Braving difficult choices alone: children's and adolescents' medical decision making.

OBJECTIVE: What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. METHODS: Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. RESULTS: Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. CONCLUSIONS: Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process

Medical Treatment Decisions and Competency in the Eyes of the Law: A Brief Survey

The question of mental competence arises in many different areas of the law. In order to make contracts and wills, have criminal responsibility, be a witness, or stand trial, a person must be mentally competent. Obviously, however, not every degree of mental deficiency or peculiarity is legally significant. Moreover, there is no single test of competence for these various contexts; rather, competency is defined in different ways for different purposes [56]. As a result, and somewhat paradoxically, a person can be legally incompetent in some areas while remaining legally competent in others. For example, since the law requires a lower degree of capacity in the making of wills than it does for the execution of contracts, one may be competent to make a will but incompetent to transact ordinary business affairs