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A Child's Right to Consent to Medical Treatment

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A Child's Right to Consent to Medical Treatment A Child’s Right to Consent to Medical Treatment By Erin E. Kilmer I. Introduction explaining how the general rights in the Convention can be Under New York state law,1 a minor child2 is not gener- guaranteed by Member States. General Comment Number 4 ally able3 to consent to “medical, dental, health or hospital articulates that children must be informed about their health services.”4 In not allowing children under the age of 18 to and given the opportunity to provide an opinion about the 16 consent to medical treatment, New York state law is not in options. line with the United Nations (UN) recommendations in the Convention on the Rights of the Child. The Convention on the A. The United States Rights of the Child outlines that children are holders of rights Although the United States has not ratified the Conven- and that they must be respected “in a manner consistent with tion, the United States signed the Convention and, conse- the evolving capacities of the child.”5 While this does not quently, it may not work against it.17 It is not uncommon for mean that all children should have an independent right to the United States to be one of few countries to not ratify an in- direct their health care, it does mean that the “evolving capaci- ternational convention. The United States has a long history of ties” of children should be taken into account when consider- not ratifying international conventions, including the Conven- ing whether a child has the ability to consent to health care. tion on the Elimination of All Forms of Discrimination Against Women18 and the International Covenant on Economic, Social However, New York state is not bound to comply with and Cultural Rights.19 The discussion in the United States sur- the Convention on the Rights of the Child as the United rounding ratification of the Convention on the Rights of the States is the only country that has not ratified or accessioned Child often concerns the worry in the United States that the the Convention.6 That being said, there is no reason for New Convention threatens the rights of parents.20 While it does not York to not work to comply with the Convention. Since 2016, seem that the United States will ratify the Convention in the New York has presented itself as a progressive state, working near future,21 because the document is so well observed and against what it sees as federal failures. If New York wishes to accepted, it is worth looking to as a starting point for reform- be progressive, one step it needs to take is modifying its laws ing children’s rights. to be in line with the Convention on the Rights of the Child. This article looks at one specific aspect of New York law, B. A Child’s Capacity the ability of children to consent to medical treatment, and suggests how New York law may be modified through the Although the Convention on the Rights of the Child does mature minor doctrine to comply with the Convention on the not specifically address a child’s ability to consent to medi- Rights of the Child. cal treatment, it does contain a number of provisions that are relevant in considering how much control a child should II. The UN Convention on the Rights of the Child have over their22 own medical treatment.23 Because all of the articles in the Convention are interdependent and indivis- The UN Convention on the Rights of the Child entered ible, the best interests standard outlined in Article 3 (“[i]n all into force on September 2, 1990,7 and today it is lauded as actions concerning children, . the best interests of the child the “most widely and rapidly ratified human rights treaty in shall be a primary consideration”) applies to all other consid- history.”8 It recognizes children’s human rights and establish- erations under the Convention.24 This not only applies to all es international law that requires all States Parties9 to ensure other articles in the Convention, but can also be viewed inde- that all children have the ability to achieve their rights in an pendently as a standard that requires all medical treatment accessible and active manner.10 Its articles are interdependent to be in the child’s best interest as far as health is considered. and indivisible, and they outline the responsibilities that the However, in all cases, the idea of a child’s best interest goes States Parties have to protect children because “by reason of further than health considerations. It may also be in the child’s [their] physical and mental immaturity, [they] need[] special best interest to be heard, to feel respected, and to “have a say” safeguards and care, including appropriate legal protection, in their own medical choices. before as well as after birth.”11 One of the few articles in the Convention to explicitly The Convention includes 54 articles that specify certain address children’s health is Article 24. Article 24 states that rights that States Parties must guarantee to all children.12 children have a right “to the enjoyment of the highest attain- Although none of these articles specifically articulates that able standard of health,” and that States Parties must take children must be given the right to control their own health actions to make this happen, particularly to guarantee “that decisions, the Convention does clearly articulate that children have the right to access to health care,13 and that children have “evolving capacities”14 which must be given due weight ERIN E. KILMER, ESQ. is a Senior Certification Analyst at Empire State De- based on the maturity of the child.15 As supplements to the velopment and a 2018 graduate of Albany Law School of Union University Convention, the Committee on the Rights of the Child has (Juris Doctor) and Alden March Bioethics Institute at Albany Medical College also issued a number of General Comments, more specifically (Master of Science). NYSBA Health Law Journal | Winter 2020 | Vol. 25 | No. 1 45 no child is deprived of his or her right of access to . health In addition to expanding on some of the less specific care services.”25 This includes specifically “that all segments articles, the Committee also touched on the idea of children’s of society . are informed, have access to education and are consent to medical treatment. The Committee wrote that supported in the use of basic knowledge of child health and “[b]efore parents give their consent, adolescents need to have nutrition.”26 a chance to express their views freely and their views should be given due weight.”35 This means that any child, with any In addition to the best interest standard outlined in Article level of maturity, should be given the opportunity to express 3, there are a number of articles that are relevant in determin- their view and that view should be considered with an ap- ing how far children should be allowed to direct their own propriate amount of weight based on the child’s maturity medical treatment decisions. Articles 5 and 12 of the Conven- and age. However, the paragraph continues on that “if the tion both specifically recognize that children have “evolving 27 adolescent is of sufficient maturity, informed consent shall be capacities” and that these capacities need to be respected. obtained from the adolescent her/himself, while informing Article 5 further acknowledges that parents have their own the parents if that is in the ‘best interest of the child.’”36 There- rights in regards to how their children are brought up. It fore, it is the Convention’s view that before the age of 18, it is states: “States Parties shall respect the responsibilities, rights highly possible that a given child will be able to consent for and duties of parents . to provide, in a manner consistent themself, and that therefore, the child’s maturity level should with the evolving capacity of the child, appropriate direction 28 be considered when determining whether they may make the and guidance.” Article 5 shows a strong respect for parental determination themself. rights, but it tempers this with respect for the child to be able to also direct their upbringing. III. A Discussion on Capacity Following this, Article 12 requires that “States Parties Unfortunately, in many clinical and legal discussions shall assure to the child who is capable of forming his or about consenting to or refusing treatment, the words “capac- her own views the right to express those views freely in all ity” and “competence” are often conflated.37 However, it is matters affecting the child” and that those views are to be important for this article to make a distinction. Capacity refers given “due weight in accordance with the age and maturity to a clinical judgment about an individual’s ability to under- of the child.”29 The idea discussed in Article 5 about evolving stand their situation and make educated treatment decisions.38 capacities is again mentioned in Article 12. Because children’s On the other hand, competence refers to a legal determination capacities are ever evolving, and because children mature at about whether an individual legally has the ability to make different rates, it is important that both age and maturity be treatment decisions.39 I am arguing that children today are taken into account when considering how much weight to determined to not be competent to make medical decisions accord any individual child’s ideas. because the laws do not allow them to consent, but that there In addition to respecting the rights of children to express are children who do in fact have the capacity to understand their own ideas, Articles 16 and 17 are also applicable to chil- their situations and make educated treatment decisions.
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