As parents we’re used to knowing every detail of our kids’ lives. We have video baby monitors in their rooms, their clothing can track their breathing and temperature and daycares and sitters leave us detailed written records of their days when we’re not there. Sometimes it’s hard for us to tell when our kids deserve the right to privacy and when they’re able to make certain decisions on their own.
The issue of a child’s right to autonomy – the right to make decisions about one’s own healthcare – is a common, but messy, topic in health care. We see this most often in issues of reproductive health, for example, when a minor seeks a prescription for birth control or access to an abortion without the parents’ knowledge.
The issue of a child’s medical autonomy raises many ethical questions, all of which tend to make parents uncomfortable. Recently, this notion came up again in response to a post on Reddit, in which a mother, who is opposed to vaccines and did not vaccinate any of her children, relates how she discovered her eldest daughter got herself vaccinated in secret, much to the mother’s chagrin. The mother asks if she can take any legal action against the doctor who vaccinated her daughter without her knowledge.
A screen capture of the original question posed on Reddit, which has since been removed by the author.
The July 8, 2015 post to the legal advice subreddit was eventually removed, but not before garnering a robust response. Quite a few commenters pointed out that given the girl’s age (16 years), she is fully entitled to make her own health care decisions without her parents’ consent. For those who support vaccines, it’s a great story: a teenage act of rebellion where the teen is the smart one, taking her health into her own hands.
Before we go on, I want to address that there is some question as to whether this story is actually true or not. Some details cast doubt on it, such as the idea of the girl paying for any of the vaccines with her babysitting money as Canada has universal healthcare, which covers all routine vaccinations. While some private clinics would charge for a vaccine, they are uncommon, and many of the nurses and doctors staffing a walk-in clinic are still covered by the Ontario Health Insurance Plan. None of this means it did not happen, but there are reasons to doubt and no means of verifying the elements of the story.
Whether the story is true or not, it brings up an important question: do the parents have a right to their daughter’s medical records? Do they have a right to legal action against the clinics for vaccinating their daughter without their consent? Do the parents’ rights supersede their daughter’s right to privacy and autonomy over her own healthcare?
Capacity to consent is, in many locations, not so much a matter of ability as it is of arbitrary age cut-offs set by law. For instance, in the United States, as far as the law is concerned, you are incapable of safely operating a car unsupervised until you are 16. Only when you reach 18 are you considered an adult, capable of making your own decisions and even altering how our country functions (via voting). But you cannot make decisions, legally, about drinking alcoholic beverages until you are 21 years old, despite the fact that, in all other regards, you are legally an adult.
As far as the legal question in the Reddit story goes, per Ontario law, anyone who is at least 16 years old has guaranteed medical autonomy, barring any conditions or disorders that impair their decision-making capacity. That means that as soon as a child turns 16, they can make their own medical decisions and their medical records are a private matter between the child and their doctor. The mother in the story has no legal right to view her daughter’s records nor to take action against the clinics or the provincial Department of Public Health for complying with her daughter’s wishes.
But what if she were 15 years old? Would her parents have a right then? Not necessarily.
While Ontario law guarantees autonomy once a person reaches 16 years of age, the province is one of several that recognizes that the ability to make medical decisions for oneself is not a simple matter of age. They employ a “mature minor” standard in that there is no statutory minimum age required for a child to consent to medical treatment on their own. If, in the physician’s judgment, the child understands the nature and consequences of their decision, then they are capable of making the choice for themselves, without any other input from the parents. Before her parents would be able to obtain the medical records relating to her autonomous decision or to take action against the clinics, her parents would need to challenge her capacity as a mature minor in court. In short, they would need to demonstrate that she did not understand the nature or consequences of her decision and that she is therefore unfit to make her own medical decisions.
But what about the ethical angle? Regardless of what the law says, should a parent have unfettered control over their child’s healthcare decisions? Should a child be considered completely autonomous and allowed to make decisions without the consent of their parents? From an ethical perspective, the answer to both questions would tend toward “no”, though more realistically, the answer is, “it depends”.
Some research notes that adolescents are capable of making informed medical decisions, and able to understand the consequences of their decisions, by the time they are 14 years old. Other research argues that people are not fully cognitively developed until they are 21 years old and can’t truly understand consequences.
Obviously, there is variation from individual to individual, and from situation to situation. A child may be capable of an informed medical choice at a young age, where they are free of peer (or parental) influence and the consequences are limited in severity. The same child may be incapable of making a medical decision for themselves when they are under the strong influence of friends or their parents, or where the outcomes are of such a great magnitude that the child is incapable of fully understanding. Whether a child is mature enough to make their own medical decisions, whether to accept or refuse treatment, depends on the child and the situation.
If the child can demonstrate that they understand, that they truly comprehend their situation and the options available, then from an ethical standpoint, they ought to be able to give or refuse consent, without the intervention of their parents. They are individuals in their own right, and as such are deserving of respect as an individual. They are not objects owned by their parents. They are not chattel for the parents to do with as they please. They are individual human beings.
In an ideal world, parents and their children would make medical decisions together, and when the child is mature enough, whether as early as 14 or not until they are legally adults at 18, decision making moves into their hands. It may be difficult for parents to accept that their children are growing up, that their kids do not need them anymore. And it can be even harder for some parents to view their children as individuals capable of making their own decisions rather than property, to put aside their own desires and beliefs in deference to what is objectively best for their child.
But no matter what age a child begins deciding for themselves, the parent does not have an absolute right over their child. When it comes to medical decisions, the parent has an obligation to do what is in the best interests of their child, even if that decision is at odds with the parent’s wishes, as is the case with vaccines and parents opposed to vaccination. Likewise, within the parent-child-doctor relationship, the doctor’s duty is to the child, not to the parents.
Unfortunately, there is no hard and fast rule, no clear cutoff point at which we can say, “This person is now capable of making informed medical decisions on their own.” It is a complex issue that is very situation-dependent. But at the very least, we can respect that parents do not own their children, no matter what misguided Kentucky politicians might say. Parents are not free to do with their children as they please, because children are not property. They are not owned. Children have rights, too. That includes the right to protect themselves when their parents fail to do so. – Edited by Leslie Waghorn
– A version of this post originally appeared on Harpocrates Speaks