THE BALANCE between protecting children and allowing them a voice in their own affairs is a difficult one. There are few areas where this tension is more acute than in relation to medical treatment and information, including contraceptive advice and highly invasive but potentially life-saving treatments.
In a recent report on these issues, the Law Reform Commission reiterated that those aged 16 and 17 should be allowed to consent to or decline healthcare and treatment, and be entitled to medical confidentiality on the same basis as those over 18. Children under 16 should have their views taken into account when obtaining medical treatment but, in general, they would not be considered capable of giving or withholding consent.
However, the commission did envisage exceptional circumstances where children under the age of 16 may have the maturity to give such consent and be guaranteed confidentiality. And it set out the considerations that should be taken into account by medical practitioners when assessing their capacity to do so.
Much of the debate in this area is likely to focus on the controversial subject of contraceptive advice for those under the age of consent to sexual activity. But a more important issue is how to deal with cases where seriously and perhaps terminally ill children in their mid and late teens, many of whom are driven by their illness to a maturity beyond their years, have firm views about their treatment that might conflict with their parents.
The report envisages 16 and 17-year-olds being able to make advanced care directives in such circumstances. In highly exceptional cases, younger teenagers may be able to do so too. However, where any person under 18 refuses life-sustaining treatment, an application to the High Court would be required to decide on the validity of the refusal. There will be instances also where young people under 18 will require psychiatric treatment, some of which has highly undesirable side-effects and may involve involuntary detention. Protections that exist for adults in this situation have not been provided for minors, and the commission proposes remedying this.
Issues such as these can create heart-wrenching dilemmas for parents, young people and medical practitioners. Yet maturity does not descend suddenly at the age of 18. It is a state that evolves, and those under that age should have their voices heard. These proposals demand calm and fully engaged debate which would be badly served by an excessive focus on their implications for matters like contraceptive advice.