Difference between revisions of "Children and Consent to Health Care"

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{{Dial-A-Law Blurb}}
{{REVIEWEDPLS | reviewer = [http://dir.gov.bc.ca/gtds.cgi?esearch=&view=detailed&sortBy=name&for=people&attribute=name&matchMethod=is&searchString=Katherine+LeReverend&objectId=18706 Katherine LeReverend], Ministry of Attorney General, Legal Services Branch|date= June 2018}} {{Dial-A-Law TOC|expanded = health}}
In BC, a child under age 19 may consent to their own health care, if the child is “capable”. Learn what this means and other issues of '''health care consent'''.


{{Dial-A-Law TOC|expanded = health}}
==Understand the legal framework==
==Can children consent to—or refuse—health care?==
Yes, [http://www.bclaws.ca/Recon/document/ID/freeside/00_96223_01#section17 section 17] of the BC ''[http://www.bclaws.ca/civix/document/id/complete/statreg/96223_01 Infants Act]'' says that children (anyone under 19 years old) can consent (or agree) to their own healthcare—'''if they are capable'''. A situation that involves just a doctor and a child patient under 19 years old can expand to include the child’s parents, plus a court and lawyers, if there are disagreements over the child’s best interests. It can also include the Ministry of Children and Family Development if there are concerns about the child’s welfare. 


==When are children capable?==
===A child may consent to their own health care, if they are “capable”===
The law considers children capable if they understand the need for a medical treatment, what the treatment involves, and the consequences (benefits and risks) if they get—or don’t get—the treatment. If a doctor or healthcare provider explains the consequences and decides that the child understands them and the healthcare is in the child’s best interest, they can treat a child who consents, without consent of the parents or guardians. The child might have to sign a consent form. And generally, if a child is capable of consenting to medical treatment, they are also capable of refusing medical treatment. (For the law on adults and consent to healthcare, check script [[Adults and Consent to Medical Care (Script 428)|428]], called “Adults and Consent to Healthcare”.)
Under the [https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-223/latest/rsbc-1996-c-223.html#sec17_smooth law in BC], a child under age 19 may consent to their own health care — '''if they are “capable”'''.
The law considers a child capable if they understand the need for the health care, what the care involves, and the consequences (the benefits and risks) of getting the care — or not getting the care.  


There is no set age when a child becomes capable. Doctors have to use their best judgment in each case to decide if a child is capable. Courts are flexible in deciding if a child is capable. It depends on how mature the child is and how serious the medical treatment is. A very young child may be able to consent to the dressing of a wound. On the other hand, an older child may not be capable of refusing life-saving treatment. For example, in 2005, the BC Supreme Court upheld a Provincial Court decision that ordered a 14-year-old Jehovah’s Witness girl to have blood transfusions that she and her parents were refusing. Another example: a mildly developmentally disable child may be capable of consenting to have a small cut treated, but not capable of consenting to antibiotics for an infection.  
If a health care provider explains these things to the child and is satisfied the child understands them, and that the health care is in the child’s best interests, they can treat the child if the child consents to the care. The provider does not need the consent of the child’s parents or guardians. The child might have to sign a consent form.  


==Do children need the consent of a parent or guardian to get healthcare?==
Generally, if a child is capable of consenting to health care, they are also capable of making a decision to refuse health care.
No—not if they are capable. They can consent to their own healthcare, without the consent or knowledge of their parents or guardians. Capable children can normally get medical treatment for things like birth control, abortion, mental health problems, sexually transmitted diseases, and alcohol and drug addiction problems.


If a parent or guardian is limiting a child’s access to healthcare, it could be abuse or neglect and the child may need protection. Anyone who knows of that situation must report it to [https://www2.gov.bc.ca/gov/content/safety/public-safety/protecting-children Child Protection Services] (1.800.663.9122) of the Ministry of Children & Family Development.
There is no set age when a child becomes capable. Doctors have to use their best judgment in each case to decide if a child is capable. Courts are flexible in deciding if a child is capable. It depends on how mature the child is and how serious the medical treatment is. A very young child may be able to consent to the dressing of a wound. On the other hand, an older child may not be capable of refusing life-saving treatment. For example, [http://canlii.ca/t/1k536 a court ordered] a 14-year-old Jehovah’s Witness girl to have blood transfusions that she and her parents were refusing. Another example: a mildly developmentally disabled child may be capable of consenting to have a small cut treated, but not capable of consenting to antibiotics for an infection.


==Is a child’s health care confidential?==
{| class="wikitable"
A child’s healthcare is confidential if the child is capable. A doctor or healthcare provider can’t talk with the parents or guardian about a capable child’s healthcare, unless the child agrees. Just as doctors must keep information about their adult patients confidential, they must also keep information about their capable child patients confidential.  
|align="left"|'''Tip'''
For the law that applies for adults, see our information on [[Adults and Consent to Health Care (No. 428)|adults and consent to health care (no. 428)]].
|}


There are exceptions to this confidentiality rule. In some cases, parents or guardians may be able to get their child’s medical information or a doctor may have to disclose information to the Ministry of Children and Family Development. For example, if there is good reason to believe that a child might harm themselves or others, or there is suspected or reportable abuse (physical, sexual or emotional) then the information may not stay private. In that case, the child should be told why their information won’t be kept private and who it will be given to.  
===A (capable) child does not need their parent to consent to their health care===
A child who is capable does not need their parent or guardian to consent to their health care. The child can consent to their own health care, without the consent or knowledge of their parents or guardians. A capable child can normally get medical treatment for things like birth control, abortion, mental health problems, sexually transmitted diseases, and alcohol and drug addiction problems.


And if a doctor considers a child not capable, they will tell the child’s parent or guardian if they treat the child. So if you’re a child and you want your doctor to keep your medical information confidential, talk to the doctor before you get treatment to see if they agree you are capable, and if they will keep your information confidential. If not, you can look for a different doctor.
If a parent or guardian is limiting a child’s access to health care, it could amount to abuse or neglect and the child may need protection. Anyone who knows of such a situation must report it to a child welfare worker. You can do so by calling the [https://www2.gov.bc.ca/gov/content/safety/public-safety/protecting-children Ministry of Children and Family Development]’s screening line at 1-800-663-9122.  


For more information on patient confidentiality, check script [[Getting Your Medical Records (Script 421)|421]], called “Getting Your Medical Records.
===The health care has to be in the child’s best interests===
Under [https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-223/latest/rsbc-1996-c-223.html#sec17_smooth BC law], for a child’s consent to health care to be legally valid, the health care provider must conclude the care is in the child’s best interests.
 
If there is disagreement about what care is in a child’s best interests, the child welfare authorities may become involved. If a child or their parent refuses health care that two doctors say is necessary to preserve the child’s life or health, the child welfare authorities can ask a court to overrule the refusal. This application is made under [https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-46/latest/rsbc-1996-c-46.html#sec29_smooth section 29] of the ''Child, Family and Community Service Act''.  


==Does healthcare have to be in the child’s best interest?==
More information is available from the Ministry of Children and Family Development. See their website at [http://www.gov.bc.ca/mcf gov.bc.ca/mcf] or call toll-free 1-877-387-7027.  
Yes, capable children can consent to healthcare only if it is in their best interest. If there is any disagreement about what a child’s best interest is, the people involved may have to see a lawyer and consider going to court. If a capable child refuses health care that two doctors say is necessary to preserve the child’s life or health, under [http://www.bclaws.ca/Recon/document/ID/freeside/00_96046_01#section29 section 29] of the ''[http://www.bclaws.ca/Recon/document/ID/freeside/00_96046_01 Child, Family and Community Service Act]'', the Director of Child Protection can ask a court to overrule the child’s refusal. More information is available from the Ministry. In Victoria, call 250.387.7027. Elsewhere in BC, call 1.877.387.7027. Or see the [http://www.bclaws.ca/Recon/document/ID/freeside/00_96046_01 ministry website]. More information is also available on the [http://www.familylaw.lss.bc.ca/ Legal Services Society Family Law website].


==Is consent to health care needed in a medical emergency?==
===Consent to health care in a medical emergency===
Consent to health care in a medical emergency may not be needed to treat a child or an adult—it depends on the situation. If a person’s life or health is seriously threatened, and it appears that the person isn’t capable of making healthcare decisions, healthcare providers may be able to treat the person without consent. Because they are dealing with a medical emergency, they may be able do whatever is necessary to try and save the person’s life or health.  
In a medical emergency, a health care provider may not need a person’s consent to provide health care. It depends on the situation. If a person’s life or health is seriously threatened, and it appears the person isn’t capable of making health care decisions, health care providers may be able to treat the person without consent. Because they are dealing with a medical emergency, they may be able to do whatever is necessary to try and save the person’s life or health.


Refusing medical treatment in an emergency raises complex legal questions. Parents and capable children who want to refuse certain treatments in an emergency need legal advice.
See our information on [[Adults and Consent to Health Care (No. 428)|adults and consent to health care (no. 428)]] for the law as it applies to adults in medical emergency situations.


Check script [[Children's Rights (Script 238)|238]], called “Children’s Rights” for general information on the rights that children have in several areas other than health care.
===A child’s health care is confidential===
A child's health care is '''confidential''', if the child is capable. A doctor or health care provider can’t talk with the parents or guardians about a capable child’s health care, unless the child agrees. Just as doctors must keep information about their adult patients confidential, they must also keep information about their capable child patients confidential.


There are exceptions to this confidentiality rule. In some situations, a parent or guardian may be able to get their child’s medical information, or a doctor may have to disclose information to the Ministry of Children and Family Development. For example, if there is good reason to believe that a child might harm themselves or others, or there is suspected abuse (physical, sexual or emotional), then the information may not stay private. In that case, the child should be told why their information won’t be kept private and who it will be given to.


[updated June 2018]
If a doctor considers a child not capable, they will tell the child’s parent or guardian if they treat the child.


'''The above was last edited by John Blois.'''
For more on patient confidentiality, see our information on [[Getting Your Medical Records (No. 421)|getting your medical records (no. 421)]].


----
{| class="wikitable"
----
|align="left"|'''Tip'''
As a child, if you want your doctor to keep your medical information confidential, talk to the doctor before you get treatment to see if they agree you are capable, and if they will keep your information confidential. If not, you can look for a different doctor.
|}


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Revision as of 22:43, 29 March 2019

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Katherine LeReverend, Ministry of Attorney General, Legal Services Branch in June 2018.

In BC, a child under age 19 may consent to their own health care, if the child is “capable”. Learn what this means and other issues of health care consent.

Understand the legal framework

A child may consent to their own health care, if they are “capable”

Under the law in BC, a child under age 19 may consent to their own health care — if they are “capable”.

The law considers a child capable if they understand the need for the health care, what the care involves, and the consequences (the benefits and risks) of getting the care — or not getting the care.

If a health care provider explains these things to the child and is satisfied the child understands them, and that the health care is in the child’s best interests, they can treat the child if the child consents to the care. The provider does not need the consent of the child’s parents or guardians. The child might have to sign a consent form.

Generally, if a child is capable of consenting to health care, they are also capable of making a decision to refuse health care.

There is no set age when a child becomes capable. Doctors have to use their best judgment in each case to decide if a child is capable. Courts are flexible in deciding if a child is capable. It depends on how mature the child is and how serious the medical treatment is. A very young child may be able to consent to the dressing of a wound. On the other hand, an older child may not be capable of refusing life-saving treatment. For example, a court ordered a 14-year-old Jehovah’s Witness girl to have blood transfusions that she and her parents were refusing. Another example: a mildly developmentally disabled child may be capable of consenting to have a small cut treated, but not capable of consenting to antibiotics for an infection.

Tip

For the law that applies for adults, see our information on adults and consent to health care (no. 428).

A (capable) child does not need their parent to consent to their health care

A child who is capable does not need their parent or guardian to consent to their health care. The child can consent to their own health care, without the consent or knowledge of their parents or guardians. A capable child can normally get medical treatment for things like birth control, abortion, mental health problems, sexually transmitted diseases, and alcohol and drug addiction problems.

If a parent or guardian is limiting a child’s access to health care, it could amount to abuse or neglect and the child may need protection. Anyone who knows of such a situation must report it to a child welfare worker. You can do so by calling the Ministry of Children and Family Development’s screening line at 1-800-663-9122.

The health care has to be in the child’s best interests

Under BC law, for a child’s consent to health care to be legally valid, the health care provider must conclude the care is in the child’s best interests.

If there is disagreement about what care is in a child’s best interests, the child welfare authorities may become involved. If a child or their parent refuses health care that two doctors say is necessary to preserve the child’s life or health, the child welfare authorities can ask a court to overrule the refusal. This application is made under section 29 of the Child, Family and Community Service Act.

More information is available from the Ministry of Children and Family Development. See their website at gov.bc.ca/mcf or call toll-free 1-877-387-7027.

Consent to health care in a medical emergency

In a medical emergency, a health care provider may not need a person’s consent to provide health care. It depends on the situation. If a person’s life or health is seriously threatened, and it appears the person isn’t capable of making health care decisions, health care providers may be able to treat the person without consent. Because they are dealing with a medical emergency, they may be able to do whatever is necessary to try and save the person’s life or health.

See our information on adults and consent to health care (no. 428) for the law as it applies to adults in medical emergency situations.

A child’s health care is confidential

A child's health care is confidential, if the child is capable. A doctor or health care provider can’t talk with the parents or guardians about a capable child’s health care, unless the child agrees. Just as doctors must keep information about their adult patients confidential, they must also keep information about their capable child patients confidential.

There are exceptions to this confidentiality rule. In some situations, a parent or guardian may be able to get their child’s medical information, or a doctor may have to disclose information to the Ministry of Children and Family Development. For example, if there is good reason to believe that a child might harm themselves or others, or there is suspected abuse (physical, sexual or emotional), then the information may not stay private. In that case, the child should be told why their information won’t be kept private and who it will be given to.

If a doctor considers a child not capable, they will tell the child’s parent or guardian if they treat the child.

For more on patient confidentiality, see our information on getting your medical records (no. 421).

Tip

As a child, if you want your doctor to keep your medical information confidential, talk to the doctor before you get treatment to see if they agree you are capable, and if they will keep your information confidential. If not, you can look for a different doctor.

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