Decision making for children and adolescents

Parents of children under 18 years of age usually hold legal power to make decisions on their behalf; however, a child or adolescent of any age who is sufficiently intelligent and mature to fully understand the nature and consequences of a minor medical procedure can give valid consent without a parent or guardian’s authorisation. In Victoria, legislation enables a child ‘with capacity’ to appoint a specific support person to assist them with their medical decision making (see also Supported decision making).

Even if a child or adolescent is not considered to have the insight, maturity or intelligence to give consent, their views and wishes should be sought, and should inform final decisions. In such cases, the authorising body will depend on the nature of the procedure (see Types of consent required for health care) and the familial context (eg whether the child is in the care of the state, the family is subject to family court proceedings, capacity of the parents to provide consent). Care should also be taken as to who to accept as the parent providing consent if there is a suspicion of domestic and family violence; see also What to do if you suspect a person with developmental disability is being abused. For more advice, see Substitute decision making and When does a guardian need to be appointed.

Key points to note when making decisions for children:

• in all states and territories, a parent cannot refuse a blood transfusion for a child
• a procedure should only take place if it is in the child’s best interests, and all less restrictive options have been explored and evidence can be produced to show those options are not viable.

If contemplating a medical procedure for a person under 18 years of age that could be controversial, consider contacting the relevant authority first, to find out whether legal authorisation is required.