Neurology Book



Consent for Treating Minors

Aka: Consent for Treating Minors, Minor Consent to Medical Treatment, Parental Consent to Treat Minor Children, Consent for Emergency Services for Children, Parental Consent, Informed Consent By Minors
  1. See Also
    1. Pediatric Emergency Care
    2. Against Medical Advice
    3. Decision-Making Capacity
    4. CURVES Mnemonic for Capacity Assessment
    5. Medical Elopement
    6. Competency Hearing
    7. Risk Management
    8. Health Insurance Portability and Accountability Act (HIPAA)
  2. Indications: Guardian consent not needed
    1. Emergency with threat to life or limb (EMTALA)
    2. Right to treatment (state protected)
      1. Child Abuse
      2. Pregnancy
      3. Sexually Transmitted Disease
      4. Substance Abuse
      5. Outpatient mental health (in some states)
    3. Emancipated minor (state defined)
      1. Married
      2. Member of the Armed Services (e.g. Navy, Marines, Air Force, Army, Coast Guard)
      3. Living independently and self-supporting (reportable case)
  3. Approach: Parent and Surrogate Decision Making for Children
    1. Contrast surrogate decision making in young children with that of older children and adults
      1. In adults, substituted judgment is based on knowing a patient's opinions and values
      2. The surrogate acts on what they believe the adult patient would want
    2. Younger children do not typically have the ability to understand their medical options and make decisions
      1. Instead, parents and surrogates practice what they interpret as best interests of the child
      2. "Best interest" is often difficult to determine, and may reasonably vary from one surrogate to another
      3. Nonmaleficence ("do no harm") may be a more manageable way to judge surrogate decision making
        1. The clinician should consider whether surrogate decision making risks significant child harm
        2. Does the decision making risk life or health loss or deprive basic needs?
    3. When surrogate decision making appear to break Nonmaleficence and put the child at significant risk
      1. Consider whether the surrogate is transiently incapacitated (e.g. Intoxication)
      2. Attempt to negotiate with the parent or surrogate if the have maintained capacity
      3. Involve law enforcement and hospital security if a compromise that is safe for the child cannot be made
  4. Approach: Resuscitation
    1. Advanced Directives (including DNR)
      1. Prevalence of life limiting illness in U.S. children: 500,000
      2. Less than 3% of U.S. children with life limiting illness have an Advanced Directive
    2. DNR Orders
      1. Confirm certified paperwork or medical alert bracelet before following DNR order
      2. Perform full Resuscitation in acutely life threatening cases where the DNR order can not be verified
      3. The legal guardian may revoke a DNR order at any time
  5. References
    1. Seeyave, Sherman and Ward (2020) Crit Dec Emerg Med 34(1): 19-25
    2. Bukata (2013) Emergency Pediatrics, EM Bootcamp, CEME

Parental Consent (C0600634)

Definition (MSH) Informed consent given by a parent on behalf of a minor or otherwise incompetent child.
Concepts Idea or Concept (T078)
MSH D033282
English Consent, Parental, Parental Consent, parental consent, consent parental
Swedish Föräldrasamtycke
Czech souhlas rodiče
Finnish Vanhempien suostumus
French Consentement d'un parent, Consentement parental
Polish Zgoda rodziców
Norwegian Foreldres samtykke, Foreldresamtykke, Foresattes samtykke
Portuguese Consentimento do Responsável, Consentimento Materno, Consentimento Paterno, Consentimento dos Pais
German Einwilligung der Eltern, Einwilligung, elterliche, Elterliche Einwilligung, Elterliche Zustimmung
Italian Consenso del genitore
Dutch Toestemming van ouder
Spanish Consentimiento Paterno
Derived from the NIH UMLS (Unified Medical Language System)

Informed Consent By Minors (C2936241)

Definition (MSH) Voluntary authorization by a person not of usual legal age for diagnostic or investigative procedures, or for medical and surgical treatment. (from English A, Shaw FE, McCauley MM, Fishbein DB Pediatrics 121:Suppl Jan 2008 pp S85-7).
Concepts Idea or Concept (T078)
MSH D057828
English Informed Consent By Minors
French Consentement éclairé chez les mineurs, Consentement éclairé des mineurs
German Einverstaendniserklaerung von Minderjaehrigen, Einverständniserklärung von Minderjährigen
Czech informovaný souhlas u nezletilých
Italian Consenso informato di minori, Consenso informato di minore
Spanish Consentimiento Informado en Menores
Portuguese Consentimento Informado por Menores
Polish Zgoda świadoma małoletniego
Norwegian Informert samtykke fra mindreårige, Mindreåriges samtykke, Mindreåriges informerte samtykke
Derived from the NIH UMLS (Unified Medical Language System)

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