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Pediatric Decision-Making

Whereas adult patients can make their own medical decisions -- and if they cannot, clinicians try to determine what the patient would have wanted -- pediatric medical decisions are made according to the "best interest" standard. Parents are presumed to be the appropriate decision-makers for their minor children ("minor" is defined in Vermont as a person under the age of eighteen), so pediatric medical decisions are usually based on what the parents feel is in their child's best interests. There are limits to parental discretion, however, as described in a famous Supreme Court case which stated that parents may be free to make martyrs of themselves (by refusing life-saving treatment), but they're not free under the same circumstances to make martyrs of their children. In such cases, a report of medical neglect is made to the Department of Children and Families, and the court may authorize the treatment over the parents' objections.

There are certain situations where minors can make their own medical decisions. One is if the minor is emancipated, which occurs if the minor is married, on active duty in the military, or has been declared emancipated by a court (which requires the minor to be at least 16 years old and be self-supporting, among other conditions). Whereas emancipated minors may make all their medical decisions, non-emancipated minors may consent to treatment for venereal disease, alcohol addiction, or drug addiction (the "minor treatment statutes"). Their parents are only notified of the treatment if immediate hospitalization is required.

Acknowledging that 18 is an arbitrary cut-off -- and that there are some remarkably mature 17-year-olds, not to mention unusually immature 19-year-olds -- some states have established a "mature minor doctrine," where a patient under the age of 18 is allowed to make their medical decisions if deemed mature either by a doctor or a judge (depending on the state). Vermont has no specific statute nor relevant case law regarding "mature minors," meaning that any attempt by an unemancipated minor to make medical decisions not covered by the minor treatment statutes is of unclear legality.


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