Navigating ethical dilemmas during child and adolescent vaccinations: a scoping review

BACKGROUND: Vaccination prevents millions of deaths each year; however, ethical dilemmas persist in vaccinating children and adolescents. This scoping review explores how healthcare professionals (HCPs) navigate these ethical challenges, focusing on commonly encountered dilemmas, contributing factors, strategies to support decision-making, and the role of biomedical ethics principles. METHODS: This review was conducted following the JBI methodology and Arksey and O'Malley framework. The Population, Concept, and Context (PCC) framework guided the research question. Databases searched included Medline, Embase, Scopus, Web of Science, and CINAHL, along with ProQuest Central and Google Scholar for grey literature. Reference lists of included studies were also manually screened. Search terms were related to ethical dilemmas, HCPs, vaccination, and children and adolescents. RESULTS: A total of 91 records published between 1995 and 2025 were included. Commonly involved ethical dilemmas were related to balancing child/adolescent autonomy with their decision-making capacity, parental autonomy with the child's best interests, and HCPs' professional duties with their attitudes and competencies. Dilemmas also existed in balancing individual rights and public health goals, and between legal requirements and ethical principles. Contributing factors were thematised as child/adolescent-related factors (e.g., decision-making capacity, vaccine hesitancy, and needle fear), parental concerns (e.g., safety issues, cultural or religious beliefs), HCP-related factors (e.g., personal attitudes, ethical skills, and experiences), public health perspectives (e.g., mandatory vaccinations), and system constraints. Strategies to address dilemmas included education and shared decision-making, professional training and teamwork, technology-based approaches, adherence to biomedical ethical frameworks, and policy and advocacy. CONCLUSIONS: Ethical challenges in child and adolescent vaccination arise from complex interactions between child autonomy, parental autonomy, HCPs' professional duties, public health perspectives, and broader legal or regulatory and system considerations. All HCPs must be equipped to apply context-related ethical decision-making to ensure equitable and respectful care.