question seems to be asking about ethics and not legality. Obviously, those are different (*gestures at numerous unjust laws and policies in the US*)
posted by needs more cowbell at 4:30 AM on July 22, 2021 [4 favorites]

Actually, it seems to me there is plenty of ethical arguments to be made and yes, the sanctity of total control of parents over children is not an unimpeachable ethical precept. Some would say, that in fact, it is the root of all child abuse.
But. I don't think this strategically ,for you or him, is a good idea. The potential for legal trouble could rob him of a supportive relative in his life. A 13 y/o should be able to make this decision for himself, and the best thing you can do is advocate for the value of personal choice and help him argue that to his parents.
Talk about freedom of choice, of bodily autonomy which the parents practiced by making these choices and so should he, and this young man (time to strategically use 'young man' ok?) is making an independent decision. Help him practice explaining that he is making a choice based on his values ('just like you taught me mom and dad'). He should talk about him making this choice not based on just on himself but because he believes it is the RIGHT THING TO DO FOR OTHERS (I honestly don't care if that's true, just this is the argument), and that's just the kind of the son they want, isn't it? One who cares about others?
Yeah, coach him, basically, and be the adult credibility on his team.
posted by wellifyouinsist at 4:42 AM on July 22, 2021 [17 favorites]

Another aspect of this dilemma to consider is that you probably do not know all of the teenager's medical history. While it doesn't sound likely in this case, the parents might have a medical-based reason for deciding not to get the teen certain vaccinations. Further, parents often do not tell children all of their own respective medical information and parents generally fail to disclose their own relevant medical history to their children. Again, I realize that this is unlikely here, but it is certainly a factor that should be weighed.
posted by ASlackerPestersMums at 5:27 AM on July 22, 2021 [4 favorites]

Hawaii News Now article from May:
"As of right now, the only shot children age 12 and up can receive is the Pfizer COVID vaccine. Because of this, it is important that when signing for an appointment that the vaccination site will be administering the Pfizer vaccine.

The shots given to children will be the same dose as what adults receive, which is two shots given three weeks apart.

Yes, parental or guardian consent is needed in order for children between the ages of 12 and 17 to get a shot.

Consent can be given in different ways depending on guidelines created by the state. Currently, most vaccination sites in Hawaii require those age 12 to 17 to be accompanied by a parent or guardian during their appointment."
So, Pfizer only.

May report from the CDC - Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel — 33 U.S. Sites, January–March 2021:
"Interim analyses indicated that the VE of a single dose (measured 14 days after the first dose through 6 days after the second dose) was 82% (95% confidence interval [CI] = 74%–87%), adjusted for age, race/ethnicity, and underlying medical conditions."
And there have been other studies suggesting that a single dose is far better than none. If you come to the conclusion that it would be ethical to help your nephew get vaccinated in the first place, I wouldn't allow concerns about only one dose to affect that.

This vaccine does have side effects strong enough that it will likely be noticed.

This, bluntly, is highly variable by individual. I personally (as, of course, an adult) had nothing more than a mildly sore area at the shot location for either of my Pfizer doses. Other people I know had maybe 24 hours of bad cold/mild flu symptoms. There is absolutely no guarantee that you or your nephew will get busted due to noticeable side effects.
posted by soundguy99 at 5:38 AM on July 22, 2021 [6 favorites]

This is 100% not at all a clear cut "well the law says..." thing, as you have correctly identified, so you can ignore any advice along the lines of "well the law says." This is simply an ethical question. People have been illegally driving their friends and sisters over state lines to get abortions without parental consent and to avoid parental notification for like, generations now. We've been covering for each other for trips to Planned Parenthood to get birth control for decades.

If your nephew wants a vaccine, I'd help him get a vaccine, because my stance on assisting minors to access healthcare is crystal clear in my head.
posted by DarlingBri at 5:42 AM on July 22, 2021 [30 favorites]

I am in a country that mostly allows competent teens to give their own consent to healthcare decisions. In the case of a vaccine recommended for an age group, it would be plausible but not certain that a 13 year old would be deemed competent to consent. I think that the rules we have here are mostly right in principle. In the specific example of your nephew, I think it unlikely that you will be able to help him get vaccinated in Hawaii without misleading the authorities, and the risks of Covid vs the risks of vaccination are finely balanced enough for that age group, that this is not worth giving healthcare workers false information. I would be more worried about the other vaccinations they haven't received - specifically for measles and mumps than I would about Covid. I think it's more than reasonable to try to work on the parents, but I would be very wary of making the nephew's life more difficult.
posted by plonkee at 5:58 AM on July 22, 2021 [2 favorites]

I think it would be ethical, and that your nephew would have significant (if incomplete) protection from a single shot. Whether you're willing to tackle any potential legal implications of lying or falsifying documents at the site, etc., we can't answer for you, but I don't think it would be unethical.

That said, as others have noted, you and he should both be really clear that his parents might find out. He might be sick for several days, I can imagine the vaccination site could follow up by mail or otherwise when he doesn't show up for his second appointment, etc. Is there any reason to be concerned about his wellbeing or safety when that happens, particularly if you're not there? If he does have any long-term side effects, does his parents' medical neglect extend to the point that they might not get him proper care? Would they be likely to retaliate in some way that would be harmful to him? Those issues would weigh into my decision, in your shoes.

If you do decide that what you can do here is to facilitate a discussion with his parents, that's still an important way you can support him and, in the long run, his siblings.
posted by Stacey at 6:08 AM on July 22, 2021

What are the chances that his parents will take your opinion seriously, assuming you do some preparation on the best way to reach people who are vaccine-averse in their specific way? Do they have a history of discounting your opinion or does it hold some weight for them? I ask because I agree with the people who are arguing that this is both ethically defensible and a moral good—but Stacey also makes a really important point about his siblings. Unless you're planning to repeatedly fly out to Hawaii to smuggle them into the vaccine center as they come of age, talking some sense into his parents could help all the children. Subterfuge helps one, halfway.
posted by babelfish at 6:15 AM on July 22, 2021 [1 favorite]

A single dose of Pfizer doesn’t actually do all that much against Delta, which is what is circulating right now. Take a look at the dashed blue line in this plot.

Ethics writ large aside, I agree with warriorqueen that you specifically are not well-enough informed for me to think you should intervene here. I think there’s a far better case for their pediatrician playing some kind of lawbreaker role than there is for you (and that likely won’t happen because of licensure concerns etc raised above). I also think that this kid (and those around them) could wind up having much bigger problems than Covid because of their parents’ anti-vax position, and that’s a damn shame. I’m sorry for your family. This is a tough position to be in.

A side note — vaccination is a thing we do for public health, not just for individual health, and considerations of risk/benefit for the individual are incomplete without considering this. The messaging around this in the US right now is driving me crazy. (But it should be informed people making those calls.)
posted by eirias at 6:46 AM on July 22, 2021 [6 favorites]

If you find after researching that a 13 year old needs parental/guardian consent to receive a vaccine I would do all I can to help him obtain it - legally. Can you help him find free (or you gift him) legal help to enable him to make this decision for himself? Would ACLU assist? Surely there are lawyers in Hawaii who would be interested in taking on this case. In other words being his ally rather than accomplice. A plus is that if he can win the right to make this decision, he can, if he wishes, receive all the other vaccines he's been denied. And it could emancipate ALL the 12 year olds in his position in Hawaii.

If you decide on the furtive approach it will probably be found out eventually. Are you willing to commit fraud? Imagine the possible blowback. Even pro-vaxxer passionate lefties probably believe they, and they alone, are in charge of the healthcare their minor kids receive. I see potential legal catastrophe for you, and potential permanent estrangement not only from your sibling but also from your nephew and other minors, at least until they are 18.

Not that it isn't important, and even right that 12 year olds are vaccinated, but the potential risks are huge, and I think addressing his legal right to healthcare and vaccination is a more strategic approach.
posted by citygirl at 6:51 AM on July 22, 2021 [2 favorites]

Ethical or morally correct? Ethical is dependent on both societal norms and your own code of conduct. What if nephew says, "While we're at it, can I get the chicken pox vax I never got too?" There is so much more to this situation than we (not sure you) will ever know. How much does this nephew understand about his choices and the implications of each. What is his plan for the second shot? Maybe his parents are aware of his asking you and are tacitly approving by remaining silent. It saves face for them if they can say to their anti-vaxx friends, we would not have done it but my sister/brother/mom/dad took him without our knowledge. Maybe they punish him for lying or going behind their back. It is easy in the abstract to say you don't care what your sister's reaction will be, but it is a lot harder when they disown you or take action in retaliation.

I do not see it as ethically ok to encourage a 13 yo to lie to his parents, lie on a government form and generally go against his parents wishes. Having said that, I do think it is morally ok to stand by your nephew. I don't think taking a niece across state lines for an abortion is ethically correct, but I do think it is morally ok and I would do it.

I think your role here is to advocate for your nephew. That advocacy is not to make decisions for his parents whom the laws have clearly said "know best", but, rather, to advocate to his parents to let him make the decision. He is only 13. If he were say 17, his parents would know that in less than 12 months, he can make whatever damn decision he wants. My goal as a parent was and is to teach my children to make decisions on their own. Understand and live with the consequences. When my daughter was in HS and was 17, she wanted to go to a post prom weekend at an unchaperoned house with 15 friends including her prom date. My ex was very reluctant to say yes. THe point I made to her was that in 3 months she will be away at college making these decisions every day. What better way for her to learn than to learn while she is still at home and has our every day support? If we had not taught her right and wrong by then, she was not going to suddenly learn it in the 3 months before school nor would she learn it by being told no.

I think you should have a long talk with your nephew and learn what he thinks, why he thinks it, and why he either hasn't or won't have the conversation with his parents. Then, and only then can you decide what to do. I do urge you to speak to his parents too. Finally, know that as the family goes, you are damned if you do and damned if you don't.
posted by AugustWest at 7:05 AM on July 22, 2021 [4 favorites]

Lots of good arguments here, but just want to underline that while the law may treat children as the property of their parents, ethics must never do so.
posted by rikschell at 7:50 AM on July 22, 2021 [37 favorites]

I would find it ethically good and proper.

The child may have a reaction to the vax, making it hard to keep his parents from knowing about it. Even 1 of the 2 Pfizer shots would provide significant protection. I would talk to the parents about respecting their child's wishes, allowing their child to make decisions. Social influence is a real thing; when a bunch of relatives assure you they've been vaccinated and tell you they honestly believe it's safe and effective, as well as the morally correct choice to stop a dangerous pandemic from spreading more harm, it may help a bit.

Whether you take your nephew for the vax or not, showing support for him and being someone he can talk to is a big help.
posted by theora55 at 7:52 AM on July 22, 2021 [3 favorites]

What if nephew says, "While we're at it, can I get the chicken pox vax I never got too?"

Just to speak to this one point, this is a bit of a straw man argument, as they specifically won't let you get other vaccines at the same time as you get a COVID-19 vaccine, in my experience. I'm due for a booster on one childhood vaccine and they recommended that I wait a bit.
posted by limeonaire at 9:00 AM on July 22, 2021 [5 favorites]

What if nephew says, "While we're at it, can I get the chicken pox vax I never got too?"

If OP is "at it" than OP has made an ethical decision to help his nephew access healthcare during his visit. So yes, he can* get the chickenpox and more importantly, MMR vaccines he never got. But this argument feels like a strawman because we're not in the middle of a chickenpox pandemic.

*I mean, he can't, because you can't get them at the same time as you get your COVID vax, but that's not the point you're making.
posted by DarlingBri at 9:11 AM on July 22, 2021 [2 favorites]

I also came to recommend VaxTeen, which has been done upthread, but want to point out that being 13 years old does not mean he is statistically "safe from Covid". Yes, hospitalizations and especially death are rare in this age group. Ongoing health issues (I.e. long covid) are not, with the best evidence I've seen coming from a large UK study that suggested they affect around 15% of kids that age who get Covid, including those who had very mild initial symptoms (other smaller and less inclusive studies have reported rates as high as 40%). Your nephew has the right to want to protect himself from these common complications as well as the statistically rarer outcomes, not to mention wanting to protect the people around him including his family. One of my friends knows a family where the teenager brought home covid (pre-vaccine) and her healthy, middle-aged father died from it. I would not be surprised if Nephew has a lot of anxieties around such potential situations and feels the moral weight of not being vaxxed, in addition to wanting to protect himself.

I feel like it's morally right to help your nephew get his vaccines via whatever mechanism is possible. However, that being said, I do think it is best if you can help him advocate for his rights with his parents. Like others have pointed out, he still has to live with them and one shot is minimally protective against the Delta variant. If this doesn't work I would think the next best option is helping him figure out if there is a way to get it without their approval; where I live 13 year olds can sign for themselves without parental consent. It looks like Hawaii requires parental consent, but I would suggest looking into this further (e.g. you could try reaching out to the folks at VaxTeen, or go with Nephew to talk to a physician about whether there are other options). Personally, if all else fails, I would feel okay about pretending to be a parent and helping him anyway. But I am coming from the bias of believing that teenagers (except in exceptional circumstances) have the capacity to consent, and their bodily autonomy and access to healthcare should be supported. Grarr, thinking about how teenagers are denied healthcare because of their parents' beliefs really pisses me off.
posted by DTMFA at 10:02 AM on July 22, 2021 [7 favorites]

Seconding the poster directly above — children and teens can get covid, can get long covid, and it’s pretty much misinformation to state that a 13-year-old is safe from it. I also live in the UK like the person who suggested this, which is where I’ve heard both the same faulty expert advice they quote and the children’s covid cases (as well as worldwide).
posted by lokta at 10:09 AM on July 22, 2021 [5 favorites]

Just to speak to this one point, this is a bit of a straw man argument, as they specifically won't let you get other vaccines at the same time as you get a COVID-19 vaccine, in my experience. I'm due for a booster on one childhood vaccine and they recommended that I wait a bit.

This was true until recently but is no longer the recommendation in the US, per the CDC - "COVID-19 vaccines and other vaccines may now be administered without regard to timing. This includes simultaneous administration of COVID-19 vaccine and other vaccines on the same day, as well as coadministration within 14 days."

(I was surprised by this because at the beginning of the summer I'd been told to postpone my Tdap booster, but when I got it this weekend after accidentally stabbing myself with a Swiss army knife the pharmacist said that the advice had changed.)

Sorry this is not related to the actual question but I didn't want to let outdated information stand.
posted by mskyle at 10:15 AM on July 22, 2021 [5 favorites]

So, if it were me, I would talk to your nephew about why he feels it's important to get vaccinated, and my response would, I think, vary depending on his answer!

If he's afraid of getting COVID -- of getting sick, of being hospitalized, of long-haul symptoms, or of spreading it to others -- then I would take him to get vaccinated. I don't think he should have to suffer and worry about getting this disease when we have a vaccine, just because he's a kid and his parents are anti-vaxxers. This scenario, to me, would be worth the relationship fallout between myself and his parents. (You might also need to act as a shield for nephew here, and take the blame yourself.)

If he wants the vaccine because he wants to be a good citizen and community member, I would tell him how wonderful and caring he is, and then I would help him advocate for himself with his parents. It sounds like his parents are uh...not inclined toward prosocial behavior, so it's extra great that he feels a responsibility toward his neighbors. This may or may not result in his getting vaccinated, but in this scenario that feels like an okay result.

He's 13, not six. He undoubtedly has reasons why he feels it's important to get the vaccine, and if his parents won't listen to him, he's lucky to have another adult who will. If you do take him, I wish you the best of luck with whatever happens next.
posted by goodbyewaffles at 10:39 AM on July 22, 2021 [2 favorites]

I do care a lot about potentially blowing up the relationship between Nephew and his parents, at a time when he is young enough to still have to reside in their household for many years to come. Especially because I live so far away that I can't meaningfully be there to assist him on any kind of regular basis.

Just this part right here seems like an enormous, deal-breaking risk in this situation.

I'd feel differently if he were sixteen or seventeen.
posted by desuetude at 10:53 AM on July 22, 2021 [6 favorites]

What negative consequences are there of him getting vaccinated for him with his parents? The health risk/benefit analysis has been done here, but will they do anything to endanger him if/when they discover he is vaccinated? Because if he is in physical harm's way, or even emotional harm's way, as a result of a vaccination, then perhaps his parents really aren't capable of being good parents anyway. Nobody should face more harm as a result of wanting to...reduce harm. Honestly like politics and religion and etc aside, it seems to be essentially neglect/abuse to refuse vaccinations for kids, and I have to raise my eyebrows at the wisdom of parents who choose this.
posted by erattacorrige at 11:56 AM on July 22, 2021

Lots of good arguments here, but just want to underline that while the law may treat children as the property of their parents, ethics must never do so.

Look, this is just not true in the real world.

I had an entire medical team telling me important information about my baby, and an entire family SURE it was God's Will that she should stay on a ventilator for the rest of her whatever-lifespan. They would have phrased it as ethics.

Is giving parents rights over their child's medical care a perfect system? No, it is not. Is a 13 year old of an age to have some input? Quite possibly. Is the law possibly wrong in this case? Could be.

I'm so upset at this thread it's difficult to say but I think I've come down to this. OP, if you feel that strongly about this, I think you should come into Hawaii with an attorney on retainer, and you and your nephew should pursue his right to be vaccinated legally. Because without parental consent, unless you lie and sign as if you are the parent, no one is going to vaccine this child anyway.

The people who are like SUPPORT THE CHILD are pedalling a fantasy.
posted by warriorqueen at 12:06 PM on July 22, 2021 [9 favorites]

In my city at least, 13-year-old kids can roll up to any pharmacy unattended & even without an ID (or at least, the IDs aren't being intensely monitored) and get vaccinated instantly. So I guess we're talking about a difference of legality moreso than ethics or a child's right to self-determination v parental authority or whatever.
I also recently learned that there are like 10^15 viruses within each of us (our virome) so we're all already chock full o' viral bits, if that piece of trivia is helpful for selling this idea to vaccine skeptics at all. (We aren't "pure" lololol.)
posted by erattacorrige at 12:16 PM on July 22, 2021 [3 favorites]

Do NOT encourage people to make medical decisions for children who are not their own in places where children are not allowed to do that. It's illegal and dangerous and encourages and increases paranoia among people who assume that the medical establishment and society do not have their best interests in mind.
posted by vunder at 12:33 PM on July 22, 2021 [1 favorite]

This might change their minds or help you make your decision.
posted by H21 at 12:40 PM on July 22, 2021

I think it makes sense to prepare for a conversation with nephew and his parents both about vaccination specifically and as practice for them to have conversations about contentious topics in the future. I think the conversation-having has a larger long-term upside than illegally vaccinating your nephew, it doesn't have nearly the downsides, and I don't think you can do both.

Also, there was a question not long ago about a young teen having sex, and lots of people wrote answers about how people have poor impulse control and poor ability to weigh consequences at that age. I think arguing that a 13-year-old has full right to make all decisions about their body is complicated by what we know about cognitive development.

It's a hard situation, but you can't swoop in and fix it with a single shot of Pfizer. You can't support him in the way you need to be able to to make vaccinating him a good idea. Find other ways to support him that you can do, and do them consistently for the next 10+ years.
posted by momus_window at 12:48 PM on July 22, 2021 [2 favorites]

Ethically: no question, I would want to sneak off and get them vaxxed. This could be life or death here. Even if all you can do is get them one shot, that would be better than nothing.
Legally: sounds like it's an absolute no-go in Hawaii.
Whether or not you can hide it from the parents: maybe. Could have noticeable side effects, or not, could be outed via database or not (would anti-vax parents check?).
Whether or not you can convince the parents: If that was even remotely possible, you wouldn't be asking this, would you?

It's going to be a risk to you to do this illegally and I don't know enough about how they check this stuff anywhere in Hawaii to know if you can get away with it or not. Like, are they asking parents to show birth certificates and legal ID to prove their parentage of the kid, or can you walk up and say "Hi, I'm Jason's dad" and nobody argues with it? Are you willing to get into legal trouble if caught at this? Can you look into how much legal trouble this is likely to be if caught? At this point you know it's ethically right and legally wrong in Hawaii, so you need to decide if you're willing to risk legal consequences and find out what those are, if possible, before you decide.
posted by jenfullmoon at 12:53 PM on July 22, 2021 [1 favorite]

DTMFA: I feel like it's morally right to help your nephew get his vaccines by whatever mechanism is possible. However, that being said, I do think it is best if you can help him advocate for his rights with his parents.

I agree with this, as well as with the affirmation by desuetude of OP's wish not to undermine their 13-year-old nephew's relationship with the boy's parents, when he is still dependent on them and OP lives far away from their nephew's family.

OP, you know your sister and brother-in-law better than any of us do. Are they the kind of people who would be open to a discussion with you and your nephew about his wish to be vaccinated against COVID?

A jumping-off point for discussion could be the informative, thoughtful and timely writing that has been done on the debate over the rights of minors get vaccinated without parental permission.

Michael Ollove of Stateline, a nonprofit news service that covers state policymaking trends,
wrote an article in 2019 about states that had passed or were considering bills to expand the access of people under 18 to preventive care, including vaccines.

Ollove's article includes a table of the 10 states, including D.C., that already have these laws in place. For the sake of public health, I would like more states to have these laws in place; I am sorry that mine does not.

Another article from 2019 that could be grist for a family dialogue is one that Jane Roberts wrote, for Undark.

It's about the decision by an Ohio 18-year-old, Ethan Lindenberger, to start getting all the vaccinations that his mother eschewed for her children. His older sister, the oldest child, had all of her childhood inoculations; she's the only one of the seven Lindenberger siblings who has.

Now that I've reread both pieces, I think that Roberts' story, from Undark, might open more doors, if you decide that a sit-down with your nephew and his parents is what you want to do. It acknowledges the impact of Ethan Lindenberger's decision on his mother, who took it as a betrayal. (His father, who wasn't quoted in the story, is in the "same camp" as his wife on vaccines but said, "Hey, you're 18, you can do what you want and we can't really stop you," Lindenberger told Roberts.)
posted by virago at 12:56 PM on July 22, 2021 [1 favorite]

"His father, who wasn't quoted in the story ..."

I should have said: "His father, who apparently wasn't interviewed for the story ...," because Ethan Lindenberger does quote from a conversation that he had with his father.

(The rest of the comment stands.)
posted by virago at 1:12 PM on July 22, 2021

I have been thinking about this question all day in large part because it is such a tricky one to answer. Part of the dilemma for me is that I am a firm believer in bodily autonomy and yet I also think parent rights should be firmly respected.

An aspect of this case that stands out to me is that you have not intervened regarding the other vaccinations that this teen has missed. The fact that you didn't do anything about those makes me wonder if the political conversation surrounding Covid-19 has swayed you to action rather than actual concern about your nephew's safety. To be clear, I believe that you are concerned about his health and well-being. I just wonder what is prompting you to want to act here about this vaccine when you didn't act when he has missed a whole slew of them? I wonder about the inconsistency, and thinking through this might help you figure out what to do.
posted by ASlackerPestersMums at 1:24 PM on July 22, 2021 [4 favorites]

I just wonder what is prompting you to want to act here about this vaccine when you didn't act when he has missed a whole slew of them?
I think OP said that it's because the nephew asked (or is soon to ask) OP for help to get the COVID vaccine. Also, while it's still plausible to get, say, the measles or polio in a Western country, it's not all that likely, because we don't have a measles pandemic running amok the way we have a COVID pandemic running amok. We DO have outbreaks of these other preventable diseases, but they are NOT classified as a pandemic, and maybe that's the distinction.
*and we don't have pandemics of these diseases precisely because most people are vaccinated for them!*
posted by erattacorrige at 1:34 PM on July 22, 2021 [3 favorites]

encouraging or helping a child to do something that frays his family relationships and perhaps ultimately support structure can also have ramifications on both physical and mental health for a long time to come. Maybe eventually positive or negative, but whether or not he gets COVID is scraping the surface of the ethical questions here.
posted by acantha at 1:56 PM on July 22, 2021 [1 favorite]

Just some anecdotal stuff: I'm glad people upthread specifically brought up the fairly common experience of driving someone across state lines to get an abortion. I have very strong memories of my sexually active 13 and 14 year old high school peers in the 90s desperately trying to source pregnancy tests, contraception, and access/rides to Planned Parenthood from their classmates, hoping for older siblings or sympathetic parents or someone with a car, because they knew their families would either abuse them, or force them to keep a pregnancy. When my mother gave me the sex ed talk, she specifically let me know that while she hoped I would always come to her, it was ok for me to keep those decisions and even medical treatment private from her-- that it was my decision, and mine alone. I also remember getting a friend with a car to take a sexually active gay friend to PP to get testing and contraception, because his parents would have become abusive if they knew he was gay; we all stuck to the story that we were going to the mall. The sense of fear and helplessness knowing that no adults in someone's family or social circle could be counted on to help was overwhelming.

Teenagers are in an in-between developmental place, with their need for autonomy often outstripping their legal rights. Teens needing to go behind their families' backs to get medical care is an unfortunate reality; it doesn't mean that the care they need is optional, and it doesn't mean they're at fault for keeping things from their parents. Some people simply are not safe to be trusted with information about their kids' lives, whether they're abusive, politically or religiously bigoted against their children, delusional, etc, and I would place antivaxxers during a pandemic that could leave children with lifelong health issues firmly in that "unsafe" category. DM me if you want practical advice about how to coordinate this, you are a godsend to your nephew.
posted by moonlight on vermont at 2:29 PM on July 22, 2021 [10 favorites]

In my view, the vaccine does not reach the level of extreme medical negligence to justify an outsider's action. I understand there are arguments that people make saying otherwise. But, some of these answers seem to be coming from a reality I am just not familiar with.

IF the OP did lie and get his nephew the vaccine, this would possibly blow apart a family. That is a significant tragedy. The nephew could get a lot of grief (or worse) from his parents. Also, he could lose a loving family member over this.

I am a vaxed person in a family group where some people are not. I have to deal with it. Some of them are smart, some are ignorant, some are being consistent with how they have always lived their life, some are not. Politically, some voted for Trump, some voted for Biden.

Ethically, there is no way I could support anyone doing this to a family member's child.

This question makes me sad, good luck OP.
posted by rhonzo at 2:40 PM on July 22, 2021 [4 favorites]

Mod note: Folks, I know this is a question that intersects on a couple of different charged topics, but I'm going to ask everybody to remember that this is Ask MetaFilter and not a general debate stage for those topics. Please do your best to answer the question ask, avoid getting into arguments with other askers, and be kind.
posted by cortex (staff) at 3:21 PM on July 22, 2021

I'm super sympathetic to your plight, OP. There are certainly secrets that I will keep for the adolescents in my life, and I will always respect their intelligence, but one thing that we adults do gain with age is the ability to think through consequences more completely and clearly .

This thirteen-year-old would have to take responsibility for:
a) hiding any side effects,
b) hiding any follow-up communications about their second dose,
c) behaving as if they're NOT vaccinated,
d) keeping their vaccination a secret from everyone,
e) guilt over the inevitable fallout for the OP if and when this scheme is found out.

I think that's too much to put on a child. For only half of a vaccine dose.
posted by desuetude at 3:37 PM on July 22, 2021 [7 favorites]

> In the US, there have been 67 covid deaths of 5-14 year olds, out of a population of 41,075,169 (0.0002%).

It's worth remembering that this is in the context of strong measures being taken at schools (masking, physical distancing etc) and people of this age being kept from almost every other social endeavor for the entire period.

When that regimen relaxes, as it certainly will, the amount of cases, serious disease, hospitalization, and death in this age group may well go up 10- to 100-fold - if the other age groups don't have a high enough vaccination rates to massively slow down the spread of the pandemic. Which in the U.S. right now, looks to be the situation.

That is to say, we're not looking at a future situation where community spread is so low in the U.S. that people can just go out and about not being too worried about encountering someone with covid. To the contrary, every school is likely to have multiple active cases at any given time and any classroom likely to have multiple active cases over the course of a term.

Point is, children and teens are at lower risk but not no risk. And our assessment of the lower risk has a lot to do with the measures that have been taken to reduce spread in young people - which to a large degree are easier and more effective than similar measures for adults.

And the point is, a 13 year old wanting to be vaccinated is not either crazy or unsafe.

I won't say more than that.
posted by flug at 3:43 PM on July 22, 2021 [3 favorites]

Damn. Kids under 18 absolutely can consent to their own medical procedures in many places in the US. The law is not consistent, and there are a lot of wrong, overly moralizing answers here. I offered to bring my kids' friends to get vaccinated if they were 16 and older, which is the age of being able to consent to medical treatment for yourself in my state.

It looks like you have to be 18 in Hawaii, unfortunately. I would still consider doing this myself, but I'd try to see if the kid had some option for getting the second shot.

Good luck.
posted by bluedaisy at 3:47 PM on July 22, 2021 [2 favorites]

It's interesting to me that you're concerned about the fallout between the child and parents, but not the parents and you. You know them best, of course, but if I were the parent, I'd be ticked off at the kid, but, like, he's 13 and I am expecting some rebelliousness at this point. But my adult sibling or sibling-in-law doing this behind my back...I would be beyond furious. This relationship would never be the same. I would never trust you again, and would probably not want you in my life in any significant way for a long time. That is my concern for you. Talk to the parents. I think the angle of allowing the child to make health decisions for themself would be the best hope.
posted by hannahelastic at 5:03 PM on July 22, 2021 [2 favorites]

I do not see it as ethically ok to encourage a 13 yo to lie to his parents, lie on a government form and generally go against his parents wishes.

This is situational. The kid's not committing wire fraud or running an illicit waste-dumping company, he's trying to get medical care his abusive parents have been witholding.

"Hey kiddo, if you have a filled-out form with what looks like a signature on it, I'll be happy to swing by a vaccination clinic on the way out for ice cream."

Regarding ethics, rank my nephew's health over his parents' whims and good humor.
posted by sebastienbailard at 5:10 PM on July 22, 2021 [5 favorites]

I'd encourage him to sign his own mmr/etc consent forms too.
posted by sebastienbailard at 5:37 PM on July 22, 2021

By the way, I haven’t had time to read through this article but there might be something helpful in here for you, OP: Slate: Meet the Young People Going Behind Their Qanon Parents’ Backs to Get Vaccinated
posted by moonlight on vermont at 6:02 PM on July 22, 2021

I think a big difference you could make for your nephew is helping find ways to advocate for himself and talk to his parents as an individual. Modeling an educated view of vaccines and public health to your sister and BIL. Since it sounds like he’ll need parent’s permission in Hawaii, I just don’t think there’s much else you can do. I do like the idea of asking his pediatrician to help, but I think you’d have to ask a parent before even contacting his doctor (unless nephew knows how to contact his dr?) This could be a way for you to help him witness another adult perspective and a way to try to rationalize with his parents, who sound difficult. The dad in particular sounds worse - like he’s influencing your sister - so what if you asked your nephew what he thinks about talking to mom and getting her on your side first.
You’re playing a therapist role here, trying to help him find tools for self advocacy. I’m reminded of the show Mad Men, when Sally’s therapist teaches her to handle her domineering mom. She essentially points out “your mom is not being healthy here. What if you learned to placate her for your own safety?” And they discuss strategies that seem to help sally.
Maybe you won’t be able to help him get vaccinated, but it sounds like he’ll need support for handling his parents world view, and this could be the opportunity to help.
posted by areaperson at 6:44 PM on July 22, 2021 [1 favorite]

I don't know that you will be practically able to get this done even if you are willing to, but it would be unethical to deny a child your help to access safe and potentially life-saving medical care simply out of fear that you yourself might get in trouble.

it's true, you might get in legal as well as familial trouble. but if directly asked by the child in question, this is a risk I would be proud to take and ashamed not to.

if you do it, I would also have a good talk with him about his own ethical obligation to show gratitude by not telling his parents about it. just as lying for him is the ethical choice for you, lying for you is the ethical choice for him. though I would be prepared for him to let it slip sooner or later anyway, he's a kid. but hey. it's worth it. and if there are bad consequences for you, he'll learn something from that, too.
posted by queenofbithynia at 9:10 PM on July 22, 2021 [4 favorites]

^^^I think a big difference you could make for your nephew is helping find ways to advocate for himself and talk to his parents as an individual. Modeling an educated view of vaccines and public health to your sister and BIL.

Exactly this.

areaperson has said what I tried to say but couldn't.

OP, this isn't going to be the only time that your nephew will want to depart from how he's been brought up. In this context, his wish could wind up being dismissed as typical adolescent posturing. Even though, as we know, whether and when to be vaccinated against COVID is pretty damn significant.

So you will be doing your nephew a service if you can help him make his case -- in a cogent and informed way -- for wanting to do Y when he's been brought up all his life to do X.

That said, nobody -- least of all me -- can predict how your sister and brother-in-law will react if you and your nephew decide to sit down one on one with them, and it would be incredibly irresponsible of me to promise that they'll change their minds on this issue or any other.

Here, again, is where I recommend reading Undark deputy editor Jane Roberts' 2019 story, Coming of Age Unvaccinated.

Roberts interviewed not only Ethan Lindenberger, an Ohio high school senior who got all of his vaccinations after turning 18, but also a Minnesota sophomore identified pseudonymously as "Danny," who asked Reddit when he was 15 if there were any way he could be vaccinated without the permission or knowledge of his anti-vax mother:
For now ..., teenagers who are still living at home and are not covered by a specific state statute may have to keep pressing their parents — or simply just wait. At the county health department in Lindenberger’s hometown in Ohio, Christina Cherry, the director of public health nursing, said all they can do is provide a teen with the appropriate information to share with their parent or guardian. “Additionally,” Cherry wrote in an email, “we can encourage the child/teen to bring the parent or guardian in to meet with us or the child’s/teen’s primary care provider to discuss the parent’s concerns about vaccinating.”

Such an approach seems to have worked, at least in a small way, for Danny, who recently turned 16. In a phone call, the high school sophomore said his mother did eventually allow him to get vaccinated against polio and tetanus following a conversation with his doctor. For any further immunizations, however, he says he’ll likely have to wait until his 18th birthday.

For that reason, Danny said he supports lowering the age of consent to be able to get the rest of his vaccinations on his own, but added that this alone won’t address the problem. “Stopping the spread of false information,” he added, along with a handful of other factors, also have to be considered. Infants also need to be vaccinated, he said, and that remains, for the most part, entirely a parent’s choice.

“The toughest aspect to understand is that they want the best for me,” Danny said of his parents. “And that decision, in my opinion, was not properly researched or informed.”
posted by virago at 1:14 AM on July 23, 2021 [2 favorites]

Just realized that I left out a few words (represented in italics below):
That said, nobody -- least of all me -- can predict how your sister and brother-in-law will react if you and your nephew decide to sit down one on one with them regarding COVID vaccination, and it would be incredibly irresponsible of me to promise that they'll change their minds on this issue or any other.
posted by virago at 1:26 AM on July 23, 2021

I don't think it's a good idea to do this behind his parent's back. It would put him in the position to either keep a Big Secret indefinitely or risk getting himself and you in "trouble" if Mom and Dad find out.

That's alot of emotional baggage for a 13 year old.
posted by space_cookie at 6:54 PM on July 23, 2021 [1 favorite]

Personally if it were my nephew I would do it. In my view I have just as much responsibility for keeping my siblings' children alive as I would for my own.
posted by bleep at 3:29 PM on July 26, 2021

Parents have total responsibility for decisions affecting their children for a very good reason: because nobody else can have it. Legally, practically, ethically, morally, and even biologically (i.e. developmentally, the kid taking responsibility for themselves), there is simply no other party that is available to take on this responsibility. Like, you, OP, you live a day's flight away from this child. How can you possibly assume responsibility for this child's medical decisions when you can't even guarantee you will stick around for getting him a second dose of his vaccine?

It's illegal as well as immoral and irresponsible for people who are not the parents of a child to commit this kind of drive-by medical guardianship fraud and then fly away, la la la la la, when the hit job is done, leaving the kid to deal with his parents and the parents to deal with a seriously damaged relationship with their kid, thanks to your incapacity to act like an actual adult by having an actual adult conversation with the parents.

If the child were in imminent danger, yes, there is absolutely an obligation for other members of a community to step in and supersede the parents' decision-making. But even then it would be illegal and immoral to sneak behind the parents' back to do it! BE AN ADULT. TALK TO THE PARENTS.

And anyway this child is not in imminent danger. He is in the exact same position that every child under the age of 12 is: exposed to the small danger posed to him by the virus, necessitating the wearing of a mask and the maintenance of social distancing. This stings, and it's inconvenient, but it is not life threatening.

Please stop justifying illegal, immoral, & dangerous behavior towards children who are not your own, all in the name of ~protecting~ this child from the mild inconvenience of masks and social distancing.
posted by MiraK at 9:59 AM on July 27, 2021

Parents have total responsibility for decisions affecting their children for a very good reason: because nobody else can have it. Legally, practically, ethically, morally, and even biologically (i.e. developmentally, the kid taking responsibility for themselves), there is simply no other party that is available to take on this responsibility.

This just isn't the law in many places in the US, so I'm not sure moral absolutes are helpful. In Oregon, 15 is the age of being able to consent to vaccinations and other medical treatment on your own. In DC, the age is 11.

And do we all really not want people under 18 to get birth control without parental consent?

I'm not saying this means the poster should absolutely do this, but children do have bodily integrity and can legally make these decisions in some places. Children do have rights.
posted by bluedaisy at 10:08 AM on July 27, 2021 [2 favorites]

Please don't misinterpret my comment using random hypotheticals and different circumstances. I'm addressing OP specifically, about the situation they are in with this child specifically, about this medical decision specifically.
posted by MiraK at 10:13 AM on July 27, 2021 [3 favorites]

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