Informed consent in children and adolescents: ethical-legal context and some problematic issues.

Abstract

Today, the Spanish Legal System recognizes the full ownership of the  rights of minors and their evolving capacities to exercise them according to their degree of maturity, recognizing that its acquisition is a developmental process. Currently the issue of informed consent is  perhaps one of the more complex and debated and also one that concern  more to clinicians. It is based on respect for self-determination and autonomy of those children or adolescents with sufficient discernment  capacity and taking into account the right to make decisions about facts  that can affect their health. The main difficulty with the doctrine of “mature minor” is the assessment of the maturity or capacity to make decisions,  due to the lack of guidelines or validated procedures. This paper reviews the main ethical and legal criteria and discusses some especially problematic situations such as: (1) Intervention with children whose parents are in a situation of marital separation or divorce, (2) parents who make an unlawful exercise of parental authority, (3) irreconcilable conflicts between the decision of the child and their parents or (4) when the minor’s decision is against their own interests.