A Guide for Health Care Practitioners in the Assessment of Young People’s Capacity to Consent to Treatment

Geist, Rose; Opler, Susan E.

doi:10.1177/0009922810363610

Cited by 20 publications

(15 citation statements)

References 16 publications

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“…Notably, in many geographic regions, there is no exact age of consent for treatment, but instead, young people are presumed to understand the treatment and foresee consequences unless they are determined to lack capacity. 51,52 In our illustrative case, the patient with average cognitive functioning was clearly able to demonstrate his understanding of the available treatments, and the benefits and consequences he saw for each of these. Many adolescents with chronic conditions have developed a level of knowledge and life experience related to their condition that further aids in their competence.…”

Section: Decision-making Processmentioning

confidence: 83%

The Dilemma of Hemispherectomy for Rasmussen's Encephalitis in a Neurologically Intact Child

Borlot

Yau

Olivieri

et al. 2020

Journal of Pediatric Epilepsy

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Rasmussen's encephalitis is a rare drug-resistant focal epilepsy characterized by progressive hemiparesis, hemianopia, and cognitive decline. Hemispherectomy is currently the only known treatment that can be curative, though expected to cause postoperative motor and visual deficits in children and adolescents. To date, medical treatment with antiseizure medications and immunosuppressive agents can only offer partial, delayed, or temporary alleviation of symptoms. Hence, patients and families are often faced with the difficult decision to consider the possibility of seizure freedom at the cost of incurring permanent deficits. Here, we discussed the unique ethical issues when faced with a cure that can cause harm, and also discussed a shared decision-making approach guided by informed consent, principles of autonomy, and patient-centered values.

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Section: Decision-making Processmentioning

confidence: 83%

The Dilemma of Hemispherectomy for Rasmussen's Encephalitis in a Neurologically Intact Child

Borlot

Yau

Olivieri

et al. 2020

Journal of Pediatric Epilepsy

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“…This inclines assessors of competence (health practitioners) to make judgements based on subjective assessments. A patient’s competence is influenced by their experience with a medical condition, hospitalisation, family relationships and social roles and development [21]. …”

Section: Discussionmentioning

confidence: 99%

Autonomy of the child in the South African context: is a 12 year old of sufficient maturity to consent to medical treatment?

2016

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BackgroundA child is a developing person with evolving capacities that include autonomy, mental (decisional) capacity and capacity to assume responsibility. Hence, children are entitled to participatory (autonomy) rights in South Africa as observed in the Children’s Act 38 of 2005. According to section 129 of the Act a child may consent to his or her own medical treatment provided that he or she is over the age of 12 years and is of sufficient maturity and decisional capacity to understand the various implications of the treatment including the risks and benefits thereof. However, the Act does not provide a definition for what qualifies as ‘sufficient maturity’ nor does it stipulate how health professionals ought to assess the decisional capacity of a child. In addition, South Africa is a culturally diverse country. The Western liberal notion of autonomy may not necessarily find equal prominence in the mores of people with a different worldview. Hence we demonstrate a few salient comparisons between legal liberal moral theory and African communitarianism as pertinent to the autonomy of the child.DiscussionChildren are rights-holders by virtue of their humanity. Their dignity as individual human persons affords them the entitlement to human rights as contemplated under the Constitution of the Republic of South Africa. However, contrary to the traditional Western notion of individual autonomous persons African societies hold a communalistic notion of person hence there is less regard for individual autonomy and rights with more emphasis on the communal good and maintaining the continuity of relationships and interdependencies shared within a community. A child considered in this view is not regarded as a full person. This implies that decisions concerning the child, including consent to medical treatment are discussed and determined by the community to which the child belongs. Lastly, in this article, we draw on the notion of capacity for responsibility to produce a pragmatic definition of sufficient maturity.ConclusionIt seems reasonable to suggest a move away from a general legal age of consent for medical treatment toward more individualised, context-specific approaches in determining the maturity of a child patient to consent to medical treatment. Perhaps, decision-making with respect to consent to the medical treatment of a child belonging to a traditional African community where the notion of a person is embedded in communitarianism ought to involve the child’s parents/guardians/caregivers where possible provided that the best interests of the child are awarded priority.

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“…Capacity assessments should account for behaviors over time, as this could provide perspective into their ability to appreciate the consequences of donation. Understanding the youth's relationship with their parents and family and its effect on decision making can also be pertinent . To assess autonomy, it is also important to look for evidence that the potential YLD has made independent, potentially life altering decisions.…”

Section: Determining the Young Living Donor's Voluntarinessmentioning

confidence: 99%

How Young Is Too Young to Be a Living Donor?

Campbell

Wright

Greenberg

et al. 2013

American Journal of Transplantation

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Assessing people in adolescence and early adulthood who wish to become living organ donors (LDs) provides unique challenges. In several Canadian provinces, 16‐year‐old can legally consent to living organ donation. While the World Health Organization states that adolescence corresponds roughly to the ages of 10–19 years, parts of the brain associated with judgment continue to develop into the mid‐20s. Therefore, it is legally possible for some young people to donate organs before their capacity to judge the benefits and risks of surgery has fully matured. Potential young living donors (YLDs) may be financially and/or psychologically dependent on their recipients (e.g. parents), which can make it difficult to determine if the YLD's donation is voluntary. This paper suggests ways to manage three ethical challenges in the use of young people as LDs: (1) determining the YLD's ability to appreciate the consequences of living organ donation, (2) determining whether the YLD's donation is voluntary and (3) evaluating the unique risks and benefits to the YLD. We conclude that there are compelling ethical reasons to offer the opportunity of living donation to selected young people. A thorough and fair evaluation process can address social, emotional and developmental issues associated with YLDs.

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A Guide for Health Care Practitioners in the Assessment of Young People’s Capacity to Consent to Treatment

Cited by 20 publications

References 16 publications

The Dilemma of Hemispherectomy for Rasmussen's Encephalitis in a Neurologically Intact Child

The Dilemma of Hemispherectomy for Rasmussen's Encephalitis in a Neurologically Intact Child

Autonomy of the child in the South African context: is a 12 year old of sufficient maturity to consent to medical treatment?

How Young Is Too Young to Be a Living Donor?

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