Public health: Vaccines and face masks

Published: November 2024

Vaccines and face masks are important public health measures that can significantly reduce the spread of infectious diseases, protecting both individuals and communities.

Articles

• Vaccinating: Doing it safely, and addressing vaccine hesitancy and refusal (7 min)
• When patients make special requests, how should you respond? (5 min)
• Can a child provide consent? (4 min)
• Challenging patient encounters: How to safely manage and de-escalate (6 min)
• CMPA principles of assistance: Public health emergencies and catastrophic events

FAQ

How do I engage parents or legal guardians who are reluctant or refuse to vaccinate their children? What if there is a dispute between the parents about the child receiving the vaccine?

1. Confirm authorized decision-maker: Physicians will need to be aware of who is legally authorized to provide consent for the child’s vaccination. When a child is not capable of consenting to treatment, the physician providing the vaccine will want to make inquiries of the adult accompanying the child for the vaccination to confirm they are the parent or legal guardian with decision-making responsibility, or have authority to consent on behalf of the child. However, when the physician determines that the child has the capacity to consent, parental/legal guardian consent is not required. In such circumstances, the physician must obtain consent from the child, even when the child is accompanied by a parent or legal guardian.
2. Respect decisions of mature minors: Except in Québec, physicians should generally respect an informed decision by a child who they consider to be a mature minor and capable of understanding the risks of accepting or refusing the vaccination. In Québec, the law generally only permits children 14 years of age and older to consent to their own care. Physicians should document the wishes of the minor and the parent/legal guardian, if known, in the medical record along with the physician’s assessment of the child’s capacity to consent and understanding of the risks.
3. Explore, address and document reluctance: If a child is not capable of consenting and the parents/legal guardians are reluctant about the vaccine, physicians should explore and address the reasons for their reluctance, answer any questions to the best of their ability, and refer them to other relevant resources for information. Physicians will want to be empathetic and respectful, and remind parents/legal guardians that the best interests of the child are the primary concern. If the parents/legal guardians still refuse to consent to the vaccination, a detailed note of both the consent discussion and the refusal should be made in the medical record.

4. Manage disputes: Communication problems can arise when a physician receives conflicting directions from parents. Even in cases where the child’s parents are separated or divorced, both parents will typically have the right to provide or refuse consent for treatment on behalf of the child, unless an agreement or court order specifically modifies the rights of the parents. To clarify the authority of each parent to consent on behalf of the child, physicians may request copies of agreements or court orders regarding decision-making. These copies should be kept in the child’s chart. When there is a dispute between the parents, the physician should make reasonable attempts to obtain a consensus in the child’s best interests. If consensus cannot be achieved, the vaccine should not be administered. While there is little more that a physician can do in such situations, members may contact CMPA for assistance.

   See also: Shen S, Dubey V. Addressing vaccine hesitancy. Clinical guidelines for primary care physicians working with parents. Can Fam Physician. 2019 March, 65(3) 175-181.

Do I have an obligation to be vaccinated against COVID-19 and other viruses? Will CMPA assist me with College or hospital matters if I do not comply with my facility’s vaccination policy?

CMPA generally encourages physicians to be aware of any mandatory vaccination programs applicable to their practice setting. Physicians will want to reasonably consider any mandatory vaccination policies that apply to them, bearing in mind their ethical, professional and legal obligations. Failure to comply with mandatory vaccination policies could lead to discipline. In particular, non-compliance with any applicable policy may result in remedial and/or disciplinary action by the hospital or health authority and may lead to an investigation by the College.

CMPA generally assists members with College and hospital matters relating to the professional practice of medicine; however, CMPA assistance will not generally be available for matters primarily arising from business or personal issues. CMPA does not generally extend assistance to members to assist them in advocating for changes to hospital, health authority or College policies.

Members are encouraged to contact their provincial/territorial medical association or federation for more information regarding policy initiatives and measures with respect to mandatory vaccine policies.

What should physicians do when a patient requests them or healthcare staff to wear a face mask?

While wearing face masks is no longer routine, some patients may request that their health providers do so. In such instances, physicians are encouraged to reasonably consider any hospital/health authority/clinic policy that applies to them, bearing in mind their ethical, professional and legal obligations, including their fiduciary duty to their patients to act in good faith, with loyalty, and not to place their own personal interests ahead of patient safety.

Can I require patients to wear a mask?

In cases where patients are requested to wear a mask despite the withdrawal of applicable mandates, it will be important to alert patients in advance of the rationale for wearing a mask when attending in-person visits. Patients may be more willing to wear a mask if the reasoning is clearly explained to them (i.e. minimizing the risk of exposing healthcare workers and other patients). Physicians should offer to provide patients with a mask if they do not have one.

For patients who decline to wear a mask, you will need to determine how best to provide care. If appropriate and in accordance with College policies and standards, you may offer to see the patient using virtual care.