Treuman Katz Center for Pediatric Bioethics Conference Informed Consent Adolescents Jessica Berg, JD, MPH Professor of Law and Bioethics Case Western Reserve University Professor of Law and Bioethics Case Western Reserve University

Treuman Katz Center for Pediatric Bioethics Conference Informed consent Ethical Doctrine –Autonomy –Health/Welfare Legal Doctrine –Statutory Guidelines –Forms and Evidence –Liability Practice Ethical Doctrine –Autonomy –Health/Welfare Legal Doctrine –Statutory Guidelines –Forms and Evidence –Liability Practice

Treuman Katz Center for Pediatric Bioethics Conference Capacity Capacity vs. Competence Presumptions –Maturity –Responsibility –Developmental Stages –Extent of medical experience/knowledge Capacity vs. Competence Presumptions –Maturity –Responsibility –Developmental Stages –Extent of medical experience/knowledge

Treuman Katz Center for Pediatric Bioethics Conference Standards of Competence General Specific –Choice –Understanding –Appreciation –Reasoning Formulating the standard General Specific –Choice –Understanding –Appreciation –Reasoning Formulating the standard

Treuman Katz Center for Pediatric Bioethics Conference Deciding for Others Who? –Parents, Guardian, Surrogate, Proxy How? –Effectuate Prior Decision –Substitute Judgment –Best Interests Who? –Parents, Guardian, Surrogate, Proxy How? –Effectuate Prior Decision –Substitute Judgment –Best Interests

Treuman Katz Center for Pediatric Bioethics Conference Deciding for Children Legal Issues Conceptual Issues Empirical Issues Legal Issues Conceptual Issues Empirical Issues

Treuman Katz Center for Pediatric Bioethics Conference Empirical Issues Semantic Understanding Developmental Issues –Cognitive (capacity) –Psycho-social (voluntariness) Perception of Authority/locus of control Role of peers and peer pressure Family dynamics Semantic Understanding Developmental Issues –Cognitive (capacity) –Psycho-social (voluntariness) Perception of Authority/locus of control Role of peers and peer pressure Family dynamics

Treuman Katz Center for Pediatric Bioethics Conference Special Situations Emancipated Minor –Marriage, Pregnancy, Parenthood, Self- Support, Military Service, High School Graduate Mature Minor –Capacity and Age Emancipated Minor –Marriage, Pregnancy, Parenthood, Self- Support, Military Service, High School Graduate Mature Minor –Capacity and Age

Treuman Katz Center for Pediatric Bioethics Conference Special Situations Contraception Pregnancy Abortion Sterilization Alcohol/Drug/MH Treatment Blood Donation Contraception Pregnancy Abortion Sterilization Alcohol/Drug/MH Treatment Blood Donation

Treuman Katz Center for Pediatric Bioethics Conference IC and Minors Assent Parental Permission Disagreement Assent Parental Permission Disagreement

Treuman Katz Center for Pediatric Bioethics Conference When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years. Mark Twain When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years. Mark Twain