Medical Consent And The Treatment Of Minors

Consent for evaluation and treatment must be obtained for medical care to be delivered in a lawful manner. State laws vary regarding the age of majority at which consent may be given by a patient, varying between 18 and 21 years of age. In the case of minor children, consent must be obtained from the legal guardian (typically a parent, unless custody has been removed) prior to initiation of treatment. This does not apply, however, to triage and examination, and children should be evaluated without delay to determine the nature of the illness or injury. If the child is not accompanied by persons able to provide consent, the parent or guardian should be contacted by phone and witnessed consent obtained. Such attempts should be documented in the medical record. Written documentation from the parent or legal guardian granting consent may suffice in many states, but this should not obviate attempted phone contact for permission to treat. In the absence of consent, the patient should be evaluated sufficiently to determine the presence or absence of an emergent situation. In the setting of an emergency situation in which delay in treatment may threaten the life or health of the child, consent can be assumed and care initiated with ongoing attempts to locate the parent or guardian. If any doubt exists, the emergency physician and patient are best served by providing treatment with documentation of efforts to determine the presence of an emergency and obtain consent for treatment. In the absence of an emergency, further care should not be provided unless specifically permitted under state law ( I§bJ.e...111-4). Most states permit minors to seek treatment for child abuse, substance abuse, sexually transmitted diseases, and pregnancy-related complaints without parental consent. Most states consider a child "emancipated" and able to provide consent if a member of the armed forces, married, or self-supporting and living on his or her own. Some states permit older minors to give consent for nonemergent care. Many states have a process for obtaining concurrent judicial review and consent. Emergency physicians are encouraged to become familiar with the specific state laws applicable to consent issues. 2 As a matter of courtesy and necessity, verbal consent should be obtained from older minors as well, typically at age 12 and older.

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