Detailed contribution information
| Contribution title | 3537 - Minors in transition: From parental care to self-determination - Children’s participation in health decisions |
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| Contribution code | PS02-71 (P) |
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| Form of presentation | Poster |
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| Abstract |
In many countries, minors have the Right to Consent for their own medical treatment if they have the prudence (capacity) to make independent decisions. In many countries, the capacity of minors to consent for a medical treatment is presumed at a specific age (e.g. England at the age of 16, Quebec (Canada) or New South Wales (Australia) at the age of 14). In other countries, such as Switzerland, the capacity to consent for a medical treatment is not tied to a specific age, but solely based on the assessment of the prudence of the patient, which is defined as the ability to act rationally. Depending on the prudence of the patient, either the minor self or his or her legal guardian(s), in most cases his or her parents, can decide on the treatment. From a legal point of view, this distinction between self-determination and parental care seems logical, legitimate and necessary. On the other hand, practical experience shows that assessing the capacity to consent of minors is often very complex, even when performed on a case-by-case basis. Even with a good understanding of the psychological background and the knowledge of the minor based on experience, it is often impossible to make a black and white decision with regard to the capacity to consent. Ultimately, a valid answer is even more difficult in the case of a psychiatric disorder. It seems that the degree of participation of a minor cannot be simply based on the assessment of the capacity to consent. It also has to respect and include the goal of the treatment as well as the medicine-ethical basic principle of primum nihil nocere. Cooperation with the minor patient as well as cooperation with his or her legal guardians are critical parts for a successful treatment. It is our opinion that in the case of a minor patient with a psychiatric disorder, autonomy and parental care should not be exclusive but rather complementary, for the benefit of the minor patient. In order to involve minors in the process of decision making with regard to medical treatment, it therefore might be more beneficial for all involved not to solely rely on the legal competence to make a decision, but rather focus on cooperation between all involved parties ensuring the best possible participation of the child. Different levels of participation for minors and shared decision making with minors to the point of “effective” self-determination may facilitate the transition from parental care to self-determination. |