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In Hungary, children help decide.

Traditionally, children below the age of majority have been presumed incapable of making decisions for themselves; thus parents have been given the power to consent to their children's medical treatment. At present, in almost all parts of the world, an individual is legally a minor and presumed incompetent until she or he has reached the age of at least eighteen; this is the case in Hungary.

Over the past decade several factors have weakened the presumption of the child's incapacity and opened the possibility for children to give valid consent. Importantly, we have come to recognize that age is not always a satisfactory measure of mental capacity.[1] Many pediatricians in Hungary now feel that they must involve their child patients in decision-making related to health care. And more and more pediatricians view the child's decisionmaking role as a larger issue than just the question of legal capacity to give informed consent independent of parental wishes. Pediatricians now realize that they must assess and enhance the decisional capacities of their child patients of different ages, and with the help of parents progressively involve children in the decisionmaking process as they mature.

Decisionmaking about health care by children requires the same abilities as those used by adults: understanding the medical information, considering or reasoning about it, and freely choosing among the options. Many children possess the capacity to take part in the decisionmaking process at some level; some children--mainly adolescents--possess all or nearly all the capacity to give truly informed consent regarding their health care. Only children who have reached the level of formal logical thinking will have an understanding that is relevant to medical decisionmaking. Most children reach this stage around twelve to thirteen years of age. There is now good evidence that by the age of fourteen many children attain a cognitive developmental stage associated with the psychological elements of rational consent, though there is variability in this.

Progressively engaging the child in decisionmaking is a process, not a series of isolated events. The pediatrician's developing interactions with the child and the family over several meetings are extremely important in establishing the physician-patient-parent relationship.

In the past, most Hungarian doctors did not want to include children in making decisions about their health care, and in dealing with parents they showed a strong paternalistic attitude toward the treatment of the minor. But over the last few years Hungarian pediatricians' attitudes regarding decisionmaking about health care by children have been changing. Increasing numbers of doctors have realized that the child's development into a full-fledged decisionmaker is the goal of all parents, and that to speed up this development pediatricians must actively involve their young patients in the decisionmaking process.

One hopeful sign of achieving this is that in 1993 the Congress of the Hungarian Pediatrics Association will--for the first time--have on its agenda the question of health care decisionmaking by children.

Reference

[1.] Willard Gaylin, "Competence: No Longer All or None," in Who Speaks for the Child?: The Problems of Proxy Consent, ed. Willard Gaylin and Ruth Macklin (New York: Plenum, 1982), pp. 27-54.
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Title Annotation:children's medical rights
Publication:The Hastings Center Report
Date:Mar 1, 1993
Words:513
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