ANESTHESIOLOGY Daily News
ANESTHESIOLOGY Daily News
Day
Friday
Saturday
Sunday
Monday
Tuesday
Topics
Ambulatory Anesthesia
Cardiac Anesthesia
Diagnostic POCUS
Enhanced Recovery After Surgery (ERAS)
Fundamentals of Anesthesiology
Geriatric Anesthesia
Neuroanesthesia
Obstetric Anesthesia
Opioid Crisis
Pain Medicine
Pediatric Anesthesia
Perioperative Medicine
Physician Well-Being & Burnout
Professional Issues
Regional Anesthesia & Acute Pain
Safety & Quality
Workforce Shortages
Resources
Meeting Info
Sessions
Claim CME
Archive
Resources
  • Meeting Info
  • Sessions
  • Claim CME
  • Archive
Topics
  • Ambulatory Anesthesia
  • Cardiac Anesthesia
  • Diagnostic POCUS
  • Enhanced Recovery After Surgery (ERAS)
  • Fundamentals of Anesthesiology
  • Geriatric Anesthesia
  • Neuroanesthesia
  • Obstetric Anesthesia
  • Opioid Crisis
  • Pain Medicine
  • Pediatric Anesthesia
  • Perioperative Medicine
  • Physician Well-Being & Burnout
  • Professional Issues
  • Regional Anesthesia & Acute Pain
  • Safety & Quality
  • Workforce Shortages
By Day
  • Friday
  • Saturday
  • Sunday
  • Monday
  • Tuesday
Facebook iconTwitter X icon LinkedIn iconInstagram icon
Oct 11th, 2021

Informed consent when caring for minors

Understanding the nuances of consent is critical when dealing with minors.


Dominic Carollo, MD.
Dominic Carollo, MD.

A Sunday Clinical Forum explored the anesthetic considerations for the teenage patient and delved into pediatric informed consent as a medical ethical issue.

Typically, parents or legal guardian are assumed to be the ones who provide legal consent for minors. Most of the time, the parents’ consent aligns with those of the medical community and have the best interests of the pediatric patient at heart. However, in some instances, they do not align.

What happens then? Dominic Carollo, MD, Ochsner Medical Center, in New Orleans, said autonomy and competence matter in those cases.

For a minor to prove competence, he or she needs to prove they have achieved sufficient intelligence to understand fully what is proposed. The criteria for testing this capacity include that the patient understands in simple terms the nature, purpose, and necessity of the procedure as well as the risks and alternatives. The patient also believes that the information proposed applies to them and is making the choice without pressure or coercion. 

Although every U.S. state has variations on the point at which a minor can provide consent, Dr. Carollo said most follow the Rule of Sevens, in which if the individual is less than 7, they can’t, if they are 7-14, you can assume they do not, and if they are older than 14, you should assume yes.

In those instances, the rules for informed consent are that the patient understands the explanation of the condition, recommended treatment, the risks and benefits, and any alternatives. The medical staff should make an assessment of the person’s understanding of the provided information, the competence of the minor or surrogate to make medical decisions, and be confident that the patient or surrogate has the ability to choose freely without coercion.

Dr. Carollo said there are exceptions to informed consent such as a medical emergency or if there is reason to doubt the parents will always act solely in the best interests of the child. He said other exceptions, which were beyond the purview of the session, include sterilization, organ donation involving siblings, and abortion. These are usually state-specific.

He cited instances of refusal of treatment that might involve forced treatments. However, he warned of the long-term psychological harms of forcing treatment. In those instances, he usually postpones a procedure until he gains a full understanding of the reasons for the refusal and is able to remedy them. Legal intervention should only be used as a last resort, he said.

Dr. Carollo also reviewed which minors can provide consent. Although this varies by state, typically it is an emancipated minor, a pregnant minor, a married minor, and is dependent on the services sought.

He also defined the mature minor doctrine, which states that a minor is mature enough to make a decision if he or she is older than 14, is capable of giving informed consent, that the treatment will be a benefit and does not provide great risk, and is well within established protocols. 

Even when they do not yet have the legal right to give their own consent to treatment, Dr. Carollo said he likes to approach the child first and the parent second. For instance, he finds teens are so involved in their cell phones that it is hard to get their full attention. In those instances, he asks to get his picture taken with the teen on their phones as a way of engaging them. Although they may not have the legal right to provide informed consent to their own treatment, there are notable benefits to involving them in the decision-making process, he said. It demonstrates respect for the minor and provides them power, which usually helps with outcomes.

Visit Anesthesiology Today Annual Meeting Edition for more articles.

From The ASA Monitor
Empowering Minds: The Role of Mental Health-Wellness in Advocacy Awareness for Residents
Empowering Minds: The Role of Mental Health-Wellness in Advocacy Awareness for Residents
You Should Run for Office!
You Should Run for Office!
Introducing ASA’s New Center for Perioperative Medicine
Introducing ASA’s New Center for Perioperative Medicine
Congratulations to the 2024 Excellence in Research and Presidential Scholar Award Winners
Congratulations to the 2024 Excellence in Research and Presidential Scholar Award Winners
Advocacy in Action
Advocacy in Action
Episode 142: Inside the Monitor – Advocacy
Episode 142: Inside the Monitor – Advocacy
More Content
Shahla Siddiqui, MD, DABA, MSc, FCCM
Anesthesiology 2021
Pain points among genders
Oct 12th, 2021
Left to right: Amy S. Pearson, MD, Elizabeth Malinzak, MD, and Amanda Xi, MD, MSE.
Anesthesiology 2021
Millennial generation’s value to anesthesiology
Oct 12th, 2021
Left to right from top: Sonya Pease, MD, MBA, Srinivas Yendru, DO, and Conrad Myler, MD. Left to right at bottom: Kelly Ivins-O’Keefe, MD, Robert W. Brandt, MD, and Cinnamon Sullivan, MD.
Anesthesiology 2021
Attendee reflections from special ASA annual meeting
Oct 12th, 2021
Lauren C. Berkow, MD, FASA, and Felipe Urdaneta, MD.
Anesthesiology 2021
Keep direct laryngoscopy in your armamentarium and add a rescue cart
Oct 12th, 2021
Christopher W. Connor, MD, PhD
Anesthesiology 2021
Is artificial intelligence coming for your job?
Oct 12th, 2021
Steven L. Shafer, MD
Anesthesiology 2021
Rovenstine Lecture a tribute to a pioneer and mentor
Oct 12th, 2021
James C. Eisenach, MD
Anesthesiology 2021
Severinghaus Lecture honors namesake in ‘Gadgeteering for Pain Relief’
Oct 12th, 2021
Left to right: George Mashour, MD, PhD, and Alex Proekt, MD, PhD.
Anesthesiology 2021
The best minds in anesthesiology at Celebration of Research
Oct 11th, 2021
Lis Evered, PhD.
Anesthesiology 2021
COVID-19 and postoperative delirium
Oct 11th, 2021
Angela Selzer, MD, and Ashish K. Khanna, MD, FCCM, FCCP, FASA.
Anesthesiology 2021
Preventing intraoperative hypotension
Oct 11th, 2021
Michael F. Aziz, MD, and Tracey Straker, MD, MPH, MS, FASA.
Anesthesiology 2021
COVID-19 impact on airway management
Oct 11th, 2021
Lee A. Fleisher, MD
Anesthesiology 2021
Lee Fleisher shares his goals for aligning standards, quality
Oct 11th, 2021
ANESTHESIOLOGY Daily News
© 2024 American Society of Anesthesiologists (ASA)
1061 American Lane | Schaumburg, IL 60173