Children play

In 2016, the American Academy of Pediatrics revised their policy statement on Informed Consent in Decision-making in Pediatric Practice. This third and updated revision was published in Pediatrics, August 2016 Volume 138, Issue 2.

Those interested can refer to this link – It is a good read and reference, especially at a time where the issue of decreasing the age from 15 to 9 years old for criminal liability in the country is being discussed.

This short article is a personal opinion and hopefully sheds light surrounding issues on why lawmakers need to hear the other side of the coin.

So why begin this post with informed permission prior to a medical intervention? The argument is simple. If you need consent from parents and legal guardians over simple medical procedures or interventions for pediatric patients, why make a child as young as 9 years old be held accountable for a criminal activity which he may or may not be a willing participant in? The second question that should be asked is – what is the basis for the cut-off age of 9 (and then shifting to 12) as the “responsible” age for any liability?

The background for securing informed consent in medical practice for children stems from the conceptual difficulties encountered “in trying to apply the framework of informed consent in the pediatric setting”, in which most “patients either lack the ability to act independently or have limited or no capacity for medical decision-making.” If children are unable to decide on what is good or bad for their health, how can we make them criminally liable for a crime they may not even be fully aware of but participate in?

Pediatric patients are unique. I am sure we all can agree on that. Developmental maturation of the child allows for increasing longitudinal inclusion of the child’s opinion in the decision-making process. Encouraging pediatric patients to actively explore options and to take on a greater role in their health care may promote empowerment and compliance with a treatment plan.”

“Adolescent decision-making is dependent on several factors, including cognitive ability, maturity of judgment, and moral authority, which may not all proceed to maturation along the same timeline. Many minors reach the formal operational stage of cognitive development that allows abstract thinking and the ability to handle complex tasks by mid adolescence. Brain remodelling with enhanced connectivity generally proceeds through the third decade of life, with the prefrontal cortex, the site of executive functions and impulse control, among the last to mature. In contrast, the risk-taking and sensation-seeking areas (limbic and paralimbic regions) develop around puberty. This temporal imbalance or “gap” between the 2 systems can lead to the risky behaviour seen in adolescence.”

This alone should make one understand the differences on how the adolescent reacts to various environmental influences for his or her behaviour. A perfect example is on how those who finish college at much earlier age, are socially and mentally immature for their age when they begin to work. Or social responsibility of adolescents who are already parents. How does a 12 year old father give consent for his newborn son who is set to undergo a complicated surgical procedure? Or a 10 year old mother who has to decide on end of life support for her premature baby? “There is clearly a paradox encountered when adolescents are allowed to make complex medical decision for their child but cannot legally direct their own medical care.”

Because parents are generally recognised as the “appropriate ethical and legal surrogate medical decision-makers for their children and adolescents”, the parents AND NOT THE CHILD should be held fully accountable for any legal liability of their children. Punishing the child is not the right frame of thought. The children’s interests should be the onus of the parents and not the other way around.

Children grow up based on the environment of their upbringing. Like sponges, a child’s brain absorbs everything. Raise them in a family of thieves and they have a higher chance of turning to the wrong side of the law. For those who are poor, they learn to survive even if it means they have to make ends meet just to feed their hungry stomachs. Those who have more in life are lucky. Life is kinder to them.

You remember when you were 9 years old? Those were happy memories. It was all about school and play. That was what we were busying ourselves with. I’m sure, most of you reading this post have similar memorable experiences. Those were the best days of our relative joys in life. Other children – those raised in conflict zones, those who are used and abused because of social conditions – their stories will always be a different one.

Parents will always have that responsibility and accountability in the lives of their children. How they mold them will always be their role. And that’s who we need to target – that final liability.