Countries, States and Provinces all have different rules as far as when someone legally becomes an adult. Is it when they turn 16, 18, or 21? Should age be used at all to make such a determination? For those teens that are not yet legally viewed as adults, the catchall expression "Mature Minor" is used. On what do authorities base their judgement of maturity especially in regards choice of medical treatment?
The American Academy of Pediatrics Task Force grants informed consent based on the patient's age, disease, severity, prognosis, risks, proposed benefits, level of intelligence, reasoning, emotional state, and cultural perspective.1 In addition, studies have shown that teens can make informed choices just as well as adults with regard to issues such as diabetes, epilepsy, and depression.2
A clear and concise statutory definition of ``mature minor'' could help all understand what is required to be determined a mature minor.
In Canada (under Common Law) in particular B.C., they have a description of the "mature minor". A child who is under the age of majority (e.g. nineteen), can be described as a mature minor, if they have sufficient intelligence to understand the nature and consequences and the reasonably foreseeable benefits and risks of a health care service or treatment. While some courts have found children as young as eight as being mature minors, this finding depends on the individual characteristics of the particular child and the nature of the health care decision they are facing. However and at the risk of over-generalizing, a mature minor is commonly understood to be a child who is 13 years of age or older and of average intelligence. But the essential feature of "mature" is the child's capacity to understand and make the particular health care decision that is before them. So it is a flexible concept.
The Seattle & King County Public Health Department provides excellent instructions on determining the maturity of a minor 3 .
Mature minor
Guidelines for an individual to be considered a mature minor include: age, living apart from parents or guardian, maturity, intelligence, economic independence, experience and marital status.
- Age 15 or older? Treating both 13 and 14 year olds as Mature Minors when they demonstrate key qualities of the Mature Minor is reasonable. Treating youth who are 12 and under is up to the provider's best judgment.
- Freedom from parents or guardian: Lives apart, managing his/her own affairs? A teenager living apart from his/her parents or guardians and managing his/her own affairs.
- Intelligence: Capable of understanding and appreciating the implication of treatment? Intelligence relates directly to the young person's ability to understand both the benefits and risks of treatment. A young person's ability to recognize his/her need for care and present him/herself at a health care site is an indicator of intelligence.
- Maturity: Absence of control by parents? Maturity relates directly to the young person's ability to provide reliable information and make important decisions. (highlighting mine)
- Training: Self-supporting? Economic independence from parents or guardians. In some cases, involvement in a work-training program may indicate an individual who is self-supporting. A self-supporting individual may be considered to be both "intelligent" and "mature."
- Experience: General conduct of an adult? The provider can use his/her own judgment in determining an individual's general conduct as an adult.
- Marital status: Married? If it has been determined that an individual is intelligent and mature, then marriage can be used to further support the case of applicability.
Therefore under common law, a minor was presumed to acquire the capacity to consent when she had the ability of the average person to understand and weigh the risks and benefits of a proposed course of action.
United States
Alabama provides a concrete definition of a mature minor as, "[a]ny minor, who is age 14 or older, or has graduated from high school, or is married, or having been married is divorced or is pregnant may give effective consent to any legally authorized medical, dental, health or mental health services, and the consent of no other person shall be necessary."
Walter Wadlington in his Minors and Health Care: The Age of Consent, [Osgood Hall L.J. 115, (1973) ] elucidated upon cases in which the ``mature minor'' doctrine had been applied, and found it to have the following commonalities: (1) treatment was undertaken for the benefit of the minor, as opposed to a third party; (2) the minor was near the age of majority, or at least 15 years of age, and was deemed to have sufficient mental capacity to fully understand the nature and importance of the proposed medical procedures; and (3) the medical procedures could be described by a court as not ``major'' or ``serious.''
To reflect minors' progressing reasoning abilities through various developmental stages, capacity is often determined by a so-called ``Rule of Sevens.'' Cardwell v. Bechtol, 724 S.W.2d 739, 745 (Tenn. 1987). The Rule of Sevens provides that under the age of seven, a child has no capacity; between the ages of seven and fourteen, there exists a rebuttable presumption that the minor has no capacity; and between the ages of fourteen and twenty-one, there exists a rebuttable presumption that the individual has capacity.
Without belabouring the point further, it is my position that a mature minor is one that is capable of understanding and objectively looking at options, risks benefits of a proposed treatment and being able to make a decision accordingly.
This principle should only be superseded when it becomes apparent that a minor is under undue influence of parents or other influential adults in the minors life.
In situations involving minors refusing treatment on religious grounds, the Courts should interview the minor to determine if alternatives have been clearly and objectively reviewed or if the child has been strictly indoctrinated into a myopic point of view. Should such be determined, the State should, in the best interests of the child, intervene so that said minor may grow to an age whereby reasonable decisions can be made hopefully without the undue influence of a high control religion.
In the case of minor Jehovahs Witnesses who (or whose parents) refuses life saving medical treatment, the presence of Church leaders and specifically HLC members should be prohibited from being part of medical discussions with families and any attempts to invade the doctor patient confidentiality on the part of said members should be barred from future visitations and names turned over for interference of the medical profession.
Any attempt by the local congregation or Branch Office of Jehovahs Witnesses to interfere with personal medical choice of minor children, including provision of lawyers should be sanctioned harshly by the courts
The fact that a minor or an adult has turned over decision making to agents of the Church should give indication to the court that Jehovahs Witness minors are in fact being unduly influenced and are not to be considered mature minors.
Footnotes
1 Christin Hanisco, Acknowledging the Hypocrisy: Granting Minors the Right to Choose, 16 N.Y.L. Sch. J. Hum. Rts. 899 (summer 2000).
...2 Shoshanna Ehrlich, Minors as Medical Decision Makers, 7 Mich. J. Gender & L. 65 at 71-72 (2000).
3 http://www.metrokc.gov/health/famplan/matureminor.htm
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