In the eye of the beholder

Considering maturity at different ages

Rely on expert advice when determining the maturity and consent required for minors, say ethicists.

The National Commission on Bioethics in 1977 published a recommendation on consent of minors that has been well-accepted in the medical community, notes Rosalind Ekman Ladd, professor in the department of philosophy at Wheaton College in Norton, MA.

"For children under the age of 7, you should try to get assent," she says. "That means trying to explain the treatment to them and get them to agree. And, the commission makes a distinction between treatment that is therapeutic and nontherapeutic. If the treatment is just for research that is not going to benefit the child, then even the small child has a veto over participation. If it is something beneficial to them, they don’t have a veto, but you should try to get assent."

Some ethicists agree that chronological age is unreliable as a determining factor for allowing refusal of consent to treatment.

"The moral guidance should be to always get the input of the child," says the Rev. John Paris, SJ, Walsh Professor of Bioethics at Boston College in Boston. "If the child is older than 14 and able to well-articulate her ideas and beliefs, you should be exquisitely sensitive to those beliefs even though they are not necessarily going to be dispositive. You have to weigh it and judge it and assset it in the context of this family and this situation. Their values in conjunction with the medical assessment has to be a strong component."