Mark Twain once said that the proper method of raising children was to, at 12, stick them in a pickle barrel and feed them through the hole. At 14 cork the hole and walk away. I’m sure that there are many parents who want to leave this post now to check Amazon for pickle barrels, please don’t.
We all know that kids can sometimes be difficult and want to be very independent, but as medical providers where does this line get drawn? When are we using implied consent and when are we abducting the child? The line is a lot greyer than people suspect.
Implied consent for the treatment covers the general assessment and treatment for injuries that provide imminent and significant potential to harm a pediatric patient but where does this line get drawn? It’s easy to accept doing CPR on a child as implied consent, (hopefully we will never have this experience) but what about bleeding? How much blood establishes the threshold for imminent and significant potential for harm?
A minor is defined as a person who has not yet reached the age of majority for their state. Each state differs slightly, but generally is considered at 18 years old. At this time the state has determined that the individual has the ability to make decisions for themselves. Before this date, however, the state does not feel that the youth can make effective decisions that have long term ramifications. But what’s the difference between someone who is 17 years 364 days and being 24 hours older? In the eyes of the state a lot; but is there really? At what age can someone make their own decisions about their own body for non-life-threatening injuries or illnesses? Can we release a 16 year old that doesn’t want treatment for a broken arm, so long as there is good distal circulation? What about a 13 year old with a sprain or controlled laceration? As medical professionals we sometimes run into teenage patients that wish to refuse our care, how do we draw this line? If we force ourselves upon someone in non-life threatening situations we may be opening up the possibility for accused abduction.
Luckily, most teens will not present themselves for treatment if they do not wish treatment so there may be injuries that occur that we are never made aware. In these cases we have no duty to act as we were never presented with a case. But what do we do when a well-wishing bystander calls for our help?
The easiest way to get consent is to find a parent or legal guardian to give us express consent to treat their minor child. Cellular phones have made this task easier as most of us are seldom unreachable; we can try to call their parents to the treatment area or receive permission via phone. But in the absence we must try different ways to obtain consent. Youth attending a group event generally have a release signed by the parents allowing the chaperones to make the medical decisions until they can be reached.
Let’s consider another area of concern for both Ambulance personnel and Ski Patrollers. After treatment, to whom do we release a minor patient? For instance a season pass holder child is dropped off for the day at the hill and falls with abrasions to the face; bleeding is controlled but we cannot find the parents. Can this child be released? As volunteers has it now become our duty to be this child’s babysitter for the remainder of the day? Can we allow them to return to skiing? Must we force them to stay in the patrol room? (Child abduction; anyone?) When can we release a minor to their own protection? On an ambulance, what happens if it’s at night or friends have left the child to be alone?
If you haven’t guessed from the plethora of question marks, there are many more questions than answers. This is a sensitive subject that seems to have as many answers are there are weekend lawyers. We must balance the need for treatment with the rights for even a child to maintain privacy and autonomy. We must also balance our role as care providers with our role as patient advocates whether volunteer or professional. We must consider the unnecessary costs involved with sending them off by ambulance or to an emergency room for non-life-changing injuries. We have all had kids presented that didn’t need more than a Band-Aid for a boo boo, yet since we’ve started care we have a duty to ensure the safe release of the patient as well. I would suggest using common sense in these situations; unfortunately common sense is no longer common. While you may make a decision that you feel is in the best interest of the youth, the parents or legal representatives may feel differently. This would be a great time to pass the buck. Contact management or Medical Control and confer with them to determine the best outcome in these situations. Document who was involved and the decisions made on behalf of the child. While there is still not a definite answer, it’s easier to defend multiple providers agreeing with the same decision for the betterment of the child.
This week let’s watch a video about assessing a pediatric patient before they start talking back.
All parents of teens will likely agree that teens can make better decisions . . . after all, they know everything! (I’m sorry; I’m now choking from the tongue in my cheek. Anyone want to practice abdominal thrusts?)