title: Minors' decision-making capacity to refuse life-saving and life-sustaining treatment: legal and psychiatric perspectives.
abstract: Laws in Belgium and The Netherlands permit euthanasia and assisted suicide for seriously ill children who experience "constant and unbearable suffering"--they have the capacity to request death by lethal injection if they convey a "reasonable understanding of the consequences" of that request. The child's capacity to understand death is therefore a prerequisite to the implementation of the request. However, modern neuro-psychological and fMRI (functional Magnetic Resonance Imaging) studies of the relationship between the neuro-anatomical development of the brain in human beings and their emotional and experiential capacity demonstrates that both are not fully developed until the early 20s for girls and mid-20s for boys. Unlike Belgium and The Netherlands, the clinical and legal implications of the immaturity of the brain on medical decision-making of minors, in particular life and death decisions, have been implicit in the Australian courts' approach to the refusal of life-saving and life-sustaining treatment by minors. This approach is exemplified by X v Sydney Children's Hospitals Network [2013] NSWCA 320 (and a series of earlier cases).
authors.forename: Danuta
authors.initials: D
authors.lastname: Mendelson
authors.forename: Ian
authors.initials: I
authors.lastname: Haywood
mesh_terms: D000293:Adolescent; D001315:Australia; D001530:Belgium; D001921:Brain / Q000254:growth & development; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D033242:Minors / Q000331:legislation & jurisprudence*; D009426:Netherlands; D011581:Psychological Tests; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*