Question

Who makes healthcare decisions for minors? When can minors make their own healthcare decisions? (Limit: 1 page)

Answer 1

To ensure that the best decisions are made for children and adolescents, these decisions should be made jointly by members of the health care team, the child or adolescent’s parents, and sometimes the child or adolescent. Children and adolescents should be involved in decision-making to an increasing degree as they develop, until they are capable of making their own decisions about treatment. End-of-life decision-making, whether or not the child or adolescent is involved, is especially complex.

This policy offers physicians some principles and strategies to facilitate the best possible decisions for their patients. It is not intended to apply to research or to the use of innovative (non-validated) therapy.

PRINCIPLES/ASSUMPTIONS

• All infants, children and adolescents – regardless of physical or mental disability – have dignity, intrinsic value, and a claim to respect, protection, and medical treatment that serves their best interests.

• Although family issues are important and must be considered, the primary concern of health professionals who care for children and adolescents must be the best interests of individual children and adolescents.

• Decision-making for children and adolescents should be interdisciplinary and collaborative, and should actively involve the family and, when appropriate, the child or adolescent.

• Children and adolescents should be appropriately involved in decisions affecting them. Once they have sufficient decision-making capacity, they should become the principal decision maker for themselves.

• All information presented to patients, families, or the child or adolescent’s legal guardian should be truthful, clear and presented with sensitivity. This information should include evidence available in the literature, and the clinical experience of the physician and his or her colleagues.

• A physician’s personal and professional values can influence patients and families. The reflective practitioner is aware that personal values should not be allowed to restrict or bias such things as options offered to patients or families.

• The principal obligation of the physician is to the individual patient rather than to society or the health care system. Physicians should act as advocates for their individual patients when scarce resources seem to limit access to care

GENERAL PRINCIPLES OF TREATMENT DECISION-MAKING AND INFORMED CONSENT

All decisions are based on a combination of known facts and personal values. In health care, treatment decisions relate to medical information and personal evaluation of this information. For people to make appropriate decisions, they must have the pertinent information, be able to understand how it applies to themselves, and then make a voluntary, or non-coerced, decision. These bases of medical decision-making actually define the three hallmarks of informed choice:

1. Appropriate information: The information necessary to make a decision.

2. Decision-making capacity: The ability to receive, understand and communicate information, and the appreciation of the personal effects of interventions, alternatives or nontreatment.

3. Voluntariness: The decision maker should not be manipulated or coerced, and the option to change one’s mind should always be available.

can minors make their own healthcare decisions?

This does not imply, however, that no one younger than 18 years can participate in their own health care decision making. Although most adolescent patients younger than 18 years cannot legally provide informed consent, they can and should provide their assent for decisions that affect their health, life, and death