Transcript 2009-pbc-berg - Seattle Children's Hospital: World

Informed Consent
Adolescents
Jessica Berg, JD, MPH
Professor of Law and Bioethics
Case Western Reserve University
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
Informed consent
• Ethical Doctrine
– Autonomy
– Health/Welfare
• Legal Doctrine
– Statutory Guidelines
– Forms and Evidence
– Liability
• Practice
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
Capacity
• Capacity vs. Competence
• Presumptions
– Maturity
– Responsibility
– Developmental Stages
– Extent of medical experience/knowledge
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
Standards of Competence
• General
• Specific
– Choice
– Understanding
– Appreciation
– Reasoning
• Formulating the standard
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
Deciding for Others
• Who?
– Parents, Guardian, Surrogate, Proxy
• How?
– Effectuate Prior Decision
– Substitute Judgment
– Best Interests
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
Deciding for Children
• Legal Issues
• Conceptual Issues
• Empirical Issues
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
Empirical Issues
• Semantic Understanding
• Developmental Issues
– Cognitive (capacity)
– Psycho-social (voluntariness)
• Perception of Authority/locus of control
• Role of peers and peer pressure
• Family dynamics
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
Special Situations
• Emancipated Minor
– Marriage, Pregnancy, Parenthood, SelfSupport, Military Service, High School
Graduate
• Mature Minor
– Capacity and Age
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
Special Situations
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Contraception
Pregnancy
Abortion
Sterilization
Alcohol/Drug/MH Treatment
Blood Donation
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
IC and Minors
• Assent
• Parental Permission
• Disagreement
Treuman Katz Center for Pediatric Bioethics - 2009 Conference
When I was a boy of 14, my father was
so ignorant I could hardly stand to
have the old man around.
But when I got to be 21, I was
astonished at how much the old man
had learned in seven years.
Mark Twain
Treuman Katz Center for Pediatric Bioethics - 2009 Conference