Here at QueerDoc, we practice informed consent and shared decision-making. Our TLDR quickie description in our free introductory appointments goes something like this:
- Our job is to give you all the information you need/want to make decisions about your health care.
- Your job is to make sure we know that you understand the information and
- That you have the capacity to consent.
The full description of all that is, well, a bit longer.
Check it out below, and feel free to read a prior blog on shared decision-making and informed consent that we wrote in 2020.
Informed Consent
First off, informed consent is an ethical and legal obligation of providers in the USA. It begins with the patient’s right to decide and direct what happens to their body. Despite the Republican agenda trying to take bodily autonomy away, we’re all in. It is YOUR BODY and YOU GET TO DECIDE WHAT HAPPENS TO IT.
Informed consent requires a discussion of the medical choices relevant to your care – ALL of the reasonable medical choices. This discussion requires information about:
- The nature of the treatment
- The risks and benefits of the treatment
- Reasonable alternatives
- The risks and benefits of the alternatives
- Including doing nothing
- An assessment of the patient’s understanding of the above requirements (capacity.)
It also requires:
- Shared decision-making
- Freedom from coercion
- A provider recommendation with an explanation of the WHY
What is Capacity?
Capacity is the patient’s ability to understand the benefits and risks of and the alternatives to a proposed treatment or intervention, including no treatment. It asks if the patient can demonstrate understanding of the situation, appreciation of the consequences of their decision and reasoning in their thought process, and if they can communicate their wishes.
Capacity requires the ability to make a reasoned decision. You may not have capacity if you:
- Have untreated severe mental health conditions.
- Have dementia.
- Have a severe cognitive disability.
- Have brain injuries that impact your decision-making capabilities.
- Have any condition that causes confusion, fatigue, or loss of consciousness.
- Are intoxicated.
Shock, a panic attack, and some medications can also affect capacity.
If your QueerDoc provider thinks that something may be affecting your capacity to consent, they’ll talk to you about it. The most common factor limiting capacity that we see is intoxication. Please don’t use mind-altering substances before your appointment.
What is Consent?
Consent gets talked about a lot, and we’re big fans of consent. It does have different meanings in different scenarios.
Consent is saying yes to something when you are also free to say no.
Consent must be voluntary.
Consent cannot be assumed.
Consent can only be given when the “something” is fully understood.
Minors and Consent
When and how minors can consent gets complicated and may be regulated at the state level.
SchoolHouse Connection is an excellent resource for learning about state-level laws around minor consent to health care.
In general, minors cannot consent to health care.
There are some situations where minors are legally able to consent (also regulated at the state level):
- emancipated minors
- minors living on their own
- unaccompanied minors experiencing homelessness
- minors who fulfill the requirements of the mature minor doctrine
- married minors
- pregnant minors
- minors in the US military
Minors may be able to consent to:
- diagnosis and treatment of infectious, contagious, or reportable diseases, including sexually transmitted infections
- mental health care
- reproductive health care
- substance abuse care
- sexual assult examinations
- vaccinations
- general medical care
- dental care
A comprehensive, but somewhat difficult-to-read chart is available in the article “State-by-State Variability in Adolescent Privacy Laws” from the June 2022 issue of Pediatrics. (Hint – pull up the PDV version to see the chart in one window)
What is the Mature Minor Doctrine?
The mature minor doctrine allows minors to consent to (usually low-risk) medical treatment when they are able to show that they have the maturity to understand the risks and benefits of their care, and takes into consideration the specific situation of the youth.
Where minors may be able to consent to medical care for sexual health, reproductive health, and mental health, and all three of those overlap in gender affirming care, most minors cannot consent to gender affirming care.
That’s why we cannot provide gender affirming care to youth without parental/legal guardian consent (except for minors who are legally able to consent.)
However, Minors Can ASSENT
What is Assent?
Assent is the ability to state your wishes or agree to treatment when you do not have the legal ability to consent.
We deeply value minors’ ability to assent and their assent is a critical part of how we provide care.
For assent to be given, the youth must:
- Understand the treatment – for example, a patch that you change once a week.
- Understand their part in the treatment – what actions they need to do.
- Understand what they can expect to happen.
- Understand that they can say no or stop at any time.
- Be able to communicate their understanding and their yes or no.
Consent and Assent in Medical Records
Some states, such as Utah require specific consent language and documentation in the medical chart. We will document that a consent discussion has occurred and the patient’s decision, regardless of state requirements.
Citations
Marianne Sharko, Rachael Jameson, Jessica S. Ancker, Lisa Krams, Emily C. Webber, S. Trent Rosenbloom; State-by-State Variability in Adolescent Privacy Laws. Pediatrics June 2022; 149 (6): e2021053458. 10.1542/peds.2021-053458
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