Assessing an Adolescent's Capacity for Autonomous Decision-Making in Clinical Care.
The purpose of this article is to provide policy guidance on how to assess the capacity of minor adolescents for autonomous decision-making without a third party authorization, in the field of clinical care. In June 2014, a two-day meeting gathered 20 professionals from all continents, working in the field of adolescent medicine, neurosciences, developmental and clinical psychology, sociology, ethics, and law. Formal presentations and discussions were based on a literature search and the participants' experience. The assessment of adolescent decision-making capacity includes the following: (1) a review of the legal context consistent with the principles of the Convention on the Rights of the Child; (2) an empathetic relationship between the adolescent and the health care professional/team; (3) the respect of the adolescent's developmental stage and capacities; (4) the inclusion, if relevant, of relatives, peers, teachers, or social and mental health providers with the adolescent's consent; (5) the control of coercion and other social forces that influence decision-making; and (6) a deliberative stepwise appraisal of the adolescent's decision-making process. This stepwise approach, already used among adults with psychiatric disorders, includes understanding the different facets of the given situation, reasoning on the involved issues, appreciating the outcomes linked with the decision(s), and expressing a choice. Contextual and psychosocial factors play pivotal roles in the assessment of adolescents' decision-making capacity. The evaluation must be guided by a well-established procedure, and health professionals should be trained accordingly. These proposals are the first to have been developed by a multicultural, multidisciplinary expert panel.
Multidisciplinary Unit for Adolescent Health, CHUV/University of Lausanne, Lausanne, Switzerland. Electronic address: Pierre-Andre.Michaud@chuv.ch.
Pierre-André
PA
Michaud
Department of Population, Family & Reproductive Health, Bloomberg, School of Public Health, Johns Hopkins University.
Robert Wm
RW
Blum
Ethics Unit, Faculty of Biology and Medicine, Interdisciplinary Ethics Platform (Ethos), University of Lausanne, Switzerland.
Lazare
L
Benaroyo
l'Institut international des droits de l'enfant, Sion, Switzerland; United Nations Committee on the Rights of the Child, Geneva, Switzerland.
Jean
J
Zermatten
Department of Maternal, Newborn, Child and Adolescent health, World Health Organization, Geneva, Switzerland.
Valentina
V
Baltag
D000293:Adolescent; D000067697:Adolescent Health / Q000592:standards*; D016497:Adolescent Health Services / Q000592:standards; D003219:Confidentiality; D003657:Decision Making; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D007391:International Cooperation; D016743:Mental Competency / Q000592:standards*; D000297:Psychology, Adolescent
Adolescent; Assessment; Decision-making; Development; Ethics; Psychosocial