to be worried about this consent form?

[LightShinesInTheDarkness]

DD (12) has brought home the NHS Consent form for the HPV Immunisation for Year 8s.

We have decided, in a discussion involving me, DD and DH, that we do not want her to have the vaccine.

However, I am upset that the form says : (quote) Please note that while your consent is important, if you refuse consent the vaccination may still be given

It also says, 'Reason consent refused (PTO for additional space to give us your reason for your decision' - do I really have to give details?

AIBU to feel concerned?

1. That the vast majority of MNers will give consent to the vaccine
2. The vast majority of MNers will encourage their daughters to give consent
3. If you consented but your DD didn't, your DD would not have the vaccination, on the basis that at 12 she can decide for herself.
4. Vice versa, if you did not consent but your DD wanted it, she would have the vaccination, based on the same premise.

Yes. Mostly.

3 is not 'on the basis that she can decide for herself', but on the basis that the nurses would not hold her down and make her have it even if you had ticked the 'yes' box..

4 is on the basis that a 12 year old could decide for herself to have a potentially lifesaving vaccine.

My personal view is that a 12 year old saying 'no' is likely to be the one who is making an irrational decision (based on 'ooh scary needle') whereas one who says 'yes' is making the correct decision and therefore is old enough to choose for themselves. Basically, if you agree with me then you pass the test - ok? :)

Are you one of these weirdos who thinks that having the vaccine will make all the 12 year olds go out and have sex? That would be having a really low opinion of your DD's intelligence.

OP, you haven't given us all the information.

We can't say yanbu unless you have a very very good reason to insist that your word be final on this vaccine. By withholding your reasons you are trying to manipulate the situation and make it about parent's rights, when in fact it is about your daughter's right not to have to contract a deadly disease if prevention is available!

My little sister is 21 and is looking into having it done privately- it is still worthwhile up to the age of about 23 I think although the chances are she will have already contracted a strain of hpv. If not, she is going ahead. Cervical cancer is the second biggest killer for women today.

By the way.

Condoms don't protect against hpv. This vaccine is the only protection we have.

"it's this provides the best solution at the best cost."

I can't get the full text (even with a University login at a university with a medical school!) so this may be PR puff, but the abstract of "Clinical update of the AS04-adjuvanted human papillomavirus-16/18 cervical cancer vaccine, Cervarix." (Advances in Therapy 26(11):983-98, 2009 Nov ) implies it may not be as straightforward as that, as Cervarix may have other benefits. If anyone can get the full text, that might be interesting.

Persistent infection with human papillomavirus (HPV) is a necessary cause of cervical cancer, resulting annually in 274,000 deaths worldwide. Two prophylactic HPV vaccines are licensed in >100 countries, and immunization programs in young, adolescent girls have been widely implemented. HPV-16/18 AS04-adjuvanted vaccine (Cervarix; GlaxoSmithKline Biologicals, Rixensart, Belgium) has demonstrated type-specific protection against the five most frequent cancer-causing types (16, 18, 31, 33, and 45) that are responsible for 82% of invasive cervical cancers globally. Cervarix has demonstrated efficacy against HPV-45, which is the third most common HPV type in cervical cancer and adenocarcinoma. Final results of a large phase 3 trial recently showed Cervarix substantially reduced the overall burden of cervical precancerous lesions (cervical intraepithelial neoplasia 2+) by 70.2% in an HPV-naive population approximating young girls prior to sexual debut, the target of most current vaccinati
on programs. Protection offered by Cervarix against nonvaccine types (mainly 31, 33, and 45) might potentially allow for 11%-16% additional protection against cervical cancers, compared to a vaccine only offering protection against HPV-16/18. Another recent study directly compared the antibody response of Cervarix to that of quadrivalent HPV-6/11/16/18 vaccine (Gardasil; Merck, Whitehouse Station, NJ, USA). Cervarix induced significantly superior neutralizing antibody levels as compared with Gardasil for HPV-16 and HPV-18 in all age groups studied. This may translate into more women having detectable (neutralizing) antibodies in cervicovaginal secretions for HPV-16 and HPV-18 after vaccination with Cervarix when compared with Gardasil. Cervarix induced significantly higher frequencies of antigen-specific memory B-cells and T-cells in responders for HPV-16 and HPV-18 as compared with Gardasil. Cervarix continues to show sustained high levels of total and neutralizing antibodies for HPV

16 and HPV-18, 7.3 years after vaccination. This is associated with high efficacy and no breakthrough cases in the HPV-naive population, and is the longest duration follow-up for safety, immunogenicity, and efficacy for any licensed HPV vaccine to date.

How in hell is there an ethical or moral reason for choosing/not choosing vaccination?

Oh that's right, it will turn our young girls promiscuous. I forgot to think like a religious loon.

sallyseton - I am sorry if you feel I am being manipulative, but actually my concern was about consent and not the pros and cons of the vaccine.
It was the principle of the consent - it could be consent for riding a bike, eating jelly babies or using a biro.
I was asking about the consent, not the vaccine.

"when actually you aren't protected from the other 30% of virus' or other nasties that a simple condom would protect you from."

"While condom use has been associated with a lower risk of cervical cancer, the use of condoms should not be a substitute for routine screening with Pap smears to detect and prevent cervical cancer, nor should it be a substitute for HPV vaccination among those eligible for the vaccine."

www.cdc.gov/condomeffectiveness/latex.htm

cervicalcancer.about.com/od/riskfactorsandprevention/a/condoms_HPV.htm

Condoms don't offer 100% protection but neither does the vaccine and they do offer protection against other STD's, they are a good thing IMO and people should be ramming that message down their children's throat, I know I will son and daughters.

mamatomany you are not seriously suggesting that better dental screening would be preferable to us all cleaning our teeth properly?

mamatomany - that argument boils down to 'I need to keep my DD fearful of sex. There has to be a threat of punishment whenever she has sex (sti,pregnancy)and this vaccine will take that sense of fear away'
Vaccinating them doesn't mean that sex education should or will stop. It's just another thing we can use to help keep our kids healthy.
I doubt the nurse will jab them then advise them not to use condoms.

But do you really think you have the right to not give consent unless there is a very, very good reason? Which you have not supplied and do not intend to supply the school with?

I think it's reasonable for your daughter to give her consent, if only because she has a relatively small window of opportunity (12-14 years) to ensure maximum efficacy, and there's no guaranteeing that you will have come round to the idea by then.

Therefore, I think it's reasonable for the NHS or whoever to put her rights to access a potentially life saving vaccine above your, yet to be articulated reasons, why she should be denied it.

I doubt that "ramming that message down their children's throat" works very well for any topic, actually. But each to their own.

So your hiding behind a consent issue to mask daft reasons for not protecting your DD? This is the impression you are giving.

Still stunned.

You, of course, don't have to give your reasons for not wanting to give the vaccine but I highly doubt you can come up with one that hasn't already been written off by the excellent and informative posts here.

You don't sound like someone who really believes we "must protect our daughters", you sound like someone who pushes their own views onto others at the cost of (potentially) their health.

Sorry for being so harsh, but this is a ridiculous situation.

tokyonambu - depends on the cost though.

Does anyone know how the nurses plan to assess the informed consent of the girls they will be injecting? Simply asking someone 'do you want the jab' isn't enough.

IMO cognitive, emotional and rational abilities differ wildly at the age of 12. Some girls will be able to think about this rationally whereas others won't. How do the nurses plan to check their understanding?

Having worked with older people and people with learning disabilities, I know a lot about informed consent and just how bloody complicated it is to actually get it. Simply asking and getting a 'yes' or 'no' answer does not constitute informed consent.

No JenaiMarrHePlaysGuitar I am suggesting that you cannot just clean your teeth you need regular dental screening too in order to stop you needing the odd cap in your 50's, how on earth could that post be misunderstood

Anyway I am not suggesting that we keep our daughters or sons fearful of sex, but unprotected sex is something to be very concerned about don't you think ?

The number of so called accidental pregnancies you read about on MN alone is cause for concern that so many people still aren't using condoms and the resulting baby is almost the least of our worries.

On the consent issue - no one has to have a good reason, or any reason to refuse consent. The only way the right to refuse consent can be taken away from you is if you are sectioned.

I wish my sister had been offered the HPV vaccine

lightshines - if you'd asked about consent for riding a bike I think the responses would be broadly similar.

"Please sign the form to say DD can do cycling proficiency classes in the playground. If you refuse consent, she may do them anyway"

If you then said, how could DD consent to ride a bike at 12, you'd had a family talk and all decided not to do it; I think there would still be a few faces around, don't you?
Especially if you said your reasons for not letting her ride a bike were not the issue...

LightShines The problem here is that your concern about the ethics of the consent form is overshadowed by your (seemingly) unfounded determination that you daughter must make this decision for herself - but can't - and that you are not prepared to give the go-ahead to what most MNers see as a potentially life saving benefit.

Without knowing your reasons for being so adamantly against her having the vaccine, it's really hard to see where you are coming from.

I am mystified by the OP. I do understand that you're trying to ask about the concept of consent in minors, as an abstract, and not about this vaccine, but here's why that's not working for us:

Either you have personally significant reasons for withholding consent - i.e., you believe that your daughter will be affected by the vaccine more than others; or
You have some knowledge about the vaccine that most of us aren't privy to. Given that a lot of us have daughters, we'd like to know it.

I understand the objections of the anti-vaxers with tiny babies, I have a couple of friends who are anti-vax (I don't agree with them but I know their arguments). But for a 12 year old, you have to be either talking about a physical side effect in which case stop being coy and tell us! some of us have daughters! or you're worried about a psychological side effect, in which case you are on very, very thin ice.

And at what legal age is someone deemed legally considered able to give consent?

There seems to be a lot of 'well I think 12 year olds can' and others saying the opposite, but does anyone know what the law says?

ovum - I see where you're coming from, but I don't see why giving consent to receive this vaccine requires much in the way of cognitive, emotional or rational skills.

I know this is a free for all, fair enough.

But I am genuinely hurt at the various suggestions that I am a religious loon, hoping that my dd will remain a virgin and marry a virgin, unable to talk to my DD about sex, pushing my views down her throat and so on..

I do not believe that any of those things are true of me.