Today’s Burning Question: I know 16 is the age of medical consent in Rhode Island. Does that mean that technically we cannot discuss the medical condition of a 17 year old with his parents without his consent?
Answer: I received this question last week and while it is not an issue everywhere, it can be an issue in any state where the age of consent for medical treatment is lower than the age of majority.
Ordinarily, a minor is considered to be legally “incompetent” and thus unable to consent to medical treatment as a matter of law. As a result, consent from a parent (either parent) or a legal guardian is required for medical treatment. RI has a statute that allows children as young as 16 to consent to medical treatment. The statute reads as follows:
§ 23-4.6-1 Consent to medical and surgical care. – Any person of the age of sixteen (16) or over or married may consent to routine emergency medical or surgical care. A minor parent may consent to treatment of his or her child.
An interesting point is that the statute does not terminate the right of a parent of a 16-17 year old to consent, it just extends that right to the child. Thus a 16-17 year old in need of medical attention may consent, but so may either parent or a guardian. At 18 the child becomes an adult by law. Here is the age of majority law in RI
§ 15-12-1 Persons of full age. – (a) Notwithstanding any general or public law or provision of the common law to the contrary, all persons who have attained the age of eighteen (18) years shall be deemed to be persons of full legal age.
(b) These persons shall have all the duties and obligations, rights, and privileges imposed or granted by law upon those persons who have previously attained the age of twenty-one (21) years.
Thus, at age 18, the parents technically are no longer able to consent for their child.
So how does all of this relate to the question?
While the 17 year old patient has the legal right to consent, that right is not an exclusive right… and does not become an exclusive right until he reaches age 18. While there are no cases on point, the same reasoning would permit the parents of the 17 year old to have a legal right to discuss their child’s medical condition with a medical provider. As parents of a minor they have a non-exclusive right to that medical information until the child reaches age 18.
Any other thoughts out there on this topic? Found a lot of interesting cases researching this issue, just none on point!!!
Oh – one more thing – if a child is emancipated then the parental right to consent and discuss the medical condition with a provider would end the same as if the child turned 18.
John Murphy sent along a link to an article with some additional thoughts on this complicated area.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1025802/pdf/westjmed00144-0120.pdf
We often have to separate adolescents from their parents to obtain sensitive information but does that transcend into consent or refusal of care?
A teenage girl may, according to her mother, be fine after an auto accident but the teen has the look of fear in her eyes because she’s pregnant or possibly pregnant. So the mother says no to transport but the child suggests otherwise.
A parent has a right to the child’s medical information but when does it become a hinderence to patient care? I’m not going to remain on scene debating with the family whether or not their teenage daughter is pregnant and she has 10/10 belly pain with distressed vital signs.
The problems of consent can go both ways. Not only “forcing” a teenager to be treated because the parents believe its in their best interest but trying to convince a parent that the 16 year old needs care based on confidential information
Jason
Good points. Usually one side or the other (parent or child) will agree to go along with our requests, whether it is (a) the parents to give the child some space to talk or (b) the child to share the info with their parents.
Your example of the teenage daughter who is pregnant is a good one. When it comes right down to the “rights” of the parties… it gets pretty complicated. If the 15 year old pregnant daughter says don’t tell my parents, and the parents base their decision to decline aid on an assumption it is a tummy ache… well, you catch my drift. The decision maker has a right to know… has a need to know. It is really a matter of informed consent (informed refusal).
The same scenario in a state like RI, if she is 16 – it may not be enough for the daughter to know because if the parents don’t know and agree with the child’s decision to decline aid… it may be no different than the 15 year old.
Am I the only who is getting a heachache?
Chief,
Could you touch on if the 16 year is a parent then are they emancipated? I have had a few arguments with the “grandparent” about treating both their child and their grandchild?
Chief – if the child is truly “emancipated”, then he/she is to be considered an adult in all respects relative to medical consent as well as entering into legally binding contracts. It is as if the child is of legal age (which in RI is 18).
If the child has a baby, she does not automatically become emancipated. The child has a right to consent to medical treatment for her baby… Let’s use a 15 year old girl as an example. By virtue of having a baby, she is not emancipated (under RI law… other states are different in this regard). But she can lawfully consent to treatment for the baby (see the above statute). Oddly enough as a 15 year old she cannot lawfully consent to her own treatment… but can consent to treatment for her baby. The 16 year old you reference can at least consent to her own treatment.
I have heard alot of speculation as to the right of her parents (the baby’s grandparents) to make medical decisions for the baby – but found no RI cases on point. Throw in the rights of the father and the father’s parents and we have the potential for quite a mess.
From a practical perspective – it is good to remember that consent means permission. If three people are legally authorized to give consent, and 2 refuse but one gives it, you have consent. Fortunately it does not usually get this complicated… but if it does, as long as one of the people gives consent, you have consent.
My headache is back….
Here in Alabama our protocols and state laws spell out the situation as follows:
8. When a minor may give consent generally: Public Health Laws of Alabama,
2006 edition, 22-8-4 states, “Any minor who is 14 years of age or older, or has
graduated from high school, or is married, or having been married is divorced
or is pregnant may give effective consent to any legally authorized medical,
dental, or health or mental health services for himself or herself, and the
consent of no other person shall be necessary.” (Acts 1971, No 2281, p. 3681,
1). An EMSP may treat and/or transport, under the doctrine of implied consent,
a minor who requires immediate care to save his/her life or prevent serious
injury. The age of adulthood in Alabama is 19 years old. If an unemancipated
minor is old enough to consent but refuses (or their parent or legal guardian
refuses) care that you think is needed, contact OLMD.
9. In other situations involving minors where no parental contact can be
obtained, OLMD contact is mandatory. To err on the side of treatment is the
safe approach. Careful documentation is important.
So in Alabama, if the patient is 15yo, pregnant, and wants treatment, the parents can’t refuse for her. If they are under 19 and are refusing lifesaving care, we pass the buck to the on-line medical director and document the heck out of it.
If the patient is over 14, graduated from high school, divorced, remarried AND pregnant…we’ve got some serious issues going on!
Thanks Chris
Again showing how every state is different. How do you handle the grandparent consent issue for the baby? If a 15 year old Mom says do not transport, but the grandparents say transport – who wins?
On the surface, no one wins. However, this is what I would do.
If the baby doesn’t appear to have an immediate life-threatening issue, we’d have to side with the mother and tell the grandparents we cannot legally force the transport of the patient. We would be as diplomatic as possible to avoid escalation and the possible involvement of law enforcement. If need be, we’d contact medical control and have the doc talk to the family. We’d then document thoroughly.
If it is life-threatening, we would try to get the mother to consent (this is where medical control would talk with the mother if possible). If medical control says transport and mom still says no, we may end up calling law enforcement for the soon-to-be hysterical mother. (Possibly LE could be involved for child abuse/neglect in progress.) Whatever happens, we would document the heck out of it for the impending lawsuit!
Paraphrased, our state protocols say: 1) If possible, provide BLS care. 2) Contact the doc and get him to talk to the family/patient. After contact, follow the doc’s orders. 3) Document everything, including patient competence.
If the patient were an adult, things would be easier. They refuse and we go on our way or wait until he goes unconscious and treat as implied consent. When the patient is a minor and the family can’t reach an agreement, we get stuck in the middle.
Luckily, I work for a non-transport agency so we can pass the buck to the ambulance crew!
Hi, Curt. The issue of consent to treat & transport is a all over the map (as are Good Samaritan and other such liability shield laws). What do some of your readers think about enlisting law enforcement to assist parties in making the right ‘consent’ decisions, especially if there is potential for child endangerment? Years ago when I was an EMT-A in CT, we responded to a late-night accidental GSW (LRQ/abdomen) to a 17 y/o. Parents were out. We were able to transport, parents contacted by Hosp. and they refused to grant consent for IV therapy, etc. on religious grounds – Hosp. had an emergency court order to treat within the hour. Not a practical solution for the field. It worked out in this scenario only because we got the pt to a hospital where they could pursue the legal right to provide advanced care in the place of the natural parents.