Skip to main content

Consent of the Pediatric Patient

Last week, an interesting question was raised in our primary care fellowship ECHO session. "Can you give consultation to a minor without the guardian's consent?" A simple scenario could be when a 15 year old girl comes to your clinic alone, anxious, and asks for a consult. Would you proceed normally? Would you ask her to call her parents and come back? What would you do?

During the session I quickly searched and found an article in Indian Pediatrics, which said that "A child between 12-18 years can give consent only for medical examination but not for any procedure". But then, I went back to see on what legal basis this was said. They seem to have referred Legal Aspects of Medical Care, a book by RK Sharma. I unfortunately do not have this book to figure out which source in law RK Sharma has used.

So I started searching more. In National Medical Journal of India, Karunakaran Mathiharan goes through various clauses of multiple statutes and state that there is a need for clarity, specifically that "The Indian Penal Code is silent about the legal validity of consent given by persons between 12 and 18 years of age"

In a "special article" in Indian Journal of Anaesthesia co-authored by a couple of anaesthetists and a lawyer, they say "A child >12 years can give a valid consent for physical/medical examination (Indian Penal Code, section 89)." (sic). And then they give reference to "Rao NG. Ethics of medical practice. In: Textbook of Forensic Medicine and Toxicology. 2 nd ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2010. p. 23-44. " Sure enough, Rao NG's book does mention this on page 35.

But, unfortunately, Section 89 of IPC doesn't really say so. Section 89 talks about "Act done in good faith for benefit of child or insane person, by or by consent of guardian." (emphasis supplied). In my reading of section 89, it only applies to acts by guardian or by the consent of guardian. A doctor doesn't become the guardian or "other person having lawful charge of that person" at no time in their usual work. So this is just propagation of errors.

There is a "Scientific Letter" in Indian Journal of Pediatrics, which reads only sections 87 to 90 of IPC and boldly claim that a child above 12 years age can give consent for routine elective surgery. The authors have affiliation to departments of forensic medicine or pathology. I agree with their interpretation of the sections, but I have to warn others that this does not ensure that a judge will agree with this interpretation. I could not find from sources I have whether this interpretation has been tested in any court.

The other side of the story is that according to Indian Contract Act, only someone who has attained age of majority is competent to contract. Age of majority is 18 in India. The doctor patient relationship is a contract - implied or explicit. Therefore, a minor cannot really enter into a doctor patient relationship. But in my opinion, this should only matter when there is a question about the legality or the validity of the doctor patient relationship. To just talk to a minor, there needn't be a doctor-patient relationship.

Here is a link to the Indian Penal Code. Read sections 87 to 90 and form an opinion on your own.

If you ask me what I would do when a 13 year old comes to me for a consult, I would say "I would go ahead and talk to them to see what they are here for, but I would not do any procedures or anything that could (even theoretically) cause harm".

Comments

Popular posts from this blog

What Doctors Don't Get to Study in Medical School by BM Hegde

Disclaimer: I realize that I could be putting myself in great academic danger by publishing this post while studying medicine in the same state of the honoured author. But whoever decides to influence my very open professors and make me fail in my exams, also please read this response by nirmukta to one of his articles, to realize that I'm not the only person who feels like there's stone in the rice, waiting to be bitten. Ah! What an interesting title and how easy a way to grab the attention of a medical student tired of reading pharmacology.Within minutes of starting to read this book, I could smell honest but blind religiosity.With all due respect to the degrees the author possesses, this book isn't worth buying. But you should definitely read it once, to understand the workings of a conspiracy theorist's mind.
If you read with a truly open mind, you will be able to ignore the blatant errors of facts or practicality and focus on the drive home message, whi…

Product Idea: "Explain My Prescription To Me" Service

Many doctors have very little time to spend with the patient. So little time that sometimes they start writing prescription before even arriving at a provisional diagnosis. Imagine how then, would they explain to their patient why they have written a particular tablet for them?

Is there a product/service idea in this vacuum of counseling that should have been provided by the doctor? Are there people who are not able to ask the right questions to the internet to find the answers?

Perhaps there should be an app that is front-end for a prescription description service. The user uploads their prescription and also attaches a short voice note with their symptoms. This goes to a doctor/nurse/pharmacologist/pharmacist at the back-end who responds by reading out the prescription and counseling the patient about what the medication is, what it does, what side effects can be expected, etc.

The counseling of each medicine can be recorded and reused for the next patient who is prescribed the same…

The Curious Case of Consultation Fees in General Practice

Today as I was returning home in metro two lawyers occupied the seats next to mine. I was reading A Reader on Reading by Alberto Manguel. But I distinctly heard one of them tell the other "I have two cases tomorrow evening". That set me thinking.

Advocates have "cases" and so do doctors. Advocates have "clients" and so do doctors. (Some doctors call their clients patients because some clients are indeed patients. But some doctors call even their patients clients, appreciating the fact that ultimately the people who come to them are dignified individuals seeking a service and with autonomy in choosing service providers.)

Advocates are also notorious for charging sometimes lakhs for an "appearance". But here doctors have itt slightly different. Doctors also get called money-minded and unscrupulous, but they get called so for charging much less than what advocates usually charge. Why is this so?

I came up with various possible reasons. One, the hu…

Why "Regulations" Are Often Not Helpful Solutions

The other day I saw an impassioned plea from a doctor asking associations to "regulate the profession". The reason they cited was that healthcare is turning commercial and often this goes against the best interest of the patient.

One of the many things I learned in National Law School listening to Prof Nandimath and others is that "regulations" come with their own set of problems.

Let us look at it more closely.

First, what is the problem we are trying to solve? The healthcare system in our country (many other countries too, perhaps) have huge flaws in it that lead to suffering and poor quality of care for the end user (the patient). Medical training is focused on the wrong parameters (recent change of UG curriculum to a competency based curriculum is proof of this). Distribution of healthcare providers is disproportionately concentrated in urban areas. Healthcare is episodic. Government policies are weakening public health system. (Public health system, even o…