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Age of Consent

Question# 745

What is the minimum age that a patient needs to be to refuse treatment and transport to hospital?

Answer:

Thank you for your question.

As you may recall from Spring CME 2023, the Health Care Consent Act, does not list a minimum age at which someone can provide consent to treatment, which includes refusal of treatment.

Historically, it was interpreted as the Age of Majority as a general rule for consent. However, the legal age of majority has become progressively irrelevant in determining when a young person may consent to their medical treatment. ​

The determinant of consent in a minor has become the extent to which the young person's physical, mental, and emotional development will allow for a full appreciation of the nature of their clinical condition, an understanding of the applicable risks, and the reasonable consequences of the proposed treatment, including the refusal of such treatments.

Depending on the clinical condition, patient capacity and verbalization of their understanding a 12-year-olds who understands the pathology may have capacity to consent to treatment; likewise, someone in their 50s or 60s, depending on the clinical condition and appreciation of the risks, may not have capacity.

Where a patient under the age of 18 lacks the necessary capacity, the parents or SDM are authorized to consent to treatment on the minor's behalf and must be guided by what is in the best interests of the patient.

First, the paramedic should assess if the patient or SDM can understand the clinical situation, verbalize an understanding of the reasonably foreseeable risks, and are able to communicate a care plan. The patient should also not have any capacity distractors (severe pain, acute fear or anxiety, new confusion or delusional thinking, unable to make a settled choice, or any other observed concerns).

Once capacity is assessed, and the patient or SDM is determined to understand and appreciate, then the informed consent conversation can proceed to outline the treatment to the specific clinical situation, the applicable risks to the proposed care plan to determine if the patient agrees.

Ultimately, a patient or SDM is capable with respect to the treatment plan if the patient is able to:​Understand the information that is relevant to making a decision about the treatment or alternatives being proposed; and​ Appreciate the reasonably foreseeable consequences of a decision or lack of decision with respect to the treatment plan.

The “Aid to Capacity Assessment” found in the ACR completion manual is a tool to assist paramedics in determining whether a patient or substitute decision-maker (SDM) is capable of making decisions regarding their treatment. We frequently associate the ability to determine capacity with the aid to capacity evaluation tool in the ACR. However, we must pay attention to the criteria below the tool in the ACR completion manual. These questions assist the paramedic in determining if there are any barriers to capacity.​ As a reminder, a patient is presumed to be capable unless a crew has a reasonable ground to believe the patient is incapable to consent to the specific treatment proposed based on the five outline criteria.

In short, capacity is fluid and changes over time. Capacity to consent or refuse treatment depends on the specific clinical situation and the patient’s own ability to understand and appreciate the situation, and the reasonably foreseeable risks.

To provide a simple example, a minor may be able to appreciate the risks of infection and consent or refuse wound care for a cut. However, a minor may not necessarily grasp the intricacies of not seeking cancer treatment (or transport to hospital for diagnostic purposes) given the complexity of disease pathology, understanding of anatomy and mortality generally; however, their substitute decisions maker (parent or guardian) may.

Hope this clarifies your question & stay safe out there.

References

BLS PCS

Published

07 November 2023

ALSPCS Version

5.2

Views

533

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.