Mrs D, a practice manager, telephoned the Medical Protection medicolegal advice line to discuss a difficult situation. AF, a 5 month old child, had recently been placed with foster parents. They had registered him at the practice. AF had not yet had any of his primary childhood immunisations and the foster parents were keen for him to start the immunisation programme as soon as possible.
However, the child’s mother, Miss F, had telephoned the practice to say that although her son was now living with foster parents, she did not wish him to have the childhood immunisations. Miss F was not a patient of the practice and refused to discuss the matter further.
Mrs D was unclear how to proceed when the child’s birth mother and the foster parents were in disagreement about his care.
Expert advice
Mrs D spoke to Dr C, an expert medicolegal adviser with a background in general practice.
Dr C advised that, with regard to childhood immunisations, it would be for those with parental responsibility to provide consent for the child to be immunised. Therefore the practice would require the consent of Miss F, unless parental responsibility had been removed by the Court.
He pointed out that parental responsibility might also be shared with the father and/or the Local Authority, given that the child was currently in foster care. Mrs D was unaware if this was the case, but had been made aware that there was a social worker assigned to AF’s case.
Dr C went on to discuss guidance from the Department of Health in Immunisation against Infectious Disease, (colloquially known as the green book). Chapter 2 addresses the issue of consent and states:
“Although the consent of one person with parental responsibility for a child is usually sufficient (see Section 2 (7) of the Children Act 1989), if one parent agrees to immunisation but the other disagrees, the immunisation should not be carried out unless both parents can agree to immunisation or there is a specific court approval that the immunisation is in the best interests of the child.”1
The guidance specifies that if there is any evidence that the person with parental responsibility has not agreed to the immunisation, or there is disagreement between the people with parental responsibility for the child, then immunisation should not be carried out until their dispute is resolved.
Dr C advised that the practice should defer AF’s immunisations until there is valid consent from those with parental responsibility.
It would be prudent for AF’s GP to clarify with the social worker who has parental responsibility for the child and to document this in AF’s records. The GP may also wish to ascertain the reason for the child being in foster care and whether this is a temporary or a longer term arrangement. This will be helpful background information in regards to providing ongoing care to AF.
It would be helpful to inform the social worker that AF’s mother has declined consent for his childhood immunisations. Ultimately, the Local Authority will have to consider this issue further. In the majority of cases it is accepted that it is in a child’s best interests to receive childhood immunisations. If they are unable to obtain consent from the mother, they may have to refer the matter to the Court for an order to permit vaccination to occur.
Learning points
- Childhood immunisations should not proceed where parental disagreement exists, until both parents provide consent or the Court orders it.
- Often resolution can be reached by discussing the risks and benefits of immunisation with the parents, although in this case the mother declined to discuss the matter.
- Medical Protection has a factsheet regarding parental responsibility that practices may find helpful.2
References
- Public Health England. Consent: the green book, chapter 2. Immunisation against infectious disease (2013) Available at: https://www.gov.uk/government/publications/consent-the-green-book-chapter-2
- MPS factsheet Parental Responsibility (2012) Available at: https://www.medicalprotection.org/uk/articles/eng-parental-responsibility