Framing of doctrine influences parental support for teen medical consent

A new study by researchers from Emory University’s Rollins School of Public Health and Vanderbilt University Medical Center found parental support for adolescent medical consent varied significantly depending on how the question was framed.

Tennessee’s Mature Minor Doctrine, which allowed for adolescent medical consent in some instances, became widely publicized during the height of the COVID-19 pandemic over highly politicized concerns that children could obtain COVID-19 vaccines against parental wishes.

State lawmakers temporarily curtailed the use of the doctrine at the time by restricting public health communications, while critics cited concerns for creating additional barriers to care.

Through the study-the findings of which were published in JAMA Network Open on Friday-the researchers randomly surveyed 1,026 Tennessee parents in an attempt to determine if the political response to the doctrine accurately reflected parents’ opinions on adolescent consent for medical services or if their opinions varied when the questions were framed using “Mature Minor Doctrine” as the primary example.

The result was a more than 20 percentage point difference in support of adolescent consent between the two study groups. Less than a quarter of parents (22.9%) expressed support when it was described as the “Mature Minor Doctrine,” whereas closer to half (43.2%) supported it when it was framed as a “rule” with an example, such as 17-year-old college students getting meningitis vaccines or children ages 14-18 talking to a therapist.

Even though this is a survey of parents in just one state, it’s an important example of how the conversations around vaccines happening at the federal level are trickling down to the states. It also provides perspective on what parents are thinking and if their thoughts align with what politicians and leaders are doing. These results really speak to how parents are practical when it comes to things like this. They might not be agreeable when you give a blanket statement around adolescent consent, but when you take the time to describe to them how this applies to their child being able to speak to a therapist or receiving a preventative vaccine while they’re away at college, it helps frame the issue for them better.”

Sarah Loch, lead author and program director in the Department of Health Policy and Management at Rollins

Since the study was conducted, Tennessee state lawmakers passed 2023’s Mature Minor Clarification Act, which counteracted the state’s longstanding Mature Minor Doctrine by requiring parental consent for childhood vaccines and written consent for COVID-19 vaccines, specifically, fueling concern for declining rates of childhood vaccination.

Because the survey results suggest the trend of parental rights legislation might not align with parents’ actual opinions, the researchers say the findings highlight the urgency for trustworthy health messaging from clinicians and public health agencies to account for the influence of trending political and cultural movements.

“Since the COVID-19 pandemic, we have seen a rise in misinformation about vaccines and a decline in vaccination rates even for routine childhood vaccines. Our study shows that providing clear and detailed information matters a lot to parents as they navigate what can be challenging issues,” says Stephen Patrick, MD, the study’s senior author and chair of the Department of Health Policy and Management at Rollins.