The Adolescent Minor and Urgent Aortic Surgery: Challenges and Solutions with Capacity and Competence in Informed Consent

Kirpekar, MK; Silvay, G; Augoustides, JG; Castillo, JG; Leong, R; Sibbald, R; Bainbridge, D; Bishop, CE; Fernando, RJ; Morris, B


Volume: 33     Issue: 4     Pages: 1139-1145     Published: APR 2019      DOI: 10.1053/j.jvca.2018.07.032

THE NOTION OF INFORMED medical consent relates to the bioethical principle of autonomy, the patient’s right to make his or her own medical decisions, without coercion from others. This principle assumes 2 major factors: patient capacity and competence. Minors may lack the capacity and competence to make their own medical decisions. Minors may have an inflated sense of risk and lack judgment in decision-making because of a multiple factors, including cognitive and psychosocial considerations. However, medical, ethical, and legal challenges arise when the minor in question is an adolescent on the cusp of adulthood. To foster a better physician-patient relationship, medical decision-making of children and adolescents ideally should include not only the agreement of the guardian and physician, but also the assent of the minor patient. This case conference concerns a consultation in the anesthesiology preoperative clinic for an adolescent male with Marfan syndrome requiring urgent aortic root replacement because of a rapidly enlarging aortic root aneurysm. The patient, however, refused surgery, while the parents consented to the surgery. To best approach this conflict in consent, a multidisciplinary approach was taken to address the patient’s concerns and to recognize a mature minor, capable of making his own medical decisions.

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