4.2.2 Abortion and the Mature Minor
Erin L. Nelson, BScPT, LLB, LLM, JSD
- To appreciate the legal and ethical issues around consent to abortion in the case of minors.
- To understand the legal basis of the mature minor doctrine.
- To appreciate the legal and ethical implications of the mature minor doctrine.
Casey is a 14-year-old female patient who has been referred to an abortion provider by her family physician. Casey says that she is pregnant, having taken a home pregnancy test. She explains that she was at a party with some friends, that she had a few alcoholic drinks and that she had sexual intercourse with a boy she does not know well. Based on what she says about the timing of her last menstrual period, the physician determines that Casey is 7 weeks pregnant. Casey is very frightened, particularly that her family and friends will find out about her pregnancy. She feels that abortion is her only option. She also insists that the physician keep all information about the pregnancy and abortion confidential. Casey tells the physician that her family is Catholic and her parents are strongly opposed to abortion under all circumstances. When asked about her feelings as to the religious and ethical implications of having an abortion, Casey says “I don't care about any of that right now. All I want to do is have an abortion and forget that this ever happened. My parents can't find out about this, no matter what.”
- Can Casey provide valid consent to the abortion procedure?
- What must Casey be capable of understanding in order to be considered a mature minor?
- If the physician determines that Casey is a mature minor and can provide consent, does she also need to seek consent from Casey's parents, or from the “father”? Must the physician inform Casey's parents of her pregnancy?
- If the physician is not required to seek Casey's parents' consent, may she inform them of the pregnancy and Casey's wish for an abortion? Are there any exceptions to patient confidentiality that require consideration here?
(Also see case 1.5.2 "Decision-Making by Minors.")
- C. v. Wren (1986), 35 DLR (4th) 419 (Alta. CA).
- CB. (R.) v. Children's Aid Society of Metropolitan Toronto,  1 SCR 315.
- Dickens BM, Cook RJ. Adolescents and consent to treatment. International Journal of Gynaecology and Obstetrics 2005; 89: 179–84.
- Gibson E. Health information: Confidentiality and access. In: Downie J, Caulfield T, Flood C, editors. Canadian health law and policy, 3d edn. Markham: Butterworths; 2007: pp. 223–55.
- CGillick v West Norfolk and Wisbech Area Health Authority and another,  1 AC 112,  3 All ER 402 (UK HL).
- Gilmour J. Children, adolescents, and health care. In: Downie J, Caulfield T, Flood C, editors. Canadian health law and policy, 2d edn. Markham: Butterworths; 2002: pp. 205–49.
- Martin NS. Adolescent minors, informed consent and health information privacy: Balancing paternalism, health and autonomy in the reproductive health care context. Health Law in Canada 2007; 28: 16–24.
- Peppin P. Informed consent. In: Downie J, Caulfield T, Flood C, editors. Canadian health law and policy, 3d edn. Markham: Butterworths; 2007: pp. 189–221.
- Picard EI, Robertson GB. Legal liability of doctors and hospitals in Canada, 4th edn. Toronto: Carswell; 2007.