LIMITS OF CHILD AUTONOMY WITHIN COVID-19 PANDEMIC

HONEY, I VAXXED THE KIDS

THE LIMITS OF CHILD AUTONOMY WITHIN THE COVID-19 PANDEMIC

By Eva McCord Michelle Ma

As soon as children transition from toddlerhood to preschool age— from chewing on teething rings to “chewing on” the contours of language, opinion, and occasionally shrill outspokenness— we ask questions.

What do you want to be when you grow up?

Did you make any new friends today?

If you could teleport to anywhere in the world at this very moment, where would you go?

In our eagerness to prod, probe, and dote on young minds, unencumbered by the nuance and cynicism conferred by age and experience, we transform children into miniature Oracles of Delphi. We find a peculiar comfort in questioning those who make up for a lack of life experience with boisterous, blind optimism— eyes glinting in the face of the future even when they cannot discern what exactly it holds.

And now, standing at one of many turning points in the COVID-19 pandemic, we must ask our children another question.

Do you feel your life is in your own hands?

With Wednesday, November 3rd marking the newfound eligibility of 28 million children aged 5 to 11 to receive Pfizer-BioNTech’s COVID-19 vaccine, there has been no time more pressing than now to discuss the complicated concept of “adolescent medical decision-making capacity.” This term encompasses the situation in which the already challenging task of making medical decisions butts heads with the very nature of being a child— lacking the experience and knowledge that would empower one to make an educated and independent decision— let alone one that is staring down the metaphorical barrel of a life-threatening disease.

In investigating academic

opinion on this issue, we can turn to a paper published by Grootens-Wiegers on medical decision-making in children and adolescents, which concludes that at age 12, children have the capacity to be competent at decision-making. However, the paper cautiously notes that the brain’s reward system generally develops faster than its control system, which means that adolescents may be less competent at decision-making in certain contexts, for instance, those involving peer pressure. Furthermore, all four criteria for decision-making competency that the study cites— communicating a choice, understanding, reasoning, and appreciation— are highly dependent on the maturity level of a given individual.

However, regardless of individual maturity or other confounding factors in the issue of medical autonomy, most states still require parental consent to receive the COVID-19 vaccine up to age 18, and all require it for those aged 5 to 11 (with the exception of the District of Columbia and Philadelphia, which allow children 11 and older to self-consent). So even as younger and younger children gain access to preventative measures against the 8th leading cause of death of the past year in their demographic, it is parents who are tasked with the challenge of caring for children amid a health crisis and coming to terms with the weight of their words in relation to their child’s medical future.

For most parents, there seems to be no question at all.

According to the Kaiser Family Foundation, less than one third of parents will allow their children to be vaccinated immediately, with two-thirds being reluctant or even adamantly opposed to the vaccine altogether. In the face of parental directives like these, where do children’s voices fit, and how will their potential demand to be heard strain the family unit? This tension during a time of metamorphosed uncertainty is emblematic of the entire nation’s journey through a post-vaccine world, with a long-standing individualistic society grappling with the implications of a personal choice that will affect not only themselves, but their community, state, and country as a whole .

And as the pandemic draws on in the face of mask mandate lifts, decreased social distancing, and notably, school reopenings, children’s vaccination statuses will become harder and harder to avoid discussing, raising many questions that may call into dispute who gets the final say.

For instance, when does the opportunity to experience a “next to normal” childhood outweigh parental beliefs, conceptions, or concerns?

When should being “mature for one’s age” yield a genuine chance to take control over one’s young life?

Is it anyone’s place to support the five-year-old, whose routine vaccinations now encompass a

greater discourse that they have yet to fully understand? What about the immunocompromised ten-year-old with anti-vax parents, or the children who are simply scared and uncertain?

What moral obligation do we have to protect a world where kids can interact and socialize with one another, when doing so without critical and careful thinking could endanger other equally vulnerable demographics—both physically and autonomously?

And at the same time, other often weaponized aspects of the pandemic now have the opportunity to be examined critically, yet with compassion: what did it mean to spend a period of one’s childhood, one’s formative developmental years, amid the pandemic? Who is accounting for the long-term effects brought on by experiencing a dark period in medical history as a young child, both powerless to do anything and unable to take control over their own protection?

The contention that arises concerning parental consent pertaining to children’s medical futures is not rooted in “sides,” as some may assume. There is no inherent correctness wielded by parent nor child over whether or not to fit in a vaccine appointment between after-school sports and playdates.

It boils down to questions, reserved for and between parent and child.

And, ironically enough, the questions we ask children are often reflections of our own, albeit “grownup,” anxieties.

To know the future. To be cared for by others. To find protection. And to not just be safe, but feel safe.

Aviv, Aubrey, Allison, and Selena Simmons-Duffin.

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Kids. Here's Why Doctors Say Do It Now.”

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Decision-Making in Children and Adolescents:

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