Mature Minor and consent for Medical Treatment (vaccines, hormones, MAID)

The concept of age is irrelevant, only the concept of 'maturity' matters.

You aren’t the child’s parent where the medical doctor determines the child is a Mature Minor. Thus you are the whim of a third party’s determination of this ‘concept’. You aren’t present for the recommendations and the listed side effects of any course of treatment, whether they were explained or whether your child understood them.

The concept of Fiduciary comes to mind. there is a power imbalance between a youth and a DOCTOR. thus the child’s ability to apprise themselves of consequences and even ensure they explored the consequences is unlikely with that power imbalance.

“Published: March 2014 / Revised: May 2021
The information in this article was correct at the time of publishing

The special relationship of trust between physicians and their patients requires that physicians always act in their patients' best interests. While physicians' responsibilities do not vary according to a patient's age, there are medico-legal considerations to keep in mind when treating patients under the age of 18.

Physician advisors at the CMPA often receive calls with regard to consent involving children. Questions about consent for treatment of children, and about who can consent to the release of children’s records, figure prominently in complaints to regulatory authorities.

Age of consent — The legal age of majority is largely irrelevant in determining when a young person may consent to medical treatment. The concept of maturity is more determinative than chronological age, except in Québec, where the age of consent is generally 14 years and older.

Consent to treatment

Medico-legal issues related to the care of children often involve the question of who is legally authorized to provide consent for treatment: the child patient or the parents/guardians.

A child need not reach the age of majority to give consent to treatment. In almost all Canadian provinces and territories, the determining factor in a child's ability to legally provide or refuse consent is whether their physical, mental, and emotional development allows for a full appreciation of the nature and consequences of the proposed treatment or lack of treatment.

Consent to treatment in Québec

In Québec, the age of consent is generally 14 years of age. If the child is below that age, or does not have the capacity to consent, the consent of the parent or guardian, or a court order, is required. If the medical treatment consented to by a minor who is 14 or over requires a hospital stay of more than 12 hours, parental notification of the stay is required.

Although consent to elective care can be provided by a minor who is 14 or older, if the care entails a serious risk to health or may cause grave and permanent effects, then parental or guardian consent must be obtained. (LL thus you often see the claim that gender affirming care is NOT permanent. By so ‘decreeing’ you enable the concept of mature minor whether they are mature or not and prevent the parent’s knowledge. Consent is then given by the mature minor).

If a minor who is 14 or over refuses treatment, a court order is usually required to provide that treatment against the minor’s wishes, except in a small set of circumstances. In an emergency, if the minor’s life is in danger or their physical or moral integrity is threatened, then parental or guardian consent is sufficient.

Determining a child’s competence

Whether a child has the mental capacity (also known as competence) to provide consent is usually determined on a case-by-case basis. When a child is found incapable of consenting to treatment, the parents or legal guardians are authorized to provide consent on the minor's behalf. However, when the physician determines that the child has the capacity, parental consent is not required. In such circumstances, the physician must obtain consent from the child, even when the child is accompanied by a parent or legal guardian.

How does a physician determine whether or not a child has the capacity to consent? In discussions with the child, the physician should be reasonably confident that the child understands the nature of the proposed treatment and its anticipated effect. The child should also understand the consequences of refusing treatment. One way to gauge this capacity is to use the teach-back technique: ask the child to re-phrase what they have just been told and invite the child to ask questions. More complex medical situations may require more rigour in determining whether the child understands. It is prudent for physicians to also encourage the child to invite a family member to attend the discussion. (LL a five year old plays match the card quite well. Being able to parrot the question or answer correctly might be a sign of the ability to recall without distraction, not the ability to understand permanent consequences for losses immaterial to the child at the time)

Physicians must use their judgment concerning a child's capacity to consent in many different circumstances, such as when a teen requests a prescription for birth control without their parents' knowledge. If the physician can be reasonably confident that the child has the capacity to consent and documents the relevant details of the consent discussion in the medical record, it is likely that a College would support the physician in the event of a complaint from a parent. Meanwhile, parental involvement is recommended (with consent of the capable minor) when the treatment entails serious risks and may have serious and permanent effects on the child. (LL again making a claim that a vaccine is SAFE and effective is interesting. by making the claim it is safe, it is impossible for it at the same time entail serious risk. Thus we get to the point: a mature (so deemed) minor can consent to a dangerous vaccine without their parents consent)

Case example: Consent

College determines physicians acted in best interests of mature minor

A 16-year-old saw a family physician for symptoms of severe depression. Speaking with the patient, the physician determined that the patient was mature enough to understand the seriousness of his symptoms and the need to address them. The patient also requested that the physician not consult with his parents. The physician referred the patient to an adolescent day treatment program where he was followed by a psychiatrist. He was diagnosed with major depression and agoraphobia.

After learning her child was undergoing treatment, the patient's mother filed a College complaint, alleging that the family physician and psychiatrist did not obtain proper consent for her child to attend the treatment program. The College stated that, by complying with the patient’s request not to consult his parents, both physicians acted in the best interests of the patient and in accordance to College practices.

Medical assistance in dying

An exception to the general rules regarding consent to treatment is medical assistance in dying (MAID). To be eligible for MAID, the patient must have reached the age of 18. (LL age 25 might be more realistic. The tempestuous teen years can involve massive reactions over relationships ending. )

Additional reading

• “Responding to requests for children’s medical records”

• Consent: A guide for Canadian physicians

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DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.”

Are you comfortable with the medical professional deciding and indeed influencing the course of treatment:

ie affirming on the pain jail time by the physician. A physician must not attempt to convert the child to their birth gender. thus all recommendations will follow the result that keeps the physician’s personal body out of incarceration.

ie. vaccination.

Let me know your thoughts on the concept of MATURE MINOR, where it can be abused and if you see it on the horizon for MAID.