Not So Gray Anymore: A Mature Minor’s Capacity to Consent to Medical Treatment
Dalizza D. Marques-Lopez, J.D., LL.M. candidate
One of driving forces behind the physician-patient relationship is the patient’s autonomy to make the “ultimate informed decision regarding the course of treatment to which he knowledgeably consents to be subjected.”1 In order to be an informed decision, the physician has the duty to disclose to the patient the available choices with respect to the proposed treatments, the benefits associated with each of the proposed treatments, the risks involved with each of said treatments, and the risks involved in the patient’s refusal to receive any treatment at all.2 The patient then evaluates all the information divulged by the physician, determines which course of action he believes to be in his best interest and then gives his informed consent to undergo a particular treatment or his decision not to undergo any treatment at all.
However, in order to engage in medical decision-making and exercise his medical autonomy, the patient has to have the legal capacity to do so. That is, the patient has to be a competent adult.3 If the patient is a minor, the law deems him to be incompetent by virtue of his age. Therefore, the common law presumes that only the parents or guardians of the minor patient have the authority to consent to the particular course of treatment to be followed. This presumption of parental authority to consent to, or even refuse, a child’s medical treatment stems from a general notion that every parent will act in the best interest of his child as well as from parent’s constitutional right to privacy in family matters.4
Since there is “no magic line that defines the attainment of majority for any individual”5 and the age of majority “is not an impenetrable barrier that magically precludes a minor from possessing and exercising certain rights normally associated with adulthood”6 the Courts and the States have recognized a “mature minor” exception to the common law rule of parental consent to the medical treatment of a minor.7 Under the “mature minor” doctrine, a minor is allowed to consent or refuse to consent to his medical treatment if it is established that the minor is sufficiently mature to understand, discern and appreciate the benefits and risks of the proposed medical treatment.8
In order for a minor to be considered mature, and therefore to have the capacity to consent to or refuse his medical treatment, there must be clear and convincing evidence that the minor fully understands the consequences of his actions.9 Courts make that determination by weighing several factors such as the age, ability, experience, education, training, and degree of maturity or judgment of the minor, as well as the conduct and demeanor of the minor at the time of the incident involved.10 However, the courts have also warned that the “mature minor” exception is not “a general license to treat minors without parental consent,” and that its application will depend upon the particular facts and circumstances of each case.11
Although the parental authority to consent or refuse to consent to the medical treatment of a child is deeply embedded in the law, it also follows that if parents refuse to consent to the necessary treatment to preserve a minor’s life, a court may nevertheless authorize the treatment after weighing the child’s best interests, the parent’s interests, and the State’s interest in the protection of a child’s welfare and the preservation of a child’s life.
