Wolfish: Competency of adolescents to make informed decisions [CMAJ

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Competency of adolescents to make informed decisions

CMAJ 2000;163(11):1424 [PDF]

Christopher Doig and Ellen Burgess have carefully and accurately researched the rights of adolescents to accept or refuse life-sustaining treatment [].¹ Pediatricians, family physicians, surgeons, nurses and paramedical staff caring for teenagers are aware of the necessity to respect the wishes of their patient, even if the patient makes decisions that are contrary to the wishes of his or her parents or the judgement of those responsible for his or her treatment.

The competency of children and adolescents to make informed decisions, if they understand the nature and consequence of that decision, has been examined by many professional bodies,^2,3,4 including the Canadian Paediatric Society,⁵ the American Academy of Pediatrics and the Society for Adolescent Medicine.^6,7 There have also been court decisions in Canada, the United States and the United Kingdom, as cited by the authors, supporting this principle.

Where the minor's decision differs from that of parents or caregivers, ethical considerations demand compassionate counselling for decision-making but the wishes of the patient must never be overriden. I am appalled that the hospital's legal counsel ignored this minor's rights. Was he or she more concerned about the hospital's potential liability than about the child?

Martin G. Wolfish
Past-President
Canadian Paediatric Society
Past-President
Society for Adolescent Medicine
North York General Hospital
Toronto, Ont.

References

    1.    Doig C, Burgess E. Withholding life-sustaining treatment: Are adolescents competent to make these decisions? CMAJ 2000;162(11):1585-8.

    2.    Rosovsky FA. The age of majority vs the age of consent. In: vol 1 of Ethical issues in paediatrics series. Toronto: The Hospital for Sick Children; 1991.

    3.    Gittler J, Quigley-Rick M, Saks MJ. Adolescent health care decision making: the law and public policy. Washington (DC): Carnegie Council for Adolescent Development; 1991.

    4.    English A. Treating adolescents: legal and ethical considerations. Med Clin North Am 1990;74:1097. [MEDLINE]

    5.    Doherty D, Kaufman M, Lindsay D, Panzer L, Sharpe D, Tonkin R. Age limits and adolescents [policy statement]. Ottawa (ON): Canadian Paediatric Society; 1994.

    6.    Sigman, G, Silber T, English A, Gans J. Confidential health care for adolescents [policy statement]. Blue Springs (MO): Society for Adolescent Medicine; 1991.

    7.    Hoffman AH. The right to consent and confidentiality in adolescent health care. In: Bandman EL, Bandman B, editors. Bioethics and human rights. A reader for health professionals. Boston: Little Brown; 1978.