Vaccinations and surgeries: Can children be treated secretly from their parents?
Olga Lukinskaya
In the US, teenagers whose parents refused they are vaccinated, they are increasingly applying for vaccinations, although not all states have such an opportunity - usually the consent of parents or guardians takes up to eighteen years. The rights of juvenile patients is a complex topic, especially in the context of a transgender transition or mutilation, which intersex people undergo in infancy. We understand at what age a child in Russia can independently decide on vaccination, can a mother be present at her daughter's visit to a gynecologist, and how the rights of minor patients in different countries are resolved.
What is the difficulty
Making decisions for a child is not as simple from an ethical point of view as it may seem. Most would agree that eliminating immediate danger, stopping the bleeding, injecting a medication when it is indicated is a necessity, even if the child is against (and he can be against it simply because the injections are painful and the antiseptics are scratching the scratches). Refusal to treat a child in need of therapy can also be quite clearly assessed - this is yet another news about a convicted mother whose child died from HIV infection. But between these extremes - a lot of situations in which parents, without breaking the law, can harm a child. These include refusal to vaccinate, insisting on unnecessary, in fact, intersex-child surgeries, circumcision, debates about the ethics of which do not subside, or cases where parents insist on continuing treatment that is no longer beneficial.
Canadian experts on bioethics explain that conflicts in decision-making can occur when the opinions and values of parents contradict the recommendations of health workers. It is proposed to meet parents, but only when their decision does not harm the child. It is recommended to clarify medical facts, prognosis, benefits and risks of treatment, and if the disagreement continues, offer to get a second opinion. If doctors are confident that the decisions of the parents clearly contradict the best interests of the child or teenager, then it is recommended to involve an ethics committee or a consultant in the matter. The next level is the bodies involved in the protection of children, and the legal system.
Back in 1982, one study found that medical decision making by teenagers of fourteen years and adults did not differ, and even nine-year-old children, although it was more difficult to convey information to them, were able to solve questions relating to their treatment. Participation in discussions and the possibility of choice are important for the child - they help to feel yourself as a person respected by others. In the Canadian publication mentioned above, it is recommended to give such an opportunity even to children of primary school age, within reasonable limits - for example, a child can choose himself which shoulder (right or left) he will be given an injection, although he cannot refuse the injection.
Informed consent
A necessary condition for any medical intervention is to obtain prior voluntary informed consent. This consent is given either by the citizen himself or by his legal representative - the latter applies to children and to those who are recognized as incapable. Legal representatives of children - most often their parents. The age of consent is often equal to the age of majority or approaching it - in different regions of Canada it is 16, 18 or 19 years, in Australia - 16, but sometimes a patient can give consent younger than that age (if, according to two doctors, the child is able to understand the nature , the consequences and risks of treatment, and the treatment itself is in the best interest of the patient).
In Israel, the age of consent is 18 years old, with some important exceptions — for example, a patient of any age can give consent to an abortion and parents notify or no consent is required. In the UK, medical decisions can be made by people aged 16 and older. In the countries of the European Union, the age of consent can range from 14 years (in Latvia) to 18 (in ten countries). In France, although before the age of 18, the decision is taken by the legal representatives of the child, they must take into account his opinion. In Austria, Belgium, the Czech Republic, Estonia, Germany, Luxembourg and Sweden, the age of consent to medical interventions is not fixed - and in each case the decision is made individually, depending on the child’s ability to participate in the process.
Some medical interventions are permitted without the consent of the patient (or his legal representative). In Russia, it is, for example, assisting in the presence of a life threat: if emergency measures are needed to save a person’s life, but he cannot give consent (for example, he is unconscious), then doctors will save him. More informed consent is not required for people with diseases that pose a danger to others, people with severe mental disorders, people who have committed crimes, as well as during a forensic or forensic psychiatric examination. According to the new bill, consent will not be required for the provision of palliative care.
Age of consent in Russia
Patients 'rights in Russia are regulated by Federal Law No. 323-ФЗ of November 21, 2011 "On the Principles of the Protection of Citizens' Health in the Russian Federation" and the Civil Code of the Russian Federation. In accordance with paragraph 2 of Article 54 ("The rights of minors in the field of health care") of the Federal Law, "minors over the age of fifteen years or drug-addicted minors over the age of sixteen have the right to informed voluntary consent to medical intervention or to refuse it ". Arina Pokrovskaya, a lawyer, psychoanalyst, head of the Pokrov Center for Psychology and Law, the author of the book “Medical Law for Children and Parents”, explains that the concept of “older” also includes the day that this age occurs, that is, we are talking about people who have reached fifteen (or sixteen) respectively. It turns out that a child can take an independent decision on, for example, vaccination, starting at the age of fifteen.
The right to medical secrecy in Russia also arises from the age of fifteen - however, the protection of personal data is broader than the issue of medical confidentiality and is regulated by other special legislation. It happens that the parent insists on his presence during the visit of the child to the doctor - and the child has already reached the age of consent. For a patient or patient, this can be very uncomfortable, especially if we are talking about a delicate situation, for example, a gynecological examination. According to Arina Pokrovskaya, in this case, the doctor should explain to the minor patient her right to confidentiality in an accessible form and invite her mother to stay outside the door. But if the patient unequivocally agrees to the presence of the mother (or another relative) and this does not interfere with the medical tasks, then the doctor is entitled to conduct a visit with them.
With regard to the transgender transition and corrective operations - in Russia, in order to get a referral to a medical commission that will give an opinion on this possibility, you need some time (from two months to two years) to be observed by a psychiatrist. Formally, a patient from the age of fifteen has the right to turn to a psychiatrist to begin this observation.
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