Heated debate in the Republican presidential race over child vaccinations also is playing out in California as Democratic Gov. Jerry Brown considers whether to a sign a bill allowing children as young as 12 to get vaccinated against sexually transmitted diseases without their parents' consent.
Religious leaders, pro-family organizations and GOP lawmakers have warned the change would erode the rights of parents to be involved in their children's medical decisions. Supporters say the legislation is needed to keep up with new prevention treatments and help slow the spread of STDs among minors.
The bill passed the California Legislature along mostly party lines and now is on Brown's desk. He has until Oct. 9 to act on AB499, and has not signaled his intent.
Currently, California minors are allowed to seek diagnosis and treatment for STDs such as the human papillomavirus, known as HPV, without parental consent but cannot get vaccinated without their parent's approval. HPV is the leading cause of cervical cancer.
"I don't think we should be playing Russian roulette with kids' lives," said Assemblywoman Toni Atkins, a Democrat from San Diego who authored the legislation.
Opponents say the push for inoculation by medical officers and women's health advocates tramples on parents' rights. Just as minors cannot get a tattoo or piercing without parental approval under California law, opponents say parents should be involved in a child's medical care, whether it's treatment for a migraine or sexually transmitted disease.
"Our children need the knowledge and wisdom of their parents in order to make complicated medical decisions," wrote Los Angeles Archbishop Jose Gomez in an online newsletter. "This legislation would leave our children to make these decisions without the benefit of their parents' wisdom."
Although the California bill was introduced back in February, vaccinating minors became a hot national topic recently when Republican presidential candidate Michele Bachmann attacked Texas Gov. Rick Perry for issuing a 2007 executive order mandating the HPV vaccine for young girls.
That mandate was overturned by Texas lawmakers, but Perry said during a GOP debate that supporting the vaccinations means supporting life.
HPV is the most common sexually transmitted disease. According to the bill's author, HPV has become the world's second leading cause of cancer deaths among women. It was blamed for more than 400 deaths in California in 2008, the latest year for which statistics are available.
Two vaccines are available. One is licensed as Gardasil by Merck and the other is Cervarix, manufactured by GlaxoSmithKline. They are most effective if given before a person becomes sexually active.
If Brown signs into law, minors also would be able to get other STD prevention treatments, including new medicines that help prevent HIV infection if given within 72 hours of exposure.
Local public health officials along with the American Congress of Obstetricians and Gynecologists and the Health Officers Association of California are sponsoring the bill. Supporters also include Planned Parenthood, NARAL Pro-Choice California and the California Nurses Association.
Opponents include the California Catholic Conference, Right to Life Committee and other family organizations.
Atkins said her bill simply updates state law to keep up with new prevention treatments. California already allows teens to access confidential care for contraception, pregnancy, mental health care and drug abuse treatment. Adding preventive care for sexually transmitted diseases makes sense, she said.
"Technology has advanced," Atkins said. "We have vaccines that cover things like Hepatitis C. We have a vaccine that covers HPV."
According to Atkins' office, all states allow minors to consent for diagnosis and treatment of sexually transmitted diseases. Supporters note that many conservative states already allow minors to seek preventive treatment.
They include Alabama, Arkansas, Idaho, Iowa, Kansas, Maryland, Montana, North Carolina, South Carolina and South Dakota.
Republican lawmakers who opposed the bill say it builds on the assumption that children know better than their parents rather than assuming that parents know and care about their children.
"That's a decision that ought to be made between parents and their child," said Sen. Ted Gaines, a Republican from the Sacramento suburb of Roseville.
Even foster children have guardians who can act as their advocates and give advice on medical care, he said.
"I don't think a 12-year-old is capable of making good medical decisions, and we continually in our society push more and more responsibility onto minors when we ought to focus on engaging the parents in what are very critical decisions," Gaines said.
Dawn Richardson, advocacy director for the National Vaccine Information Center, an anti-vaccine group, is urging Californians to ask Brown to veto AB499. She wrote that it would take authority away from parents.
Supporters say the bill is necessary to allow teenagers and some pre-teens to access confidential medical care when they feel they cannot talk to their parents or guardian. They note that it's simply good public health policy because sexually transmitted diseases are spreading among young people.
"We are seeing younger women and men becoming sexually active and engaged," Atkins said.
The Centers for Disease Control "monitors those numbers nationally. We have clear evidence of a growing problem with young people under age of 18 _ HIV and AIDS in young people as young as 14. That should alarm us."
Atkins said conservatives who support parental consent laws tend to believe minors should not have access to prevention or treatment of sexually transmitted diseases even though they may be sexually active without their parents' knowledge.
"Like most physicians, I encourage my teen patients to involve their parents, and the good news is that most do," Dr. Katharine Sheehan, medical director of Planned Parenthood Pacific Southwest, said in a statement. "However, for some teens, good family communication is not possible or may actually be dangerous."