Mature minor doctrine

In the United States, a typical statute lists: "Who may consent [or withhold consent for] surgical or medical treatment or procedures."

:"...Any unemancipated minor of sufficient intelligence to understand and appreciate the consequences of the proposed surgical or medical treatment or procedures, for himself."{{cite web |work=Mississippi Code |url=https://law.justia.com/codes/mississippi/2010/title-41/41/41-41-3/ |title=Miss. Code Ann. § 41-41-3 |access-date=2021-08-02 |via=Justia |quote=§ 41-41-3. Consent for surgical or medical treatment or procedures on unemancipated minors. |archive-date=26 August 2021 |archive-url=https://web.archive.org/web/20210826205221/https://law.justia.com/codes/mississippi/2010/title-41/41/41-41-3 |url-status=live }}{{cite web |work=2019 Arkansas Code |via=Justia |url=https://law.justia.com/codes/arkansas/2019/title-20/subtitle-2/chapter-9/subchapter-6/section-20-9-602/ |access-date=2021-08-02 |title=Title 20 - Public Health and Welfare; Subtitle 2 - Health and Safety; Chapter 9 - Health Facilities and Services Generally; Subchapter 6 - Consent to Treatment; § 20-9-602. Consent Generally - Definition |year=2019 |archive-date=2 August 2021 |archive-url=https://web.archive.org/web/20210802110046/https://law.justia.com/codes/arkansas/2019/title-20/subtitle-2/chapter-9/subchapter-6/section-20-9-602/ |url-status=live }}

{{See also|Emancipation of minors}}

By definition, a "mature minor" has been found to have the capacity for decisional autonomy, or the right to make decisions including whether to undergo risky but potentially life-saving medical decisions alone, without parental approval.{{Cite journal|last=Tunick|first=Mark|date=2021|title=State Authority, Parental Authority, and the Rights of Mature Minors|url=https://rdcu.be/cxbt3|journal=The Journal of Ethics|volume=Online first, Sept. 4, 2021|pages=1–23|via=Springer Nature|access-date=18 September 2024|archive-date=19 September 2024|archive-url=https://web.archive.org/web/20240919002156/https://link.springer.com/epdf/10.1007/s10892-021-09379-x?sharing_token=vTYvK1J0aUFXQFkkzP1iVPe4RwlQNchNByi7wbcMAY71VgLp1kwl_2FqY2kxNWBALUruDKTrN362MxqM8LZtwIaCBGcl1d9QbfpQ7N3gHUSRIFxsZJ2NYd1cZl5SwwFuDQZyVKkyptJ41DkprQJ7HN7Ar2lK8L6WyA8IWVpPtIs%3D|url-status=live}} By contrast, "medical emancipation" formally releases children from some parental involvement requirements but does not necessarily grant that decision making to children themselves. Pursuant to statute, several jurisdictions grant medical emancipation to a minor who has become pregnant or requires sexual-health services, thereby permitting medical treatment without parental consent and, often, confidentiality from parents. A limited guardianship may be appointed to make medical decisions for the medically emancipated minor and the minor may not be permitted to refuse or even choose treatment.{{cite book |title=Children and the Law |first1=Douglas E. |last1=Abrams |first2=Sarah H. |last2=Ramsey |publisher=West Group |year=2003 |page=769 |isbn=9780314263254 }}

One significant early U.S. case, [https://scholar.google.com/scholar_case?case=10967297783373086168&q=431+P.2d+719.&hl=en&as_sdt=2,31 Smith v. Seibly], 72 Wn.2d 16, 431 P.2d 719 (1967), before the Washington Supreme Court, establishes precedent on the mature minor doctrine. The plaintiff, Albert G. Smith, an 18-year-old married father, was suffering from myasthenia gravis, a progressive disease. Because of this, Smith expressed concern that his wife might become burdened in caring for him, for their existing child and possibly for additional children. On March 9, 1961, while still 18, Smith requested a vasectomy. His doctor required written consent, which Smith provided, and the surgery was performed. Later, after reaching Washington's statutory age of majority, then 21, the doctor was sued by Smith, who now claimed that he had been a minor and thus unable to grant surgical or medical consent. The Court rejected Smith's argument: "Thus, age, intelligence, maturity, training, experience, economic independence or lack thereof, general conduct as an adult and freedom from the control of parents are all factors to be considered in such a case [involving consent to surgery]."

The court further quoted another recently decided case, [https://scholar.google.com/scholar_case?case=18043554202269328547&q=422+P.2d+812&hl=en&as_sdt=2,31 Grannum v. Berard], 70 Wn.2d 304, 307, 422 P.2d 812 (1967): "The mental capacity necessary to consent to a surgical operation is a question of fact to be determined from the circumstances of each individual case." The court explicitly stated that a minor may grant surgical consent even without formal emancipation.

Especially since the 1970s, older pediatric patients sought to make autonomous decisions regarding their own treatment, and sometimes sued successfully to do so.{{cite journal|url=https://pubmed.ncbi.nlm.nih.gov/9474494/|doi=10.2307/3527716|jstor=3527716|title=Affirming the Decisions Adolescents Make about Life and Death|last1=Weir|first1=Robert F.|last2=Peters|first2=Charles|journal=The Hastings Center Report|year=1997|volume=27|issue=6|pages=29–40|pmid=9474494|access-date=18 September 2024|archive-date=19 September 2024|archive-url=https://web.archive.org/web/20240919003218/https://pubmed.ncbi.nlm.nih.gov/9474494/|url-status=live}} The decades of accumulated evidence tended to demonstrate that children are capable of participating in medical decision-making in a meaningful way;{{Cite journal|url = https://pubmed.ncbi.nlm.nih.gov/12771592/|pmid = 12771592|year = 2003|last1 = Zawistowski|first1 = C. A.|last2 = Frader|first2 = J. E.|title = Ethical problems in pediatric critical care: Consent|journal = Critical Care Medicine|volume = 31|issue = 5 Suppl|pages = S407-10|doi = 10.1097/01.CCM.0000065274.46402.DB|s2cid = 40746856|access-date = 18 September 2024|archive-date = 16 February 2023|archive-url = https://web.archive.org/web/20230216101553/https://pubmed.ncbi.nlm.nih.gov/12771592/|url-status = live}}{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/11185027/4|doi=10.1111/j.1748-720x.2000.tb00001.x|title=Mature Minors Should Have the Right to Refuse Life-Sustaining Medical Treatment|year=2000|last1=Derish|first1=Melinda T.|last2=Heuvel|first2=Kathleen Vanden|journal=Journal of Law, Medicine & Ethics|volume=28|issue=2|pages=109–124|pmid=11185027|s2cid=21131455|access-date=18 September 2024|archive-date=19 September 2024|archive-url=https://web.archive.org/web/20240919003206/https://pubmed.ncbi.nlm.nih.gov/11185027/|url-status=live}} and legal and medical communities have demonstrated an increasing willingness to formally affirm decisions made by young people, even regarding life and death.{{Cite journal|url = https://pubmed.ncbi.nlm.nih.gov/12795064/|pmid = 12795064|year = 2001|last1 = Beidler|first1 = S. M.|last2 = Dickey|first2 = S. B.|title = Children's competence to participate in healthcare decisions|journal = JONA's Healthcare Law, Ethics, and Regulation|volume = 3|issue = 3|pages = 80–87|doi = 10.1097/00128488-200109000-00004|access-date = 18 September 2024|archive-date = 3 June 2024|archive-url = https://web.archive.org/web/20240603154652/https://pubmed.ncbi.nlm.nih.gov/12795064/|url-status = live}}

Religious beliefs have repeatedly influenced a patient's decision to choose treatment or not. In a case in 1989 in Illinois, a 17-year-old female Jehovah's Witness was permitted to refuse necessary life saving treatments.{{cite news |url=https://www.theatlantic.com/health/archive/2015/01/you-must-be-this-old-to-die/384303/ |title=You Must Be This Old to Die |work=The Atlantic |first=Nicholas |last=St. Fleur |date=January 7, 2015 |access-date=July 30, 2021 }}

In 1990, the United States Congress passed the Patient Self-Determination Act; even though key provisions apply only to patients over age 18,{{Cite journal|url = https://pubmed.ncbi.nlm.nih.gov/8436486/|pmid = 8436486|year = 1993|last1 = Mezey|first1 = M.|last2 = Latimer|first2 = B.|title = The Patient Self-determination Act. An early look at implementation|journal = The Hastings Center Report|volume = 23|issue = 1|pages = 16–20|doi = 10.2307/3562274|jstor = 3562274|access-date = 18 September 2024|archive-date = 16 February 2023|archive-url = https://web.archive.org/web/20230216101555/https://pubmed.ncbi.nlm.nih.gov/8436486/|url-status = live}} the legislation advanced patient involvement in decision-making. The West Virginia Supreme Court, in Belcher v. Charleston Area Medical Center (1992) defined a "mature minor" exception to parental consent, according consideration to seven factors to be weighed regarding such a minor: age, ability, experience, education, exhibited judgment, conduct, and appreciation of relevant risks and consequences.{{cite court |url=https://scholar.google.com/scholar_case?case=14842078072813819970 |litigants=Belcher v. Charleston Area Medical Center |date=July 15, 1992 |reporter=S.E.2d |vol=422 |opinion=827 |archive-url=https://web.archive.org/web/20210730143038/https://scholar.google.com/scholar_case?case=14842078072813819970 |url-status=live }}{{cite web |title=Mature Minors and Emancipated Minors |work=Health Sciences Center, West Virginia University |url=http://www.wvendoflife.org/MediaLibraries/WVCEOLC/Media/laws/Minors.pdf |access-date=2011-08-04 |archiveurl=https://web.archive.org/web/20111226055543/http://www.wvendoflife.org/MediaLibraries/WVCEOLC/Media/laws/Minors.pdf |archivedate=2011-12-26 |url-status=dead }}

The 2000s and 2010s experienced a number of outbreaks of vaccine-preventable diseases, such as the 2019–2020 measles outbreaks, which were fueled in part by vaccine hesitancy. This prompted minors to seek vaccinations over objections from their parents.{{Cite journal|url = https://www.nejm.org/doi/full/10.1056/NEJMp1905814|doi = 10.1056/NEJMp1905814|title = Vaccination over Parental Objection — Should Adolescents be Allowed to Consent to Receiving Vaccines?|year = 2019|last1 = Silverman|first1 = Ross D.|last2 = Opel|first2 = Douglas J.|last3 = Omer|first3 = Saad B.|journal = New England Journal of Medicine|volume = 381|issue = 2|pages = 104–106|pmid = 31167045|hdl = 1805/22186|s2cid = 174811777|hdl-access = free|access-date = 18 September 2024|archive-date = 19 September 2024|archive-url = https://web.archive.org/web/20240919003311/https://www.nejm.org/doi/full/10.1056/NEJMp1905814|url-status = live}}{{cite web |url=https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2019/06/24/teens-of-anti-vaxxers-can-get-their-own-vaccines-some-states-say |work=The Pew Charitable Trusts |title=Teens of 'Anti-Vaxxers' Can Get Their Own Vaccines, Some States Say |date=June 24, 2019 |first=Michael |last=Ollove |access-date=30 July 2021 |archive-date=30 July 2021 |archive-url=https://web.archive.org/web/20210730143039/https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2019/06/24/teens-of-anti-vaxxers-can-get-their-own-vaccines-some-states-say |url-status=live }} Beginning in the 2020s during the COVID-19 pandemic, minors also began seeking out the COVID-19 vaccine over the objections of their vaccine-hesitant parents.{{cite news |url=https://www.nytimes.com/2021/06/26/health/covid-vaccine-teens-consent.html |title=As Parents Forbid Covid Shots, Defiant Teenagers Seek Ways to Get Them |work=The New York Times |date=2021-06-26 |access-date=30 July 2021 |first=Jan |last=Hoffman |archive-date=30 July 2021 |archive-url=https://web.archive.org/web/20210730152755/https://www.nytimes.com/2021/06/26/health/covid-vaccine-teens-consent.html |url-status=live }} This has led to proposals and bills allowing minor to consent to be administered with any approved vaccine.{{cite web |url=https://www.latimes.com/opinion/story/2022-08-19/vaccines-teenagers-consent-vaccination-sb866 |title=Editorial: Vaccines are safe. So why shouldn't teens be able to get them on their own? |work=Los Angeles Times |date=19 August 2022 |access-date=28 August 2022 |author=L.A. Times Editorial Board |archive-date=27 August 2022 |archive-url=https://web.archive.org/web/20220827221911/https://www.latimes.com/opinion/story/2022-08-19/vaccines-teenagers-consent-vaccination-sb866 |url-status=live }}

The Supreme Court of Canada recognized mature minor doctrine in 2009 in A.C. v. Manitoba [2009] SCC 30; in provinces and territories lacking relevant statutes, common law is presumed to be applied.

Several states permit minors to legally consent to general medical treatment (routine, nonemergency care, especially when the risk of treatment is considered to be low) without parental consent or over parental objections, when the minor is at least 14 years old.{{cite journal |title=The Legal Authority of Mature Minors to Consent to General Medical Treatment |first1=Doriane Lambelet |last1=Coleman |first2=Philip M. |last2=Rosoff |journal=Pediatrics |volume=131 |issue=4 |pages=786–793 |date=April 2013 |url=http://pdfs.semanticscholar.org/1caf/65c110f65f6e0b91c74956043da9cbac0dbb.pdf |doi=10.1542/peds.2012-2470 |pmid=23530175 |s2cid=686006 |accessdate=12 March 2019 |archive-url=https://web.archive.org/web/20190219235201/http://pdfs.semanticscholar.org/1caf/65c110f65f6e0b91c74956043da9cbac0dbb.pdf |archivedate=2019-02-19 |url-status=dead }}

In addition, many other states allow minors to consent to medical procedures under a more limited set of circumstances. These include providing limited minor autonomy only in enumerated cases, such as blood donation, substance abuse, sexual and reproductive health (including abortion and sexually transmitted infections), or for emergency medical services. Many states also exempt specific groups of minors from parental consent, such as homeless youth, emancipated minors, minor parents, or married minors.{{cite report |title=State Minor Consent Laws: A Summary, 3rd Edition |first1=Abigail |last1=English |first2=Lindsay |last2=Bass |first3=Alison Dame |last3=Boyle |first4=Felicia |last4=Eshragh |date=January 2010 |url=https://www.freelists.org/archives/hilac/02-2014/pdftRo8tw89mb.pdf |publisher=Center for Adolescent Health & the Law |access-date=12 March 2019 |archive-date=9 August 2019 |archive-url=https://web.archive.org/web/20190809100912/https://www.freelists.org/archives/hilac/02-2014/pdftRo8tw89mb.pdf |url-status=live }} Further complicating matters is the interaction between state tort law, state contract law, and federal law, depending on if the clinic accepts federal funding under Title X or Medicaid.

{{See also|Informed refusal}}

In the United States, bodily integrity has long been considered a common law right; The Supreme Court in 1990 (Cruzan v. Director, Missouri Department of Health) allowed that "constitutionally protected liberty interest in refusing unwanted medical treatment may be inferred" in the Due Process Clause of the Fourteenth Amendment to the United States Constitution, but the Court refrained from explicitly establishing what would have been a newly enumerated right. Nevertheless, lower courts have increasingly held that competent patients have the right to refuse any treatment for themselves.{{Cite journal|pmid = 8759232|year = 1996|last1 = Lemmens|first1 = T.|title = Towards the right to be killed? Treatment refusal, assisted suicide and euthanasia in the United States and Canada|journal = British Medical Bulletin|volume = 52|issue = 2|pages = 341–353|doi = 10.1093/oxfordjournals.bmb.a011549|doi-access = free}}

In 1989, the Supreme Court of Illinois interpreted the Supreme Court of the United States to have already adopted major aspects of mature minor doctrine, concluding,

:Although the United States Supreme Court has not broadened this constitutional right of minors beyond abortion cases, the [Illinois] appellate court found such an extension "inevitable." ...Nevertheless, the Supreme Court has not held that a constitutionally based right to refuse medical treatment exists, either for adults or minors. ...[U.S. Supreme Court] cases do show, however, that no "bright line" age restriction of 18 is tenable in restricting the rights of mature minors, [thus] mature minors may possess and exercise rights regarding medical care... If the evidence is clear and convincing that the minor is mature enough to appreciate the consequences of her actions, and that the minor is mature enough to exercise the judgment of an adult, then the mature minor doctrine affords her the common law right to consent to or refuse medical treatment [including life and death cases, with some considerations].In re E.G., 549 N.E.2d 322, 133 Ill. 2d 98, Supreme Court of Illinois, November 13, 1989, [http://il.findacase.com/research/wfrmDocViewer.aspx/xq/fac.19891113_0001777.IL.htm/qx Retrieved 2011-05-16] {{Webarchive|url=https://web.archive.org/web/20110818090809/http://il.findacase.com/research/wfrmDocViewer.aspx/xq/fac.19891113_0001777.IL.htm/qx |date=18 August 2011 }}

In 2016 the case of "In re Z.M." was heard in Maryland regarding a minor's right to refuse chemotherapy.{{cite web |url=https://www.courts.state.md.us/sites/default/files/import/cosappeals/pdfs/201610schedule.pdf |title=Court of Appeals Documents |date=October 3, 2016 |website=courts.state.md.us |access-date=2019-07-08 |archive-date=8 July 2019 |archive-url=https://web.archive.org/web/20190708235617/https://www.courts.state.md.us/sites/default/files/import/cosappeals/pdfs/201610schedule.pdf |url-status=live }}

In Connecticut, Cassandra C. a seventeen-year-old, was ordered by the Connecticut Supreme Court to receive treatment. The court decided that Cassandra was not mature enough to make medical decisions.{{Cite news|date=February 15, 2015|first=Paige Miles|last=Feldmann|url=http://campbelllawobserver.com/the-choice-is-not-always-yours-a-minors-right-to-make-medical-decisions/|title=The Choice is Not Always Yours: A Minor's Right to Make Medical Decisions|newspaper=Campbell Law Observer|language=en-US|access-date=2016-10-11|archive-date=12 October 2016|archive-url=https://web.archive.org/web/20161012080449/http://campbelllawobserver.com/the-choice-is-not-always-yours-a-minors-right-to-make-medical-decisions/|url-status=live}}

In 2009, the Supreme Court of Canada ruling in A.C. v. Manitoba [2009] SCC 30 (CanLII) found that children may make life and death decisions about their medical treatment. In the majority opinion, Justice Rosalie Abella wrote:

:"The result of this [decision] is that young people under 16 will have the right to demonstrate mature medical decisional capacity. ...If, after a careful analysis of the young person’s ability to exercise mature and independent judgment, the court is persuaded that the necessary level of maturity exists, the young person’s views ought to be respected."

A "dissenting"That is, dissenting to the disposition of this specific case rather than the larger point of law opinion by Justice Ian Binnie would have gone further:

:"At common law, proof of capacity entitles the 'mature minor' to exercise personal autonomy in making medical treatment decisions free of parental or judicial control. ...[A] young person with capacity is entitled to make the treatment decision, not just to have 'input' into a judge’s consideration of what the judge believes to be the young person's best interests.""A.C. v. Manitoba (Director of Child and Family Services)", Supreme Court of Canada, June 26, 2009, Docket 31955, [http://www.lewisday.ca/ldlf_files/pdf/AC.pdf Retrieved 2011-05-16] {{Webarchive|url=https://web.archive.org/web/20120118054719/http://www.lewisday.ca/ldlf_files/pdf/AC.pdf |date=18 January 2012 }}

Analysts note that the Canadian decision merely requires that younger patients be permitted a hearing, and still allows a judge to "decide whether or not to order a medical procedure on an unwilling minor".{{cite news |title=Charter Offers No Protection from Forced Blood Transfusion for Young Jehovah's Witness |first=Jim |last=Young |work=Center for Constitutional Studies |date=July 2, 2009 |publisher=ALM |via=law.com |url=http://www.law.ualberta.ca/centres/ccs/news/?id=313 |url-status=dead |archiveurl=https://web.archive.org/web/20091010150134/http://www.law.ualberta.ca/centres/ccs/news/?id=313 |access-date=2011-05-16 |archive-date=10 October 2009 }}

• Emancipation of minors
• Marion's Case (Australia)
• Gillick competence (UK)
• Age of consent
• Age of majority

{{reflist}}

{{DEFAULTSORT:Mature minor doctrine}}

Category:Family law

Category:American legal terminology

Category:Rights

Category:Age and society

Category:Health law in the United States

Category:Health policy

Category:Health law in Canada

Category:Juvenile law

Category:Medical ethics

Category:Canadian legal terminology

Category:Minimum ages

Category:Family law legal terminology

Category:Canadian juvenile law

Category:Family law in Canada