Consent by Proxy for Nonurgent Pediatric Care

Abstract

Minor-aged patients are often brought to the pediatrician for nonurgent acute medical care, physical examinations, or health supervision visits by someone other than their legally authorized representative, which, in most situations, is a parent. These surrogates or proxies can be members of the child's extended family, such as a grandparent, adult sibling, or aunt/uncle; a noncustodial parent or stepparent in cases of divorce and remarriage; an adult who lives in the home but is not biologically or legally related to the child; or even a child care professional (eg, au pair, nanny). This report identifies common situations in which pediatricians may encounter “consent by proxy” for nonurgent medical care for minors, including physical examinations, and explains the potential for liability exposure associated with these circumstances. The report suggests practical steps that balance the need to minimize the physician's liability exposure with the patient's access to health care. Key issues to be considered when creating or updating office policies for obtaining and documenting consent by proxy are offered.

Ethical and legal issues in integrated care settings: Case examples from pediatric primary care.

“…Legal standards of care for both psychological and medical treatment initiation stipulate that informed consent for services must be obtained from a legal guardian. However, in the medical setting providers may not routinely ask questions regarding legal guardianship for continuation of nonurgent medical services (McAbee & the Committee on Medical Liability & Risk Management, 2010), which is how the PCP in this case illustration likely perceived the warm-handoff IPC consultation. Additionally, the APA guidelines emphasize the consent process begin as soon as possible when initiating treatment, whereas the AMA guidelines state that “physicians treating pediatric patient generally must obtain informed consent from a parent or a legal guardian,” (Opinion 10.016, “Pediatric Decision-Making”; AMA, 2012), and do not contain information about when it is necessary to obtain consent again for a different type of service in the medical setting.…”