Informed Consent for HPV Vaccination: A Relational Approach
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The aim of this study was to explore the relational aspects of the consent process for HPV vaccination as experienced by school nurses, based on the assumption that individuals have interests related to persons close to them, which is not necessarily to be apprehended as a restriction of autonomy; rather as a voluntary and emotionally preferred involvement of their close ones. Thirty Swedish school nurses were interviewed in five focus groups, before the school based vaccination program had started in Sweden. The empirical results were discussed in light of theories on relational autonomy. The school nurses were convinced that parental consent was needed for HPV vaccination of 11-year-old girls, but problems identified were the difficulty to judge when a young person is to be regarded as autonomous and what to do when children and parents do not agree on the decision. A solution suggested was that obtaining informed consent in school nursing is to be seen as a deliberative process, including the child, the parents and the nurse. The nurses described how they were willing strive for a dialogue with the parents and negotiate with them in the consent process. Seeing autonomy as relational might allow for a more dialogical approach towards how consent is obtained in school based vaccination programs. Through such an approach, conflicts of interests can be made visible and become possible to deal with in a negotiating dialogue. If the school nurses do not focus exclusively on accepting the individual parent’s choice, but strive to engage in a process of communication and deliberation, the autonomy of the child might increase and power inequalities might be reduced.
KeywordsHPV vaccination Informed consent Relational autonomy School nursing Sweden
This study was funded by the Swedish Cancer Society and the Solsticke Foundation. We are most grateful to the school nurses who participated in the investigation. Thanks also to the Ethics of Family in Health and Social Care Research Consortium as well as to the anonymous reviewers of HCAN for helpful comments on earlier versions of the manuscript.
- 1.Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford: Oxford University Press.Google Scholar
- 2.Benhabib, S. (1992). Situating the self, gender, community and postmodernism in contemporary ethics. New York: Routledge.Google Scholar
- 12.Hardwig, J. (1990). What about the family? Hastings Center Report.Google Scholar
- 16.Jameton, A. (1984). Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
- 18.Limia, A., & Pachon, I. (2011). Coverage of human papillomavirus vaccination during the first year of its introduction in Spain. Eurosurveillance Weekly, 16(21), 12–15.Google Scholar
- 19.Mackenzie, Catriona., & Stoljar, Natalie. (2000). Relational autonomy: Feminist perspectives on autonomy, agency, and the social self. New York: Oxford University Press.Google Scholar
- 21.Mosina, L., Martin, R., Eckert, L. (2010). HPV vaccination in Europe: Experience from national immunization programmes WHO: 5th annual global immunization meeting Retrieved January 9, 2012, from http://www.who.int/immunization_delivery/systems_policy/HPV_vaccination_in_Europe.pdf.
- 23.Ogilvie, G., Anderson, M., Marra, F., McNeil, S., Pielak, K., Dawar, M., et al. (2010). A population-based evaluation of a publicly funded, school-based HPV vaccine program in British Columbia, Canada: Parental factors associated with HPV vaccine receipt. PLoS Med, 7(5), e1000270.PubMedCentralPubMedCrossRefGoogle Scholar
- 25.Socialstyrelsen. (2008). Background to a vaccination programme for the human papilloma virus in Sweden 2007 Retrieved Aug 14, 2012, from http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/8868/2008-132-2_20081322.pdf.
- 26.Stretch, R., McCann, R., Roberts, S. A., Elton, P., Baxter, D., & Brabin, L. (2009). A qualitative study to assess school nurses’ views on vaccinating 12–13 year old school girls against human papillomavirus without parental consent. BMC Public Health, 9, 254.PubMedCentralPubMedCrossRefGoogle Scholar
- 27.UN. Office of the United Nations High Commissioner for Human rights: Convention on the rights of the child Retrieved Jan 23, 2011, from http://www2.ohchr.org/english/law/crc.htm.
- 29.WMA. (2008). WMA declaration of Helsinki—ethical principles for research involving human subjects. Retrieved April 10, 2012, from http://www.wma.net/en/30publications/10policies/b3/index.html.