Minors' Rights in Medical Decision Making

Abstract

In the past, minors were not considered legally capable of making medical decisions and were viewed as incompetent because of their age. The authority to consent or refuse treatment for a minor remained with a parent or guardian. This parental authority was derived from the constitutional right to privacy regarding family matters, common law rule, and a general presumption that parents or guardians will act in the best interest of their incompetent child. However, over the years, the courts have gradually recognized that children younger than 18 years who show maturity and competence deserve a voice in determining their course of medical treatment. This article will explore the rights and interests of minors, parents, and the state in medical decision making and will address implications for nursing administrators and leaders.

Assent is not consent

“…Yet, rather than feeling compelled to fulfil another regulatory requirement, we urge investigators to view assent as an opportunity to engage with the child about their participation in research, showing respect for their developing autonomy and self-worth. While children are not considered to have the necessary emotional and cognitive capacities to give fully informed consent,5 6 it is ethically appropriate that we should allow the child to take part in the decision-making process regarding his research participation at the relevant level, even if we rely ultimately on the parent's consent.…”

Paid protection? Ethics of incentivised long-acting reversible contraception in adolescents with alcohol and other drug use

“…Adolescents also have higher rates of unintended pregnancy when using non-LARC methods compared with adults, which indicates a need for providers to take a more active role in advocating for the most effective contraceptive option 44. Although it may seem that older adolescents are likely to have a more developed sense of autonomy, the complexity of determining a minor's competence for making medical decisions is recognised in the literature and may include assessments of self-sufficiency, experiences, maturity and other case-specific considerations 45. Thus, age alone cannot determine the propriety of encouraging a particular treatment in adolescents.…”

Ethical principles and legal requirements for pediatric research in the EU: an analysis of the European normative and legal framework surrounding pediatric clinical trials

“…While the right of minors to be informed and to dissent is taken very seriously, there is no clarity concerning the active role that minors can and should play in the actual decision-making process apart from affirming or refusing participation. In addition, it is hard to determine the decision-making capacities of individual minors [17]. Therefore, practical support for the active involvement of minors in decisions on research participation could be of great help in making the principle of respect for persons operational in the setting of pediatric research.…”