Mature Minor Doctrine Research Articles

State Actions to Ban Gender-Affirming Care for Minors and the Ways Forward

As of October 2023, twenty-one states have passed laws that ban medically necessary gender-affirming care to minors. This Note will discuss the actions of three such states—Texas, Florida, and Arkansas—in 2022.2 These state actions demonstrate three different ways in which states have restricted access to medically necessary gender-affirming care. To move forward, lawyers and advocates must continue to litigate against these bans, state legislatures should enact sanctuary statutes protecting trans youths’ access to gender-affirming care, and the U.S. Food & Drug Administration (FDA) should make medications—including puberty blockers and hormones—available on-label and across state lines through Telehealth. It is important to recognize that disapproving parents pose insurmountable barrier to minors’ self-realization, exploration of their genders, and access to care. There is abundant legal scholarship on parental consent in this context and analogous ones, such as the mature minor doctrine that concerns minors accessing abortion and reproductive care like birth control. However, this Note focuses solely on situations in which transgender youths’ parents support their children’s identities and allow them to receive gender-affirming care. When a state has a ban on gender-affirming care, parents’ consent would not matter in the face of such a ban, unless the family is financially able and willing to move to a state allowing access to such care.

Competence or Experience

Competence or Experience

Mature Minor Doctrine Clarification Act: A Setback in Pediatric Immunizations.

The Mature Minor Doctrine Clarification Act, a Tennessee bill stating that a healthcare provider may not provide vaccination to a minor without the informed consent of a parent/legal guardian, poses significant challenges to pediatric immunization. We outline changes implemented to our processes in response to this bill.

Life without Gillick: Adolescent sexual and reproductive healthcare in Ireland

The decision of the House of Lords in Gillick v West Norfolk Area Health Authority carved out a safe space for competent minors to confidentially access sexual and reproductive health care and advice in the UK. Ireland is one of the few common law jurisdictions that has not endorsed Gillick or a similar mature minor doctrine, nor has it securely legislated for the right to consent of those aged 16 and 17 years. The legal lacuna created by this deficiency has left young persons in Ireland seeking sexual and reproductive healthcare, and the clinicians who provide this, in a challenging place. While this void has been partially filled with policy statements by bodies such as the Irish College of General Practitioners and the Health Service Executive, nonetheless the legal shortcomings leave both a sense of insecurity, and real world difficulties for adolescents seeking to access to sexual and reproductive healthcare.

Ready or Not: Key Insights to Enabling Adolescents' Access to Their Personal Health Information.

Granting minors with online access to their personal health information (PHI) is a complex policy and implementation issue, requiring a balance of rapid changes in adolescent maturity and autonomy, adolescent need for privacy and confidentiality and care responsibilities of custodians and providers. There are currently no standard legislation or policies that enable access; however, most implementations use the age of majority or the mature minor doctrine as an approach - each with its own limitations. This paper highlights key legislative and implementation insights for organizations seeking to enable adolescents with online access to their PHI, calling for leadership to address this issue.

Addressing Legislation That Restricts Access to Care for Transgender Youth.

* Abbreviations: GAC — : gender-affirmative medical care GnRHa — : gonadotropin-releasing hormone analogue TGD — : transgender and gender-diverse Transgender and gender-diverse (TGD) youth experience barriers to accessing health care and are at risk for poorer overall health compared with cisgender peers. In the last year, dozens of US legislative bills have been proposed to restrict the rights of TGD youth.1 A subset of these bills aims to restrict access to essential treatment of youth diagnosed with gender dysphoria, even when they meet rigorous criteria, as determined by a multidisciplinary evaluation (Table 1).1,2 Other proposed legislation would criminalize clinicians who provide gender-affirmative medical care (GAC) for TGD adolescents, with one bill currently under consideration in Oklahoma classifying providing GAC as a felony punishable by 3 years to life in prison.1 Clinicians and parents fear that legislation eliminating access to GAC will lead to worsening mental health and increased suicidality for their TGD children.3 View this table: TABLE 1 Bills Proposed During the 2021 US State Legislative Session to Date Despite these objections, in December 2020, the Bell versus Tavistock ruling in the United Kingdom mandated … Address correspondence to Jessica Kremen, MD, Division of Endocrinology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: jessica.kremen{at}childrens.harvard.edu

Medically assisted gender affirmation: when children and parents disagree

Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have...

,,,The Mature Minor Doctrine: Can Minors Unilaterally Refuse Medical Treatment?

,,,The Mature Minor Doctrine: Can Minors Unilaterally Refuse Medical Treatment?

Conflating Capacity & Authority: Why We're Asking the Wrong Question in the Adolescent Decision-Making Debate.

Whether adolescents should be allowed to make their own medical decisions has been a topic of discussion in bioethics for at least two decades now. Are adolescents sufficiently capacitated to make their own medical decisions? Is the mature-minor doctrine, an uncommon legal exception to the rule of parental decision-making authority, something we should expand or eliminate? Bioethicists have dealt with the curious liminality of adolescents-their being neither children nor adults-in a variety of ways. However, recently there has been a trend to rely heavily, and often exclusively, on emerging neuroscientific and psychological data to answer these questions. Using data from magnetic resonance imaging and functional MRI studies on the adolescent brain, authors have argued both that the adolescent brain isn't sufficiently mature to broadly confer capacity on this population and that the adolescent brain is sufficiently mature to assume adolescent capacity. Scholars then accept these data as sufficient for concluding that adolescents should or should not have decision-making authority. Two critical mistakes are being made here. The first is the expectation that neuroscience or psychology is or will be able to answer all our questions about capacity. The second, and more concerning, mistake is the conflation of decision-making capacity with decision-making authority.

Not of Minor Consequence?: Medical Decision-Making Autonomy and the Mature Minor Doctrine

Not of Minor Consequence?: Medical Decision-Making Autonomy and the Mature Minor Doctrine

Cassandra’s Choice: The Right to Refuse Treatment

Cassandra, a teen patient from Connecticut, was diagnosed with Hodgkin lymphoma in September 2014. After being diagnosed, she and her mother missed several appointments, motivating providers at Connecticut Children's Medical Center to notify the state Department of Children and Families. The child welfare agency investigated Cassandra’s situation and a trial court soon granted temporary custody over her wellbeing. Cassandra will turn 18 in September of next year and therefore, in the eyes of the court, is still considered a minor and unable to make her own medical decisions. The case went to the Connecticut Supreme Court and the court concluded that Cassandra was not mature enough to make her own medical decisions. However, Cassandra and her mother both are continuing to rebuke the treatment, calling the chemotherapy treatment “poison” being injected against the patients will. Cassandra’s mother, Jackie, claimed that she was not being negligent and instead seeking alternative treatments to chemotherapy. According to clinicians at Connecticut Children’s Medical Center, chemotherapy would allow an 85 percent chance of survival for Cassandra, while withholding it would result in her dying within two years. Cassandra had previously been described in November as “very bright” by court documents, with a lucid understanding of her condition. However, she is now confined within a room at Connecticut Children’s Medical Center where she is now mid-treatment. In most cases, adults have the option to reject a medical treatment despite how successful it may prove in saving the patient’s life. The patient’s wishes are generally treated with utmost respect, and if the patient is too young, the patient’s legal guardian may represent the patient’s wishes. In this case, legal guardianship was transferred to the state Department of Children and Families. While Cassandra is not considered mature enough to make a choice regarding her own medical decision in this case, she is able to make others due to Connecticut law. In Connecticut, a 17 year old is allowed to obtain contraception, seek psychiatric care, and undergo an abortion, all without parental consent. This begs the question, what does it mean to truly be mature enough to make rational decisions regarding one’s own care? The court was specifically reviewing this case under the “mature minor doctrine,” already recognized by many other states. In these cases the court allows for hearings wherein minors who are 16 and 17 can prove they are mature enough to make medical decisions. The court denied that there was substantial evidence to prove Cassandra’s maturity. According to the Assistant Attorney General, Cassandra exhibited “magical thinking” and she was not taking her case as seriously as she should. When a patient does not make the choice society believes she should be making, when is it permissible for society to override the choice? There are more outcomes to consider besides Cassandra’s chance of survival. With chemotherapy, Cassandra will most likely also experience appetite changes, bleeding problems, malaise, memory changes, hair loss, nausea, sexual changes, and a weakened immune system. This change in Cassandra’s lifestyle represents a liminal stage in her life, faced with forced treatment, her identity and relationship with others will change. The treatment will change her. Quality of life will be drastically reduced and this is not easy to accept for anyone in this case. For Cassandra, her quality of life is more important than overall health. The clinicians at Connecticut Children’s should respect her wishes; while it may not be easy, it is the right thing to do. Law may dictate that she is not mature enough, however, she is still a human with wishes, hopes, and desires. If Cassandra does not want the “poison” injected into her body, the clinician should honor these wishes, and be there to hold her hand. Legally, Cassandra may become an adult overnight, but psychologically she has faced circumstances many adults never have to confront until much later. Cassandra is faced with the prospects of depravity, disability, and death, she wants to live according to her wishes. Does the state and the hospital truly have the right to dictate what will happen to her body more so than she does? Is mortality all that should be considered in this case? Healing is not a zero-sum game, it is a deeply meaningful process that requires the patient to approve of the treatment, trust the healer, and accept what may come.

Ethics of pharmacological research involving adolescents.

Pharmacological research in the adolescent population is not meeting adolescents' needs. Medication is still frequently prescribed off label, and studies especially in sensitive areas of adolescent health care are underrepresented. Adolescents did not benefit from the new knowledge gained in cancer research, and their outcome has essentially not improved during the last two decades in comparison to younger children and adults. There are many obstacles that make it challenging to enroll adolescents in pharmacological research. Access can be difficult. Confidentiality plays an essential role for minors and may be a hindrance, notably to studying sexual and mental health matters. Pharmaceutical companies may exclude the adolescent patient because of a lack of profit and in fear of a complex study design. Research concepts should be explained to the adolescent in a comprehensive manner, and assent and consent forms should be clear and understandable. New laws and incentives have been developed to encourage pharmaceutical companies to engage adolescents in their research projects. Centralization and collaboration of all parties involved may make the whole approach to adolescent research more efficient and uniform. The mature minor doctrine has facilitated the enrollment process. Parental consent may be waived for low-risk medical trials to promote recruitment. Ethics committees therefore play a major role in protecting the adolescent from harm from participating in research. In conclusion, pharmacological research in adolescents has to be encouraged. This will increase the safety of current medical treatment regimens and will allow this population to benefit from therapeutic advancements.

Confidentiality and treatment decisions of minor clients: a health professional's dilemma & policy makers challenge.

Issues relating to confidentiality and consent for physical and mental health treatment with minor clients can pose challenges health care providers. Decisions need to be made regarding these issues despite the absence of clear, direct, or comprehensive policies and legislation. In order to fully understand the scope of this topic, a systemic review of several pieces of legislation and guidelines related to this topic are examined. These include the: Canadian Human Rights Act, Children’s Rights: International and National Laws and Practices, Health Information Act, Gillick Competence and Medical Emancipation, Freedom of Information and Protection of Privacy Act, Child, Youth and Family Enhancement Act, Common Law Mature Minor Doctrine, and Alberta Health Services Consent to Treatment/Practice(s) Minor/Mature Minor. In order to assist health professionals with decisions regarding confidentiality and treatment with minor clients a case study and guide for decision-making is also presented.

Will Your Religion Allow Youuto Live? The Mature Minor Doctrine, Religious Exemptions, and a Look into Louisiana Law

Imagine being fifteen years old and diagnosed with a rare disease that will kill you if you do not undergo certain medical procedures. Further imagine that the treatment the doctors say will save your life is a treatment that is utterly against your religion. Would you follow your religious beliefs, or would you follow the doctor’s highly recommended procedures? Would you weigh your parent’s beliefs, or are you mature enough to make the decision for yourself? Even if you think you are mature enough, will your home state allow your “mature” decisions to be considered in court? The 1974 Child Abuse Prevention and Treatment Act originally required states to adopt religious exemptions to child neglect in order to keep federal funding for child-protection programs. Despite the lifting of this requirement, many states still have the exemptions in force. Due to these exemptions, many children have died because their parents believe that they are not required to give their children proper medical treatment if it is against their religion. The mature-minor doctrine makes these issues even stickier. While some states use this doctrine in a very limited sense, others have adopted a broad interpretation that would allow a mature minor to refuse medical treatment while not holding the parents responsible. Each state has its own unique interpretation of religious exemptions and the mature-minor doctrine. Thus, both should be interpreted with particular caution. This article uses a 2013 Wisconsin Supreme Court case, Dane County v. Sheila W., as a factual backdrop to discuss the issues of religious exemptions and the mature-minor doctrine. These issues have not been heavily discussed in Louisiana, and this article seeks to provide an overview and a guide for when Louisiana is faced with a similar situation.

Does Recent Research on Adolescent Brain Development Inform the Mature Minor Doctrine?

US Supreme Court rulings concerning sanctions for juvenile offenders have drawn on the science of brain development and concluded that adolescents are inherently less mature than adults in ways that render them less culpable. This conclusion departs from arguments made in cases involving the mature minor doctrine, in which teenagers have been portrayed as comparable to adults in their capacity to make medical decisions. I attempt to reconcile these apparently incompatible views of adolescents' decision-making competence. Adolescents are indeed less mature than adults when making decisions under conditions that are characterized by emotional arousal and peer pressure, but adolescents aged 15 and older are just as mature as adults when emotional arousal is minimized and when they are not under the influence of peers, conditions that typically characterize medical decision-making. The mature minor doctrine, as applied to individuals 15 and older, is thus consistent with recent research on adolescent development.

Parents, Adolescents, and Consent for Research Participation

Decisions concerning children in the health care setting have engendered significant controversy and sparked ethics policies and statements, legal action, and guidelines regarding who ought to make decisions involving children and how such decisions ought to be made. Traditionally, parents have been the default decision-makers for children not only with regard to health care but with regard to other matters, such as religious practice and education. In recent decades, there has been a steady trend away from the view that parents are in authority over their children and toward the view that children are rights-bearers who should be granted greater authority over themselves. The mature minor doctrine refers to the decision to grant mature minors the authority to make decisions traditionally reserved for their parents. This essay (1) documents the trend towards expanding the understanding of some minors as "mature" and hence as having the right and authority to give informed consent, (2) examines the reasons for which some commentators have a special interest in expanding the mature minor doctrine to the research setting and allowing minors to enroll in research without parental permission, and (3) defends the view that the mature minor doctrine, regardless of its application to clinical health care decisions, ought to be set aside in the research setting in favor of greater parental involvement.

Lectura clínica de una sentencia judicial: el derecho a la vida y su aplicación en la toma de decisiones clínicas

In 2009, the case of a child affected by acute lymphoblastic leukemia took place. He is treated with good results resulting in complete remission, but relapse occurred later. The parents did not consent to the new treatment, creating a conflict that reaches the legal world and leads to two court rulings of great interest to health professionals. One explained the meaning of the right to life in the clinical practice, and the other dealt with the decision-making process regarding minors based on the theory of the mature minor doctrine, a jurisprudential milestone in Chile. In order to help clarify the meaning of the ruling of the Corte de Apelaciones of Valdivia, its content is presented in clinical terms and ended with the most significant contributions.

'Cure Me! I'm Gay!': Social Orientation Change Efforts — A Fundamental Right or a Legal Injustice

For centuries, homosexuality has been viewed as a social stigma, leading many homosexuals to feel isolated, abnormal, and unaccepted. Not until the 1970s was homosexuality no longer considered to be a mental illness, but rather an immutable trait, or by some opinions, a lifestyle choice. With homosexuals facing a lack of widespread acceptance throughout history, methods were developed in an attempt to “cure,” “rewire,” or “alter” sexual orientation in hopes of setting these individuals free from the oppression they faced as homosexuals. These efforts became known as sexual-orientation-change therapy. In 2012, the California Senate passed SB 1172, which made it illegal for any psychologist to administer any form of sexual-orientation-change therapy to any individual under the age of eighteen regardless of parental consent or their own willingness. The term sexual-orientation-change therapy refers to the various methods by which some researchers believe sexual orientation may be reversed. This article presents pertinent historical development leading up to the passage of the bill, discussion on the efficacy and effects of such therapy, as well as an exploration of the possible legal issues presented by the bill itself and lawsuits filed in its opposition including whether a ban on sexual-orientation-change efforts infringes on individual’s fundamental rights; whether a ban on sexual-orientation-change efforts infringes on parents’ rights to rear their children, and whether passage of SB 1172 is in fact necessary in order to protect the psyche of young people. The author’s research shows that SB 1172 would likely fail a constitutional challenged because of the bill’s infringement upon individuals’ fundamental rights in the presence of less restrictive, less invasive means of accomplishing the existing compelling government interest — specifically — the provision of a Mature Minor Doctrine.

When Ethics Consultation and Courts Collide: A Case of Compelled Treatment of a Mature Minor

A fourteen year old is diagnosed with aplastic anemia. The teen and his parents are Jehovah's Witnesses. An ethics consult is called on the day of admission by an ethically sophisticated social worker and attending. The patient and his parents see this diagnosis as "a test of their faith." The ethical analysis focuses on the mature minor doctrine, i.e. whether the teen has the capacity to make this decision. The hospital chooses to take the case to court, with a result that is at odds with the ethics consultation recommendations. Ethics was never deposed or otherwise invited to be involved with the hearing. Thus the larger question of the relation of ethics and law was brought into stark relief.

A Practice of Anesthesia for Infants and Children, 3rd Edition.

A Practice of Anesthesia for Infants and Children, 3rd Edition.