When Does A Minor’s Legal Competence To Make Health Care Decisions Matter?

Weithorn, Lois A.

doi:10.1542/peds.2020-0818g

Cited by 12 publications

(8 citation statements)

References 31 publications

(45 reference statements)

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“…18 The few published papers on children’s consent to treatment concentrate on those aged 12 years upwards, deemed in the (formerly British) Commonwealth Gillick competent, 19 and in the US mature minors. 20 Some lawyers are critical that ‘adolescent autonomy is little more than a myth’ and state that ‘no minor has a right to refuse treatment’. 4 High standards of informed consent promote respect for adult patients and for parents, but leave children deemed pre-competent with no right to be informed, or involved in decisions.…”

Section: Resultsmentioning

confidence: 99%

Children’s informed signified and voluntary consent to heart surgery: Professionals’ practical perspectives

et al. 2022

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Background: The law and literature about children’s consent generally assume that patients aged under-18 cannot consent until around 12 years, and cannot refuse recommended surgery. Children deemed pre-competent do not have automatic rights to information or to protection from unwanted interventions. However, the observed practitioners tend to inform young children s, respect their consent or refusal, and help them to “want” to have the surgery. Refusal of heart transplantation by 6-year-olds is accepted. Research question: What are possible reasons to explain the differences between theories and practices about the ages when children begin to be informed about elective heart surgery, and when their consent or refusal begins to be respected? Research design, participants and context: Research methods included reviews of related healthcare, law and ethics literature; observations and conversations with staff and families in two London hospitals; audio-recorded semi-structured interviews with a purposive sample of 45 healthcare professionals and related experts; interviews and a survey with parents and children aged 6- to 15-years having elective surgery (not reported in this paper); meetings with an interdisciplinary advisory group; thematic analysis of qualitative data and co-authorship of papers with participants. Ethical considerations: Approval was granted by four research ethics committees/authorities. All interviewees gave their informed written consent. Findings: Interviewees explained their views and experiences about children’s ages of competence to understand and consent or refuse, analysed by their differing emphases on informed, signified or voluntary consent. Discussion: Differing views about children’s competence to understand and consent are associated with emphases on consent as an intellectual, practical and/or emotional process. Conclusion: Greater respect for children’s practical signified, emotional voluntary and intellectual informed consent can increase respectful understanding of children’s consent. Nurses play a vital part in children's practitioner-patient relationships and physical care and therefore in all three elements of consent.

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Section: Resultsmentioning

confidence: 99%

Children’s informed signified and voluntary consent to heart surgery: Professionals’ practical perspectives

et al. 2022

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“…In the United States, caregivers have surrogate decision-making responsibility (9)(10)(11)(12)(13)(14). As displayed with this study's adolescent patient, a mature child's opposition to a significant intervention can cause distress for the caregiver and provider team (9,13,15).…”

Section: E603mentioning

confidence: 84%

“…Caregiver-child accord influenced caregivers’ regret associated with making decisions for their child. In the United States, caregivers have surrogate decision-making responsibility (9–14). As displayed with this study’s adolescent patient, a mature child’s opposition to a significant intervention can cause distress for the caregiver and provider team (9, 13, 15).…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, caregivers have surrogate decision-making responsibility (9–14). As displayed with this study’s adolescent patient, a mature child’s opposition to a significant intervention can cause distress for the caregiver and provider team (9, 13, 15). In this case, the caregiver’s persistent regret highlights the emotional burden of an adverse outcome following a high-risk decision without a child’s clear assent.…”

Section: Discussionmentioning

confidence: 99%

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Bereaved Caregiver Perspectives on the End of Life in Pediatric Patients With Ventricular Assist Devices

Bui

Schneider

Brown

et al. 2022

Pediatric Critical Care Medicine

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Ventricular assist devices (VADs) are increasingly used in pediatric heart failure as bridges to heart transplantation, although 25% will die with VADs. Family experiences in this population are not well-described. The objective is to understand bereaved families' perspectives on VAD and end-of-life decision-making.DESIGN: Semistructured interviews with bereaved caregivers of pediatric VAD patients. SETTING: Tertiary children's hospital.PATIENTS: Families of six pediatric VAD patients who died from 2014 to 2020. INTERVENTIONS: Not available. MEASUREMENTS AND MAIN RESULTS:Applying a grounded theory framework, interviews were coded by two independent readers using qualitative software. Themes were discussed in iterative multidisciplinary meetings. Participants were interviewed at a median 2.4 years after their child died. Three major themes emerged: 1) "lack of regret" for VAD implantation despite the outcome; 2) "caregiver-child accord" (via patient's verbal assent or physical cues) at implantation and end-of-life was important in family decision-making; and 3) development of a "local surrogate family" (medical team and peer families) provided powerful support. CONCLUSIONS:Bereaved families' perspectives provide insight into quality decision-making for major interventions and end-of-life care in pediatric patients with chronic illness who face decisions regarding technology dependence.

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“…Many states, however, grant decision‐making authority and confidentiality protections to minors for specific medical conditions, including pregnancy, substance use disorders, mental illness, and sexually transmitted diseases. 12 , 13 …”

Section: Conceptual Moral and Legal Foundationsmentioning

confidence: 99%

Privacy and confidentiality of emergency department patient information: Contemporary considerations and challenges

Brenner,

Delpier,

Simon

et al. 2024

JACEP Open

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This article provides a brief review of moral and legal duties to respect confidentiality in emergency medicine. The article considers current challenges to confidentiality in emergency departments and proposes strategies to address them. It is offered as an update of the two‐part review of confidentiality in emergency medicine in 2005 by Moskop et al published in 2005 in Annals of Emergency Medicine.

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When Does A Minor’s Legal Competence To Make Health Care Decisions Matter?

Cited by 12 publications

References 31 publications

Children’s informed signified and voluntary consent to heart surgery: Professionals’ practical perspectives

Children’s informed signified and voluntary consent to heart surgery: Professionals’ practical perspectives

Bereaved Caregiver Perspectives on the End of Life in Pediatric Patients With Ventricular Assist Devices

Privacy and confidentiality of emergency department patient information: Contemporary considerations and challenges

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