Developmental trends in adolescents' psychological and legal competence to consent to abortion

United States Supreme Court has affirmed the right of states to require parental consent or notice from minors seeking abortion. We examine an underlying presumption that minors are not competent to consent to abortion. Participants (N=75 age 13–21, seeking a pregnancy test at a women's medical clinic) completed an interview that was audiotaped and scored on four cognitive and volitional criteria of legal competence. Competence was compared in three age groups (≤15; 16–17; 18–21) for participants who considered abortion and for those who did not. Adolescents age 16–17 and adolescents ≤15, who considered abortion, appeared as competent as legal adults; only≤15-year-old adolescents who did not consider abortion appeared less competent. Regression analysis was used to identify psychosocial predictors of competence. Results challenge the presumption that minors are not competent. An alternate policy based upon informed consent and empowerment of minors as decision makers is proposed.     

Adolescents' capacities to provide voluntary informed consent

Minors' capacities to provide a valid informed consent for the treatment of medical and psychological disorders are contingent in part on the determination of whether they can make voluntary treatment decisions. The gravity of a medical dilemma and the nature of parental influence are two factors hypothesized to effect and perhaps compromise the voluntariness of treatment decisions made by adolescents. In the present study 40 14- and 15-year-old subjects were asked to note their conviction for treatment decisions they had made in response to hypothetical medical dilemmas in which parental influence varied. It was found that adolescents making treatment decisions are generally deferent to parental influence, although they are more likely to resist parental influence when the consequences of the decision have serious implications for the hypothetical adolescent's health.This investigation was supported in part by a grant from the American Psychology-Law Society/ Division 41 of the American Psychological Association, whose assistance is gratefully acknowledged. Gratitude is also extended to the Albemarle County School District, the Blue Ridge School. and St. Anne's-Belfield for their kind cooperation. The authors wish to thank William Gardner, Jeanne Smith, and Edith Lawrence for their work on behalf of this project. Special recognition is due to Lois A. Weithorn for her guidance and support of this research endeavor.     

A qualitative examination of ethical and legal considerations regarding dating violence

Despite the increased attention to dating violence among adolescents and young adults, limited information is available on ethical and legal considerations specific to this population. Therefore, this qualitative study explores 21 trainees' and practitioners' conceptualization of ethical and legal issues pertaining to adolescent dating violence. Data are collected through focus groups included as part of an ethics and legal issues seminar. Six themes are identified to illustrate ethical and legal issues concerning dating violence: knowledge, client welfare, counseling interventions, informed consent and disclosure, barriers, and counselor reactions.     

Evaluating adolescent decision making in legal contexts

Challenges the use by policy researchers of a model for comparing adolescent and adult decision making that is based on informed consent standards. An expanded decision-making framework designed to evaluate judgment in adults and adolescents can better test the empirical basis of paternalistic legal policies. The theoretical and empirical literature on the informed consent framework is critiqued and an alternative framework incorporating judgment factors is proposed. Three judgment factors—temporal perspective, attitude toward risk, and peer and parental influence—and their effects on decision making are explored. Finally, implications for future research are analyzed in several decision-making contexts.Several of the ideas in this article were originally presented by the first author and were published as part of a symposium on competence (see Scott, 1992). The current article expands and refines these ideas, provides a more substantial research base, and suggests several future research directions. We thank Joseph Allen, Richard Bonnie, Baruch Fischhoff, William Gardner, John Monahan, Edward Mulvey, Richard Redding, Paul Slovic, and three anonymous reviewers for their helpful comments. Special thanks to Thomas Grisso for providing much constructive criticism and to Wendy Shang for outstanding research assistance. Finally, we would like to acknowledge the MacArthur Foundation, which supported this work in its early stages.     

Grade related changes in young people's reasoning about plea decisions

The present study examined the development of young people's ability to reason about legal issues involved in a plea decision in a criminal matter. Forty-eight subjects in each of grades 5,7, and 9, and 48 young adults participated in a semistructured interview containing four vignettes, each depicting a young person who had committed a criminal offense was charged, and retained a lawyer. Subjects received information regarding the charge and the prosecution's evidence (weak in half of the vignettes and strong in the other half). Subjects were asked to decide what they would plead if they were in the defendant's shoes, and to justify their choices. Contrary to prediction, a majority of even the Grade 5 subjects based their plea decisions on legal rather than moral criteria. Nonetheless, there were significant grade-related changes both in legal reasoning scores and in the use of guilt-based plea justifications. In addition, according to a panel of lawyers, subjects' plea choices were rated as more reasonable when the evidence against the story character was strong (and thus congruent with “moral” guilt) than when it was weak. This difference, diminished with grade as subjects became better able to separate moral from legal issues in their decision making.     

The doctrine of informed consent: a tale of two cultures and two legal traditions

In this article, the author compares and contrasts the notion of informed consent in medical decision making in the Western legal system with the traditional Jewish biblical legal system. Walter critically examines the philosophical underpinnings of disease and medical healing in both legal systems, and describes the practical consequences that emanate from the different ideologies in terms of the individual's rights of choice of treatment. She explains that the Western system is predicated on notions of individual autonomy and self determination. Patients therefore have the autonomous ability to select and direct their own medical therapy. By contrast, the traditional biblical system of law is based on the concept that the body does not belong to the individual. Instead, the body is given to man by God as a trust to respect and preserve. Therefore, the individual patients "has no absolute right to control his body and ... he has no real decision making power as to medical treatment choices." In the Jewish biblical tradition, consent is not necessary for obviously beneficial or obviously non-beneficial procedures; consent is only necessary in decisions with uncertain outcomes or when making choices between equal options. Patients are encouraged to seek the counsel of religious authorities and to conform to rabbinical interpretations of the traditional Jewish law.     

The medically examined applicant for private insurance and his/her right to informed consent: a comparative analysis

Within the context of health and insurance law, an important question that arises is "to what extent is an applicant for private insurance truly capable of giving his/her 'free' and informed consent for a medical examination?". It should be borne in mind that it is the private insurer who requires a medical examination in order to gather medical information, and, moreover, that the insurer will not be inclined to conclude or carry out an insurance contract without this medical information. A distinction has to be made between not being free by legal coercion and not being (completely) free by factual circumstances. Exercising the right to informed consent involves exactly weighing up the consequences of the decision. Hence the applicant must be put in a position of being able to weigh up the consequences and take them into consideration.     

Parental Effects on the Exchange of Sex for Drugs or Money in Adolescents

Research has examined risk factors related to involvement in prostitution and sex trafficking using samples of adult prostitutes, runaway and homeless youth, and youth involved in the juvenile system. There is scant research that includes adolescents who cannot be categorized into these groups. Additionally, research is limited related to how parents affect the decision for adolescents to engage in sex for drugs or money. We examine risk factors concerning the exchange of sex for drugs or money from a nationally representative sample of adolescents. The data are structured where responses can be compared to a group of adolescents who indicated never exchanging sex for drugs or money. We used a negative binomial regression analysis to examine how the effects of parental and individual factors influence the exchange of sex for drugs or money among adolescents. Analyses revealed that individual factors were significant while parental factors were not significant; however, parental effects were significant when dimensions of parental involvement were examined.     

Competence to give informed consent for medical procedures

This study shows that referrals to psychiatry for evaluation for competence to give informed consent generally were made on patients who refused medical treatment. In this sample of referred patients, the only patients found to be incompetent to give informed consent were those with organic brain syndromes. No one with either schizophrenia or depression was found to be incompetent. It is possible that schizophrenic and depressed patients may generally be competent to give informed consent to medical treatment. This finding might be true notwithstanding the fact that many such patients have been found in other studies to be incompetent to consent to voluntary psychiatric treatment. For example, a patient may have delusions that others can read his mind and thoughts, but he still can understand that he needs dialysis for renal failure. Alternatively, it may be relatively rare that an emergency procedure is necessary before a patient's psychosis can be brought under control and consequently internists and surgeons themselves may prefer to wait. The significance of the results is unclear. Because of active interest in the doctrine of informed consent for psychiatric and medical patients by both physicians and attorneys and the few studies within this population, there is a strong need for more study regarding competence to give informed consent. Further study is especially important for psychotic patients for whom psychiatric consultation is not requested.(ABSTRACT TRUNCATED AT 250 WORDS)     

由谁来行使知情同意的权利:患者还是家属?

知情同意权是患者的一项基本权利,但是在我国目前的医疗实务中,该项权利却普遍地由患者的家属予以行使。本文围绕应当由谁来行使“有同意能力的患者”的知情同意权这一问题,由现行法的态度出发,从正反两个角度论证了应当由患者本人行使其知情同意权的观点。     

论知情同意的豁免

本文围绕医疗实务中的知情同意豁免，首先讨论了知情同意豁免规则的法律政策，详细分析了紧急情形豁免、治疗豁免、知情同意权的放弃和强制治疗这四种豁免情形，简述了医务人员在适用知情同意豁免规则时可能的法律责任。     

Abortion, breast cancer, and informed consent

The purpose of this article is to show that the current level of scientific evidence linking induced abortion with increased breast cancer risk is sufficient to support an ethical and legal duty to disclose fully the risk to women who are considering induced abortion. The article examines the relationship between this evidence and the elements of a medical malpractice claim alleging failure to obtain informed consent. The first part focuses on the elements of informed consent, which require the plaintiff to establish that the physician had a duty to disclose information, which he failed to disclose, that this failure to disclose was a legal cause of the plaintiff's decision to undergo the procedure, and the procedure was a legal cause of the plaintiff's injury. The second part compares two prevalent standards for determining which risks a physician has a duty to disclose. Part three reviews the scientific evidence of the abortion/breast cancer (ABC) link and explains why it survives both the Frye and the Daubert tests for admissibility of expert testimony. The fourth part assesses the materiality of the risk posed by the ABC link. Parts five and six discuss evidentiary issues and the possibility of punitive damage awards.     

Informed Consent: Physician Inexperience is a Material Risk for Patients

This paper examines the case for an expanded interpretation of the concept of "material risk" such that it necessitates voluntary disclosure of physician inexperience with a specific medical procedure. Informed consent law in the United States, Canada, and most commonwealth jurisdictions has become a driver of standards of risk disclosure by physicians during the informed consent process. The legal standard of risk disclosure expected of a physician hinges on the interpretation of the entity called "material risk." Any impairment of the physician related to drug usage, disease, or alcohol which compounds the risk of a procedure is very likely to be considered material by a patient. This paper argues that physician inexperience is a factor that a reasonable patient would attach significance to and that it should therefore be viewed as a "material risk" requiring disclosure.     

“It’s a Rush”: Psychosocial Content of Antisocial Decision Making

Changes in the juvenile justice system have led to more serious sanctioning of adolescents (Heilbrun, Goldstein, & Redding, 2005). A salient question for understanding whether such sanctions are appropriate pertains to whether adolescents are less mature than adults in making decisions that lead to antisocial activity. The current study codes for psychosocial content of antisocial decision making in adolescents (ages 12–17), young adults (18–23), and adults (ages 35–63). Results suggest that adolescents and young adults display increased psychosocial content in their antisocial decision making relative to adults. However, the unique effect of psychosocial content on self-report criminal behavior was significantly greater among adolescents than among adults, whereas for young adults this was not the case. Implications for legal policy are discussed.

What constitutes a psychiatric emergency: clinical and legal dimensions

In true medical emergencies, informed consent is presumed or implied without application of the usual standard. In the litigation over the right to refuse treatment in psychiatry, a limited right for involuntarily committed patients to refuse treatment has been upheld, absent a finding of a psychiatric emergency. Increasingly, clinicians may find that their sole extrajudicial option in instituting treatment over the patient's objection is in invoking a psychiatric emergency. The purpose of this communication is to discuss the clinical and legal issues in defining and invoking a psychiatric emergency in treatment refusal. The substantive and procedural issues in the use of the emergency exception in treatment refusal are discussed with recommendations for their use in clinical practice.     

Gillick v West Norfolk and Wisbech Area Health Authority

England's Court of Appeal, Civil Division, ruled that parents had the right to prevent a physician at the local health authority from prescribing contraceptives to girls under the age of 16 without parental consent. Since a girl was legally incapable of giving valid consent in other matters before that age, neither could she give valid consent to contraception or abortion. A doctor who provided contraception or abortion treatment to a girl under 16, except in an emergency or with permission of the court, would infringe on the legal rights of the parents. An appeal was taken to the House of Lords.     

从《精神卫生法》看精神障碍患者的知情同意权

知情同意权是医患关系中的主要问题之一,新出台的《精神卫生法》在多个条文中明确规定了精神障碍患者的知情同意权,成为精神病患者知情同意权的基本法律依据。本文立足于知情同意权的一般法理,梳理《精神卫生法》中精神障碍患者知情同意权的法律规定,以此为基础探讨精神障碍患者知情同意权的基本内容。     

Lowering the age of consent: Legal,ethical, and clinical implications of adolescent-directed therapy

This article discusses a recently enacted Colorado law that aims to reduce the youth suicide rate by lowering the age of consent for psychotherapy from age 15 to age 12. The author discusses the challenges therapists face when young adolescents seek therapy without parental consent in cases involving interparental conflict. Suggestions for managing adolescent-directed therapy are offered.     

Informed consent in Canada: an empirical study

The case of Reibl v. Hughes has significantly altered the law regarding informed consent in Canada. It might be expected, therefore, that its impact on the Canadian medical profession would be significant. However, in the first study to examine the practice of Canadian doctors in this respect, Professor Robertson concludes that the profession is largely unaware of either the decision or its importance. Further, the study examines doctors' current perceptions and opinions on the disclosure of risks to patients and the results, among others, raise serious questions regarding both the awareness and reception of important legal rulings.     

Minors' rights to consent to treatment: navigating the complexity of State laws

State laws recognize that a competent adult patient has the right to consent to or refuse medical treatment. While the law is clear with regard to the right of competent adults, state statutes are more complicated when the patient is a minor. While the law should, and does, attempt to balance the rights and obligations of parents and guardians against the access and privacy rights of minors, complicated state statutory schemes often fail to simultaneously address those contrasting goals in a consistent and uniform manner. The result is a confusing set of seemingly arbitrary and sometimes conflicting provisions that require the detailed attention of healthcare providers to ensure legal compliance. With the aim of helping healthcare practitioners meet their legal obligations, this Article examines state laws governing minor's consent rights byfocusing on the instances in which a minor's parent, guardian, or other authorized adult is permitted to consent to treatment on behalf of a minor and the instances in which a minor is authorized to act independent of adult intervention.