Obtaining Consent from a Minor

BACKGROUND

Lowan, an occupational therapist (OT) working in a publicly funded youth mental health program, is contacted by 14-year-old Xander, who requests counselling services due to recent bullying he has experienced in school. Lowan asks if Xander’s parents or guardians are aware he’s seeking occupational therapy services. Xander says they’re not and he doesn’t want his parents to know he’s being bullied or seeking counselling. Lowan is unsure how to proceed as this is the first time a minor had sought his occupational therapy services without their parent’s knowledge. He decides to have a discussion with Xander about the nature of the bullying and his reasons for not wanting to involve his parents in the counselling sessions. Xander tells Lowan his parents are going through some marital issues, and he doesn’t want to add any further stress.

Lowan proceeds to discuss the role of occupational therapy, what the sessions would entail, the risks and benefits as well as the consequences of not proceeding with counselling and other options available through the youth program. Lowan asks some questions to determine what Xander understands from the conversation. Xander provides answers that demonstrate a depth of understanding about the nature of services and an appreciation for the consequences of proceeding or not proceeding. Lowan determines Xander has the capacity to consent to the occupational therapy services and explains to Xander that he will provide the counselling services, however he would be obligated to inform Xander’s parents or others if he felt at any time Xander was at risk of harm due to the bullying. Xander agrees and provides informed consent to proceed with the occupational therapy services.

Four weeks into the counselling sessions, Lowan receives an angry voicemail from Xander’s mom, who has discovered Xander is receiving counselling without her consent. Lowan wonders how he should respond.

CONSIDERATIONS

  • Lowan reviews the Health Care Consent Act, 1996 and notes, in Ontario there is no minimum age of consent. Anyone “capable with respect to treatment” can consent to treatment on their own behalf. The Act further states that a health care practitioner should assume a person is capable unless there is reason to believe they are not. If the person is not capable of providing consent to the treatment being proposed, the health care practitioner must obtain consent from a substitute decision-maker.

  • Lowan reviews the Standards for Consent and contacts the College Practice Resource Service, who advise him that he needs to look at the applicable legislation as well as client factors such as age, level of maturity, the type of occupational therapy services provided, and the risk level involved. 

  • Lowan reflects on the actions he took considering Xander’s situation, his age, his insight, his capacity to consent, and the risk level of his occupational therapy services and feels confident in his decision to proceed with the counselling sessions. 

OUTCOME 

  • During their next session, Lowan discloses to Xander that he received a voice message from his mother. He discusses her concerns and how she found out he was attending counselling. Lowan and Xander examine the possibility of informing his mother about the bullying at school and his counselling services. Lowan advises Xander that he needs his consent to speak to his mother. 

  • Xander considers their discussion and feels comfortable with Lowan telling his mother about his situation, however he would like to speak to her first. Xander provides consent for Lowan to call his mother and follow up regarding her voicemail and any outstanding questions regarding his treatment.
  • After giving Xander a few days to speak with his mother, Lowan contacts her and they review how he obtained consent from Xander to proceed with the occupational therapy services. Xander’s mother decides she would like to attend one of the counselling sessions with Xander, to which Xander agrees. Lowan schedules a date for the session to occur.

DISCUSSION

The College encourages OTs to use professional judgement and care when determining if a minor is capable of consenting to occupational therapy treatment. A minor can have the capacity if they understand the proposed treatment and the risks and benefits involved. Some factors to consider are: 

  • age of the minor,
  • level of maturity, 
  • type of treatment being proposed, and 
  • level of risk involved. 

A minor may be capable of consenting to some components of a treatment plan, but not others. 

If an OT determines a minor is incapable of providing consent, the OT cannot proceed until they obtain informed consent from a substitute decision maker such as the minor’s parent or guardian. 

REFERENCES

CONTACT

If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org

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