Julien Brisson supports removing age-based restrictions on adolescent healthcare consent, advocating for decisions to be made on the adolescent’s capacity to understand the treatment.

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The ethical debate surrounding adolescents’ ability to independently consent to research and healthcare services is both complex and controversial, especially as observed in recent years regarding transgender adolescents’ access to gender-affirming care. A critical yet often overlooked aspect of this debate is the variation in the minimum age at which adolescents are considered competent to consent independently. This variation occurs both within and across countries and has substantial ethical implications because it raises questions about fairness, autonomy, and cultural relativism in determining adolescents’ capacity to consent.

In Canada, the age of medical consent varies by province, for instance, it is 14 in Quebec and 16 in Manitoba. Internationally, the differences are even more pronounced. In Guatemala, adolescents must be 18 to consent to HIV testing independently, while in South Africa, the age is as low as 12. These discrepancies raise the question of whether the age of adolescent consent should be culturally relative or if universal ethical norms should be established by determining a single age at which adolescents can independently consent to research and healthcare services. Establishing a universal norm could imply that policies not complying with this standard would be deemed unethical, leading to normative judgments of other cultural practices, which can be ethically troublesome, for instance, through reflecting a colonial practice of ethnocentrism.

Photo Credit: Norma Mortenson/pexels. Image Description: A group of teenagers smiling at the camera.

The concept of adolescence and the transition into adulthood, which often signifies the capacity to consent, are culturally dependent. Some cultural contexts, like in India, lack a distinct concept of adolescence as understood in the West, while others, like the Hmong culture, consider the transition to adulthood to occur around 12-13 years old. If the minimum age for independent consent is determined through cultural contexts, it would be unethical to criticize different minimum consent ages across cultures because it disregards cultural diversity and imposes one’s cultural standards on another. However, accepting cultural relativity in parental consent requirement policies raises issues of justice. It is unjust if a 14-year-old can independently consent to health services in one location but not in another, as age becomes a discriminatory factor dependent upon cultural contexts.

A significant challenge in defining adolescent consent through age is the absence of objective criteria to determine a specific age for when an individual is mature enough to consent independently. Maturity varies widely among adolescents, making it difficult to set a universal age norm for medical and research consent. While having a specific age in policies simplifies matters administratively for healthcare professionals and researchers, the variety of consent ages worldwide invites reconsideration of age-based criteria. For example, in Ontario, there is no minimum age for consent. Healthcare consent is determined case-by-case, based on the adolescent’s capacity to understand the nature and consequences of the treatment. As such, the responsibility lays on the healthcare professional to ensure the adolescent patient can consent to healthcare services instead of assuming a patient can automatically consent because they have reached a specific chronological age.

Given the lack of consensus on adolescent independent consent, as seen with the variety of minimum age policies, a case-by-case approach might be a more just and ethically sound way to handle adolescent consent, ensuring each individual’s maturity and understanding are adequately assessed.

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Julien Brisson is a postdoctoral fellow at the University of Toronto’s Dalla Lana School of Public Health. @brisson_julien.