1.5.2 Medical Decision-Making and Mature Minors
Michelle Jackman, MD, MSc, FRCPC; and, Andrew McRae MD, PhD, FRCPC
Updated December 1, 2013
- To understand the legal and ethical considerations in decision-making by minors.
- To learn how to determine whether a minor has capacity to make health care decisions.
Susan is a 14-year-old girl with ulcerative colitis. She has been receiving medical therapy since her diagnosis two years ago. She is admitted to the in-patient general pediatric ward for an exacerbation of her disease, requiring systemic steroids. On the fifth day of her admission, she develops acute abdominal pain, fever and hypotension. Her laboratory tests reveal leukocytosis and hypoalbuminemia. Computed tomography imaging shows evidence of toxic megacolon, which is an indication for urgent surgical intervention. The surgeon on call is consulted and explains to Susan and her parents the need for urgent laparotomy.
Susan refuses to undergo surgery, citing fears of scarring. The surgeon is concerned that she does not understand that declining surgery may lead to sepsis and death. The parents want her to proceed with the surgery. Susan tells her parents about her concerns about scarring and the importance of her body image to her overall well-being and confidence. She states that she would rather risk death than have a scar.
- Does Canadian law define an age of decision-making capacity?
- Are there any professional society guidelines on the issue of decision-making by minors?
- How does one determine the capacity for decision-making in adolescents? What are the similarities between adults and adolescents?
- Are there any differences in this capacity between adolescents and adults?
- How would you manage this case if the consensus was that Susan was incapable?
- How would you manage this case if Susan is determined to be capable?
Q1. Does Canadian law define an age of decision-making capacity?
Q2. Are there any professional society guidelines on the issue of decision-making by minors?
Q3. How does one determine the capacity for decision-making in adolescents? What are the similarities between adults and adolescents?
Q4. Are there any differences in this capacity between adolescents and adults?
Q5. How would you manage this case if the consensus was that Susan was incapable?
Q6. How would you manage this case if Susan was determined to be capable?
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