We all know what informed consent is, and many have made use of our right to consent to any diagnosis or medical treatment. The times when the doctor decided unilaterally about our health have already passed And now patients value bidirectional communication with health experts.
This act it is usually done by word, but it has to be written in surgical interventions and other risky procedures. Written consent is also required in clinical trials, organ removal and transplantation, sterilization procedures, assisted reproduction techniques and donation and use of human embryos and fetuses.
And what happens to the children? Can you also give your consent?, from Family we extend the knowledge of this very specific aspect. According to the standard, any action in the field of health should have the corresponding consent. It is understood that in the actions that involve a certain risk it must be done in a more complete and clear way and in the rest of the situations it is necessary to offer all the necessary information but without falling into an excessive formalism.
Can children give their consent?
These are the rules to consider in a minor population:
Children smaller than 12 years: The consent is granted by the legal representative, usually the parents, after having heard the child's opinion.
Between 12 and 16 years old: The minor has the right to give consent for himself if the doctor considers that he is emotionally and intellectually capable of understanding the information about benefits, risks and alternatives to an action on his health.
It is often not easy to determine the child's ability to assume that responsibility and depends on the assessment of the doctor. But in the face of a serious risk action, the parents will be informed and their opinion will be taken into account without this supposing to replace the child's decision
- From 16 years old: We would be on the call coming of age and, for all intents and purposes, the subject is autonomous to make decisions without any other person having to intervene.
In the Participation in clinical trials, assisted reproduction techniques, and organ extraction and transplantation authorization requires that the subject has reached the legal age of majority, that is 18 years, or, otherwise, must be expressed by their parents or guardians.
In the case of girls of 16 and 17 years, the consent for voluntary termination of pregnancy belongs exclusively to them and at least one of the legal representatives must be informed of that decision, unless the minor alleges that this will cause a conflict serious, such as domestic violence, threats or ill-treatment
What if the doctor is facing a conflict situation?
The intervention of the legal representatives of a minor is supposed to It must always favor the health of the person represented. But it could happen that the will of the child with sufficient capacity for judgment and that of his parents or guardians will conflict.
It has come to my mind now (although I am sure that the range of possibilities is broader) any of those cases in which the parents refuse to have the child intervened / received treatment, for religious reasons.
In those cases, provided that it is considered mature enough, the will of the minor prevails. We will have to try to reach an understanding between both positions, but if there are finally doubts we should consult the judge, who will decide the solution to be taken.
However, in the face of an emergency that endangers life and cannot wait for a judicial resolution, the doctor must always act for the benefit of the child, even without the approval of the parents.
Communication does not end with the signing of a paper. The information must be maintained continuously and progressively and the option of canceling prior consent must always remain open.. In the written consents the general models are not valid, but must be specified according to the diagnostic procedure or treatment in question.
And finally I want to highlight (because it seems important to me) that 'From an ethical point of view, clear, understandable and adapted to the patient's needs information is more important than the consent document itself' .
