Mature Minor Assessment Tool
The decision to provide services to a minor on the merit of her/his own informed consent will be made on a case by case basis as per the Mature Minor doctrine.
Under this doctrine, a mature minor is a child under 18 who has the capacity to fully appreciate the nature and consequences of a proposed health treatment, and is capable of giving informed consent. It is not based primarily on age but on capacity to understand and make decisions.
Factors to consider in assessing capacity should include the age and maturity of the youth, their ability to understand the health issue and the nature and complexity of the treatment and the consequences of consenting or refusing to give consent. Generally, a child under 12 is considered to not have capacity to give consent. The capacity of a youth over 12 must be assessed by the health care provider. A youth 16 and over is generally considered to have capacity unless there are factors that indicate otherwise.
If the child has this capacity, then the child’s consent is both necessary and sufficient; the parent’s consent is not required nor can the parent override the child’s decision.
Core assessment questions
What is the nature, and purpose of the treatment?
Risks and benefits?
Does the young person have the intellectual capacity to understand the information relevant to the health decision and the potential risks and benefits?
Are there any emotional, cognitive or psychiatric vulnerabilities, broader lifestyle or social affiliations (influence of religious, cultural, or other group affiliation) that might impact their ability to provide informed consent?
Despite any assessed vulnerabilities, do they understand the implications of treatment or non-treatment?
Is there any evidence of coercion or undue influence on the young person’s ability to exercise independent decision-making?
Are the young person’s views stable, and appear to be a true reflection of their core values?
Other questions to consider in medical decision making:
Have they made medical decisions before?
Do they need more time to think about the information?
Have they been offered the opportunity to discuss the decision with a parent/guardian?
*A harm reduction approach to delivering health care to youth means offering services based on where they are at, explaining the risks and harms and respecting their rights to make their own choices to reduce harms.