Do you have a policy in place if you encounter a minor who requests medical treatment? Usually minors are accompanied by a parent or legal guardian, but in the rare instance that an unaccompanied child under the age of eighteen seeks treatment, are you prepared to address the issue of whether the minor can consent for himself or herself?
Generally, minors must have the consent of a parent or guardian before receiving medical care. However, there are several exceptions to this general rule. Emancipated minors and “mature minors” can give consent, and there are also certain statutory exceptions.
A “mature minor” is someone over the age of fifteen who can show a health care provider that he or she has enough maturity and understanding to make medical care and treatment decisions without parental consent. On a case-by-case basis, a provider must use the same criteria that would be used to determine if an adult is capable of making medical decisions. If the minor is found capable of consenting, a provider must give the minor the same informed consent an adult would receive.
There is little case law in Ohio and other states regarding the mature minor doctrine. Recently, however, the Connecticut Supreme Court deliberated whether a sixteen year-old girl named Cassandra, diagnosed with Hodgkin’s lymphoma, was considered a mature minor and thus competent to make her own medical decisions. Both Cassandra and her mother refused to obtain appropriate medical treatment for the cancer, prompting the Department of Children and Families to seek temporary custody.. She eventually returned to home, but ran away before her treatment started. At a subsequent hearing to remove Cassandra from her home and authorize the department to make medical decisions, Cassandra argued that she was a mature minor capable of consenting to treatment for herself. The Supreme Court found that there was ample evidence that Cassandra was not yet fully separated from or independent of her mother - that she was prone to engage in compulsive and risky actions, was unable or unwilling to speak her true mind to those in authority, and was reluctant to hold opinions that her mother did not share. Thus, Cassandra was not considered a mature minor, and the Supreme Court declined to adopt the doctrine.
A minor who is emancipated may also consent to medical treatment. According to case law in Ohio, a minor who is no longer under the protection and control of parents or guardian is considered emancipated. An emancipated minor includes someone under the age of eighteen who is married, is in the armed forces, is self-supporting and is living away from the parent’s home. Under ORC §5120.172, a minor who is imprisoned as a result of being prosecuted as an adult is also deemed emancipated. An emancipated minor usually is considered capable of making medical treatment decisions.
By statute, a minor may consent to the following services without parental consent:
- Physical examination of a minor who is a victim of a sexual offense at a hospital with organized emergency services, with written notification to the parent or guardian that such examination has taken place (ORC §2907.29);
- HIV testing (ORC §3701.242);
- Diagnosis/treatment of any venereal disease by a licensed physician (OR §3709.241);
- Outpatient mental health services (excluding the use of medication) at the request of a minor fourteen years of age or older (ORC §5122.04) ;
- Diagnosis/treatment for substance abuse of any condition which is reasonable to believe is caused by a drug of abuse, beer, or intoxicating liquor (ORC §3719.012); and
- An abortion by a court order authorizing the minor to consent (ORC §2919.121, 2151.85).
A minor may also receive emergency medical treatment to preserve life and prevent serious impairment without the consent of a parent or guardian. For services a) – e) above, the minor’s parent or guardian is not liable for the cost of the services.
It is important to know the state of the law regarding when minors can consent to medical treatment. If you ever encounter a minor seeking treatment, make sure that you can distinguish whether the minor can consent.