A 15-year-old male adolescent presenting for a well‑visit has not yet received human papillomavirus (HPV) vaccination; the patient and his mother consent to vaccination, but the father objects. What is the most appropriate action?

Administer the HPV Vaccine During the Visit

In this situation, you should administer the HPV vaccine during the visit because the 15-year-old patient has the legal capacity to consent to vaccination, both he and his mother have provided informed consent, and delaying vaccination compromises cancer prevention in an adolescent who may already be at risk for HPV exposure.

Legal and Ethical Framework for Adolescent Consent

The key issue here is understanding adolescent consent capacity and parental authority:

• Adolescents aged 15 years have sufficient maturity to participate meaningfully in healthcare decisions, particularly for preventive services like vaccination 1
• When one parent provides consent along with the adolescent's assent, this is legally sufficient for vaccination in most jurisdictions 2
• The father's objection, while noted, does not override the consent already obtained from both the patient and the custodial parent present at the visit 2

Clinical Urgency of Timely HPV Vaccination

Delaying vaccination in this scenario creates significant clinical risks:

• HPV vaccination is most effective when administered before sexual exposure, with approximately 24% of adolescents reporting sexual activity by 9th grade and 58.1% by 12th grade 1, 3
• The cumulative incidence of HPV infection approaches 40% within the first two years after first sexual intercourse 1, 3
• At age 15, this patient requires a 3-dose schedule (at 0,1-2, and 6 months) rather than the 2-dose schedule available to younger adolescents, making timely initiation even more critical 1, 3
• Providers should adopt a "now or never" mentality with adolescent vaccination, as follow-up compliance is notoriously poor in this age group 1

Why the Other Options Are Inappropriate

Option 2 (Contacting the Father) Creates Harmful Delays

• Attempting to contact the father introduces unnecessary delay that compromises cancer prevention 1
• There is no legal requirement to obtain consent from both parents when one parent and the adolescent have already consented 2
• The father may be unavailable, further prolonging the delay and potentially resulting in a missed vaccination opportunity 1

Option 3 (Referring to County Health Department) Is Medically Inappropriate

• Referral represents an abdication of clinical responsibility and creates barriers to vaccination 1
• The patient is already in your office with appropriate consent; referring elsewhere guarantees delay and reduces the likelihood of vaccination completion 1
• This approach contradicts recommendations to administer vaccines at any healthcare encounter rather than delaying until a "complete" preventive visit 4

Option 4 (Refusing Due to Father's Disapproval) Violates Clinical Standards

• Refusing vaccination based on one parent's objection when the other parent and adolescent consent is not supported by guidelines 2
• This approach prioritizes parental conflict over the adolescent's health interests and cancer prevention 1
• It contradicts the principle that provider recommendation is the single most influential factor driving HPV vaccine uptake 1, 3

Practical Implementation

When administering the vaccine in this situation:

• Document thoroughly: Record that you discussed benefits and risks with both the patient and mother, that both provided informed consent, and that the father's objection was noted but does not constitute a legal barrier 2
• Emphasize cancer prevention: Frame HPV vaccination as a critical cancer prevention strategy, which is the most powerful message for vaccine acceptance 1
• Normalize the vaccination: Administer HPV vaccine alongside other age-appropriate vaccines (such as Tdap or meningococcal vaccines if due) to reinforce that this is routine preventive care 1
• Provide educational materials: Offer resources about HPV vaccination that the mother can share with the father to potentially address his concerns 2

Common Pitfalls to Avoid

• Do not delay vaccination while attempting to achieve unanimous parental agreement—this compromises the adolescent's health and may result in missed vaccination entirely 1, 4
• Do not underestimate the adolescent's role in the decision—at age 15, his informed assent carries significant weight 1, 2
• Do not assume you can predict when the adolescent will become sexually active—attempting to time vaccination based on anticipated sexual debut is impractical and often results in delayed or missed vaccination 1

The evidence strongly supports proceeding with vaccination when the adolescent and one parent consent, as this maximizes cancer prevention while respecting both adolescent autonomy and appropriate parental involvement 1, 3, 2.