Abstract
BackgroundBy law, the provision of medical treatment to minors in the State of Israel is conditional upon the consent of their parents. In 2004, the Head of the Medical Administration Unit in the Ministry of Health issued Circular No. 4/2004 regarding the treatment of un-accompanied minors in primary care clinics. This circular aims to expand on the law, and permits the treatment of certain minors without parental attendance or consent. The circular does indicate that parents should be notified of the treatment retroactively, and provides cases in which it is possible to avoid notification altogether.The objectives of this study were: (a) to examine the scope of treatment of unaccompanied minors in primary care clinics; (b) to examine caregivers’ knowledge of the provisions of the law and of the circular; and (c) to examine the implementation of the law’s and the circular’s provisions relating to the treatment of unaccompanied minors in primary care clinics in the community.MethodsIn a cross-sectional study, we surveyed 158 doctors and nurses from primary care clinics of the Haifa and Galilee districts of “Clalit Health Services”. Respondents were selected via a snowball method, with attention to ensuring a heterogeneous clientele and geographic dispersion.ResultsTreatment seeking by unaccompanied minors is an existing and even widespread phenomenon. The vast majority of unaccompanied minors were in effect treated without parental consent. The main reason for minors’ solitary treatment seeking was parents being busy. In 40% of the cases, where minors were treated without the presence and consent of their parents – parents were not notified of the fact. None of the respondents correctly answered all questions regarding the relevant provisions of the law and circular, and only 10% answered all the questions regarding the circular’s parental notification requirements.ConclusionsThe Israeli legal arrangement, pertaining to the provision of treatment to minors without the consent of their parents, is vague, unclear to medical and nursing practitioners and limited in terms of the needs of the minors themselves, as well as the needs of the medical system.There is a need for methodical and coherent regulatory thinking on the subject, as well as more thorough education of both nurses and physicians, in order to ensure the rights and interests of minors as well as the rights of their parents.
Highlights
By law, the provision of medical treatment to minors in the State of Israel is conditional upon the consent of their parents
Most respondents work in an urban set clinic (77.8%, n 123), serving mostly a Jewish population (66.5% n 105)
The response rate veered around 32%, and a relative small number of respondents came from rural, predominantly Arab community serving clinics (n.3) – a fact that limits the relevant statistical analysis in our research as well as its generalizability
Summary
The provision of medical treatment to minors in the State of Israel is conditional upon the consent of their parents. Extensive discussion has been conducted over the years – in the academic [5,6,7], professional [8, 9] and regulatory [10,11,12] spheres alike, about the limited scope of the exceptions to the parental consent requirements, and the need to expand them, in order to promote a range of goals, primarily the best interests of minors and the rights of minors seeking treatment This discussion has succeeded in somewhat extending the legal recognition of the rights of minors to influence their treatment (for example in allowing a 16 year old minor to veto his genetic testing [13], as well as conditioning a 15+ year old patient’s psychiatric commitment on his additional assent [14] among others). The legal obligation to receive parental consent, for any treatment that does not fall into such exceptions, remained as comprehensive as ever
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