Legal, Medical, Ethical Question - Emancipation

[WolfmanHarris]

Worth noting for the sake of contrast that Canada does not have a legal age for consent for medical treatment. When challenged before the courts capacity to decide (or not) has been determined on a case by case basis.

So in the case for me: consent from the patient as I would from any other, age is essentially irrelevant. Spouse is irrelevant in this case though if the patient is unable to answer and the two are common-law they would be my de facto next of kin. If parents to the patient arrived on scene and there was a dispute then I would act in the best interests of my patient as I saw them and treat/transport. Deal with the conflict on scene as I would any other and let the longer term implications be dealt with when either the patient is able to state their own wishes again. If that's going to be impossible (i.e. coma) than determining the substitute decision maker will have to go to court anyways since there's a dispute.

[ERDoc]

You damn Canukistanians have to make everything so simple. You need to have a complex legal system that even experts in the field don't understand like your big brothers to the south have developed. It makes legal/ethical debates a lot more enjoyable.

[AnatomyChick]

I agree..the comment that she was engaged plays no role in this.. it was just a point that one of my students wanted to clarify..and to give the full picture I added.

Yes, I agree, that she is Emancipated.... Statuatory Rape has no basis on this question as it was about consent, and the "baby daddy's" age was not given..however, interesting discussion.

My goal is to see what my "peers" decided....seems like the majority of us agree that if she is "with child", she is a "parent" for now anyway, and thus would be considered an Emancipated Person and able to make her own medical decisions.

Thanks so much for all of the input.

[Just Plain Ruff]

Missouri, if the chick is pregnant and under 18, then she's legally able to make her own decision which begs the question if she is under the age of consent, and she's under the age of adult hood and she got pregnant which is usually under the age of 18 a BAD DECISION why the HELL should she be able to make any other smart decisions when she's proven she cannot make one good decision?

The above statement is not intended to be a blanket statement for all pregnancies, just the ones where the girl or boy didn't use protection or were just stupid.

[WolfmanHarris]

While I may agree that her decision making ability is suspect, that too is irrelevant to our ethical obligations as a provider.

We cannot start passing judgement and taking a paternalistic stance with this hypothetical patient any more than we can with a drug user, a smoking obese heart patient, or a diabetic shovelling candy. Capacity is the ability to make a decision and appreciate the potential consequences. They may disregard them and still choose to not act in their own best interest but that doesn't automatically give the provider any right to overrule their wishes.

The patient's right to autonomy and informed consent (or the absence of consent) is and must be the foundation of medical ethics.

[Just Plain Ruff]

While I may agree that her decision making ability is suspect, that too is irrelevant to our ethical obligations as a provider.

We cannot start passing judgement and taking a paternalistic stance with this hypothetical patient any more than we can with a drug user, a smoking obese heart patient, or a diabetic shovelling candy. Capacity is the ability to make a decision and appreciate the potential consequences. They may disregard them and still choose to not act in their own best interest but that doesn't automatically give the provider any right to overrule their wishes.

The patient's right to autonomy and informed consent (or the absence of consent) is and must be the foundation of medical ethics.

I never questioned her ability to make medical decisions for her and her baby now, what I question is the wisdom of the lawmakers who make the rules about the emancipation.

I would treat her like "the adult" she is and allow her to make any and all treatment decisions for herself. She's made her bed, so to speak so she has to lie in it. The decisions are hers and I hope that she makes the right ones from here on out.

But as a emancipated minor I would never take away her right to make any decisions for herself or her unborn baby.

My moral stance is absolutely irrelevant in her situation, I can consider her a stupid child but she's her own decision maker and she deserves to make those decisions with me supporting them as her EMS Caregiver.

Edited March 11, 2013 by Captain ToHellWithItAll

[WolfmanHarris]

Sorry, I think I may have misread what you were saying initially and took what you were saying about emancipation and applied it to medical decision making.

On the topic of emancipation, I gotta ask if she's making medical decisions, making decisions on whether or not to keep her child and then on how to raise them, what decisions are left? If anything without emancipation we place significant responsibility in the hands of this patient while keeping the risk on the parents (financial, legal). I don't see how this is better than shifting full responsibility for their life to this minor.

[Just Plain Ruff]

Wolfman, my experience has been this

Call to a house, usually a shit hole of a house, a 15 year old snot nosed kid living with 4 other snotnosed kids, and this one kid saying "I'm emancipated and I need to go to the hospital"

I tell him "I need to see the court papers that you are emancipated" and he cannot provide them. So we force him to call his parents and he refuses. So the police are called.

Then he ends up calling them and the parents come and they have some sort of either tearful reunion or the parents refuse to come and give permission to transport over the phone.

On the topic at hand, the pregnant teen, The teens I've usually dealt with have been girls who do indeed have the best interest of the baby and are keeping it. The ones who don't intend on keeping it have either already aborted it or they are going to give it up for adoption.

The ones who are keeping it do make good decisions for the health of the baby but some don't. Some who are pregnant do have parents who are with them. But others are indeed on their own. They don't have much but they have this baby and they don't want to lose the baby so they do what's right for the baby often to the detriment of their own health thus the reason why we are usually called.

The ones who are giving it up for adoption in my experience almost always have their parent with them and a supportive parental group they have.

There is more that I can add but it might detract from the discussion.

I have not been involved in these types of issues in the inner city because my work experience has not been in the inner city or the really low income areas.

[mikeymedic1984]

Pregnant teens are emancipated adults in my state also.

[MariB]

We had an attourny in our class for legal and ethics. What we learned is unless there is a court document, the teenager is not considered emancipated. We can treat life-threatening illnesses under implied consent only but need a legal guardian for anything else.