title: The attitude of Flemish paediatricians regarding informed consent of adolescents.
abstract: BACKGROUND
  Since 2002 the Belgian law requires an informed consent of the patient before each medical intervention. This provision applies also for adolescent patients on condition that the physician considers the young patient as competent to autonomously participate in the decision making process.
  
  
  OBJECTIVE
  The purpose of this study is to evaluate to what extent Belgian paediatricians from the Flemish part of the country have implemented the legal requirements for informed consent of adolescent patients, in particular when they consult alone.
  
  
  METHODS
  In the frame of a larger study regarding the relation between paediatricians and their patients, a questionnaire was sent via regular mail to 570 Flemish paediatricians, evaluating how and how often they obtain an informed consent of the adolescent when consulting a physician unaccompanied.
  
  
  RESULTS
  In only 1% of all consultations an adolescent consulted the physician alone and agreed to a medical intervention on his/her own. The information given by the paediatrician did not differ if the adolescent consulted alone or was accompanied by (one of) his/her parents for the following items: purpose and type of treatment (100% vs 100%), duration of treatment (92% vs 94%) and aftercare (89% vs 93%). However, the information differed with regard to alternatives to the treatment (65% vs 76%), degree of urgency (89% vs 95% ), treatment related risks (82% vs 90%) and cost (21% vs 45%). 18.6% of the paediatricians consider age as the single criterion to evaluate the competence of the adolescent to provide an informed consent; other criteria that are considered: experience (92%), insight into and factual understanding of the clinical picture (84%). To fulfil the tasks of providing information and asking for consent, paediatricians rarely had recourse to prior established protocols (14%), they preferred to rely on proper experience and expertise (81%). Fifty percent appealed to the opinion of other health care providers.
  
  
  CONCLUSIONS
  Although the Belgian law stipulates regulations that should be complied with by the physician during the decision making process about any medical intervention on adolescents, this legislation has rarely been put into practice, as the adolescents used their right to autonomously consent in barely 1% of all paediatric consultations. For the majority of the respondents other criteria than age were taken into account to consider an adolescent as able to provide informed consent.
authors.affiliation: Departement of Paediatrics, UZ Brussel Kinderziekenhuis, Vrije Universiteit Brussel, Belgium. michel.deneyer@uzbrussel.be
authors.forename: M
authors.initials: M
authors.lastname: Deneyer
authors.forename: J
authors.initials: J
authors.lastname: Otten
authors.forename: J
authors.initials: J
authors.lastname: Marchand
authors.forename: R
authors.initials: R
authors.lastname: Buyl
authors.forename: C
authors.initials: C
authors.lastname: Clybouw
authors.forename: Y
authors.initials: Y
authors.lastname: Vandenplas
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001530:Belgium; D002648:Child; D005260:Female; D006801:Humans; D057828:Informed Consent By Minors / Q000331:legislation & jurisprudence* / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence / Q000523:psychology; D008875:Middle Aged; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires