Proxy Consent

Civil code of the Philippines Civil code of the Philippines Competency of minorsCompetency of minorsArt. 38. Minority, insanity or imbecility, the

state of being a deaf-mute, prodigality and civil interdiction are mere restrictions on capacity to act, and do not exempt the incapacitated person from certain obligations.

Art. 402. Majority commences upon the attainment of the age of twenty-one years. • The person who has reached majority is

qualified for all acts of civil life.

Informed consentInformed consent

• Right & responsibility that each person has with regard to his/her own well-being & pursuit of happiness & eternal life.

• Physician, Patient, Proxy• Christian concept:

– Right to choose & request the medical care that will fulfill one’s responsibility to God, self & neighbor

• If a person is not able to give Informed consent, it must be obtained from the patient’s proxy

Elements of Free and Informed ConsentElements of Free and Informed Consent

1. Information

Presentation – full disclosure to the person must be in understandable words and manner

2. Comprehension - the person must understand the information.

3. Freedom - independence of the person to make a free choice.

Competence - ability of the person to receive the information, remember, understand, and assess it.

Children cannot provide informed consent because they lack the

capacity to become fully informed

Proxy• Person designated when the patient is not

competent to make medical decisions himself/herself.– pediatric patients– severely ill patients

• Selected from the patient’s family or by means of advanced directive.

- Basis : relative loves the patient, thus, medical decisions are based on relative’s best interest

ChildrenChildren

• Considered incompetent under the law

• Usual surrogates: Parents of the child

• Unusual circumstances: Other parties authorized by law

• The physician should:ascertain the exact nature of the

relationshipverify the authority of the surrogatedocument the legal basis of the surrogate-

child relationship and the exercise of the informed consent

Parents and legal guardians

• Legal

• Assumed to act in the best interest of the child

• Most appropriate decision makers– Genetic bond– Social aspect of the family– Affection for the child– Long term relationship with the child– Legal obligation to take care of the child

Others

• Grandparents

• Step-parents

• Adults not biologically or legally related to the child

Issues in Therapeutic Therapy

1. Emergencies - situations when the child's life is in imminent danger and the parent cannot be informed should be treated with bias toward preserving life and limb at all cost

2. Disagreements - parents may be poorly informed about a disease process and its treatment; distrust the physician providing information.

Sometimes, physicians should oppose parental actions or decisions. The physician must always report suspected child abuse or neglect regardless of parental wishes Possible harm to child

3. Refusal of Medical Intervention (vaccination)

- gains and risks for the individual child need to be weighed, as well as the public health risk an unvaccinated child poses to other children (public health issue); medical neglect, withholding immunization from a child may harm that child

4. Disclosure of Information - information that is presented in an age-appropriate manner to help them participate in decision-making

Pediatric Legal Consent of Pediatric Legal Consent of MinorsMinors

Exceptions To Parental Authority 1. Special statutes giving authority to minors2. Emancipated minors3. Mature minors4. During emergencies

Exceptions To Parental Authority

1. Almost all jurisdictions now have special provisions for the treatment of certain conditions without the consent of the minor’s parents.– Drug Abuse– Venereal Disease– Contraception, Abortion and Mental Illness

(sometimes included and at other times are specifically excluded)

2. Emancipated Minors e.g. Married Minors, Those in the Armed

Forces and Those Living Away at College

3. Mature MinorsLegal Authorities Concluded that the Physician May Respond to their Requests Under the Following Conditions: 

– Patient is at the age of discretion (15 years or older)– Medical measures are taken for the patient’s own benefit– The measures can be justified as necessary by medical

opinion– For some good reason– It is also advisable for the physician to clarify any billing

arrangements, medical bills may be sent to parents and thus may breach the confidentiality of the patient

4. Emergency (self explanatory…)

Pediatric Parental IncapacityPediatric Parental Incapacity

Parents of Serious Incompetence

• Parents with psychiatric disorder• Parents who seemed unable to comprehend the

needs and interests of a child

Neonatal Care• Withdrawal of life-sustaining medical

treatment: Who decides?

1. Parents

2. Physician

3. Infant Care Review Committees

• Parents; Presumed to be the appropriate decision-makers for their children

LOVE is the factor that motivates them to do what is best

• Physician; Position to help ensure that parental decisions do not close off a child’s open future as a unique person

• Infant Care Review Committees; To assist parents and physicians in developing sound decisions regarding difficult choices