In This Article Adolescent Consent to Medical Treatment

  • Introduction
  • Practitioner Texts
  • Textbooks
  • Databases
  • Refusing Treatment
  • Europe
  • New Zealand
  • Canada

Childhood Studies Adolescent Consent to Medical Treatment
by
Emma Cave
  • LAST REVIEWED: 28 April 2017
  • LAST MODIFIED: 22 April 2013
  • DOI: 10.1093/obo/9780199791231-0138

Introduction

Subject to certain exceptions, (e.g., emergency treatment), clinicians need a valid consent before they can treat a patient. This operates both to protect clinicians from liability and to protect the autonomy interests of patients. Consent may be express or implied. More serious procedures generally require express consent, which is usually documented on a consent form. Special arrangements are put in place when patients are unable to provide a valid consent due to a lack of autonomy. This might occur when patients are children or young persons (collectively referred to as “minors” in this article). The starting position is that minors cannot provide a valid consent, but in most jurisdictions there are exceptions to this rule. Some rules are status-based (based on age, marital status, etc.); some depend on the treatment sought (e.g., there may be special rules regarding life-sustaining treatment); and others are functional (based on maturity, understanding, experience, etc.). In relation to the latter, the law might limit the minor’s authority to make medical treatment decisions on grounds other than his or her lack of competence. Minors have a special legal status based on their potential vulnerability, which flows from a lack of life experience. Laws balance their welfare interests and their interests in autonomous decision making. In some cases, minors can agree to some types of treatment even if they lack de facto competence. For example, in some jurisdictions there are provisions enabling some minors to consent to counseling for a mental health problem, treatment for a drug dependency, or sexual advice without parental consent or notification. Conversely, the law might prohibit certain treatments, such as female genital mutilation, even if a competent minor or parent is willing to consent to them, or it might require court authorization for certain treatments (sterilization of a minor, for example). Where minors lack competence or are otherwise deemed unable to provide a legal consent, an alternative source of consent must be found to justify what would, in the absence of a lawful defense such as necessity, constitute a breach of tort or contract law. The views of minors remain relevant to decisions made about them. In some cases, their assent (agreement) to treatment is required, in addition to the legal consent provided by someone with parental authority. This bibliography focuses on when, how, and why minors can provide the requisite consent to medical treatment. Beginning with sections on Informed Consent and Children’s Rights, it moves on to consider different definitions of competence and the difficult case of treatment refusal. Finally, it contrasts approaches in Europe, Australia, New Zealand, Canada, and the United States. The review does not incorporate the law on confidentiality or specialist legal issues relating to biomedical research, human tissue donation, or treatment for mental health disorders, each of which have an extensive literature of their own. The research for this bibliography was undertaken as part of a research project called Medical Practitioners, Adolescents, and Informed Consent, sponsored by the Nuffield Foundation in 2011–2012. The Nuffield Foundation is a charitable trust with the aim of advancing social well-being. It funds research and provides expertise, predominantly in social policy and education. It has supported this project, but the views expressed here are those of the author and not necessarily those of the foundation. More information is available online.

Practitioner Texts

There are few books dedicated solely to this topic, though there are edited collections with relevant chapters (Hendrick 2010) and a number of useful practitioner guides ( British Medical Association 2000, Grisso and Appelbaum 1998) and empirical works (Alderson 1993). The issues differ from one clinical specialty to another, and this is reflected in specialist practitioner texts. For example, Nair and Holroyd 2011 outlines the issues arising in different types of surgery. Many textbooks are aimed at particular health-care practitioners, such as nurses (Hendrick 2010) or medical students (Breen, et al. 2010).

  • Alderson, Priscilla. Children’s Consent to Surgery. Buckingham, UK: Open University Press, 1993.

    E-mail Citation »

    Presents qualitative research on when children are old and mature enough to understand relevant medical information and make decisions.

  • Breen, Kerry J., Stephen M. Cordner, Colin J. H. Thomson, and Vernon D. Plueckhahn. Good Medical Practice: Professionalism, Ethics and Law. Cambridge, UK: Cambridge University Press, 2010.

    DOI: 10.1017/CBO9780511844935E-mail Citation »

    This book is aimed at medical students in Australia. Chapter 4 focuses on consent and includes a section on children and teenagers. There are also relevant sections on confidentiality.

  • British Medical Association, ed. Consent, Rights and Choices in Health Care for Children and Young People. London: BMJ, 2000.

    E-mail Citation »

    British guidance for doctors and health-care professionals on consent and refusal of treatment.

  • Grisso, Thomas, and Paul S. Appelbaum. Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals. Oxford: Oxford University Press, 1998.

    E-mail Citation »

    Guidance for doctors and health-care professionals on competence. Though principally relating to adults, sections on the theoretical relevance of competence and practical methods of assessment are also of relevance to young people.

  • Hendrick, Judith. Law and Ethics in Children’s Nursing. Chichester, UK: Wiley-Blackwell, 2010.

    DOI: 10.1002/9781444320428E-mail Citation »

    In particular, see chapter 4 on consent.

  • Nair, Rajesh, and David J. Holroyd, eds. Handbook of Surgical Consent. Oxford: Oxford University Press, 2011.

    DOI: 10.1093/med/9780199595587.001.0001E-mail Citation »

    Of special interest to surgical trainees, this book offers legal and practical guidance. It mirrors and interprets guidance from the UK Department of Health. While it does not have a chapter relating specifically to pediatric surgery, it does differentiate between different types of surgery (e.g., neurosurgery, cardiac surgery, etc.) and chapter 1 has a section devoted to treating children.

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