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Adult patients have the moral and legal right to make decisions about their own medical care. Because young children are not able to make complex decisions for themselves, the authority to make medical decisions on behalf of a child usually falls to the child's parents.
Who has the authority to make decisions for children?
Parents have the responsibility and authority to make medical decisions on behalf of their children. This includes the right to refuse or discontinue treatments, even those that may be life-sustaining. However, parental decision making should be guided by the best interests of the child. Decisions that are clearly not in a child's best interest can and should be challenged.
What is the basis for granting medical decision making authority to parents?
In most cases, a child's parents are the persons who care the most about their child and know the most about him. As a result, parents are expected to make the best medical decisions for their children. Furthermore, since many medical decisions will also affect the child's family, parents can factor family issues and values into medical decisions about their children.
When can parental authority to make medical decisions for their children be challenged?
Medical caretakers have an ethical and legal duty to advocate for the best interests of the child when parental decisions are potentially dangerous to the child's health, imprudent, neglectful, or abusive. When satisfactory resolution cannot be attained through respectful discussion and ethics consultation, seeking a court order for appropriate care might be necessary.
What if parents are unavailable and a child needs medical treatment?
When parents are not available to make decisions about a child's treatment, medical caretakers may provide treatment necessary to prevent harm to the child's health.
Should children be involved in medical decisions even though their parents have final authority to make those decisions?
Children with the developmental ability to understand what is happening to them should be allowed to participate in discussions about their care. As children develop the capacity to make decisions for themselves, they should be given a voice in medical decisions.
What happens when an older child disagrees with her parents about a medical treatment?
The wishes of competent older children regarding their medical care should be taken seriously. If the medical caretaker judges a child competent to make the medical decision in question, she should first attempt to resolve the issue through further discussion. If that fails, the medical caretaker should assure that the child's voice has been heard and advocate for the child. In intractable cases, an ethics consultation or judicial hearing should be pursued.
Under what circumstances can minors make medical decisions for themselves?
Minors have the ethical and legal authority to make medical decisions for themselves when they have reached the legal age of majority or become "emancipated." Most states recognize an emancipated minor as a person who meets one of the following criteria:
- self-supporting and not living at home
- married
- a parent
- in the military
In addition, most states allow treatment without parental consent for sexually transmitted diseases, pregnancy, and drug or alcohol abuse.
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