1. Family law Who can make medical decisions for a minor child?

2. Who is a minor child?  Anyone who is 17 years old or younger  Exception: “Emancipated minor”  A 16 or 17-year-old who has obtained an order of emancipation from a district court judge  Married  Serving in the armed forces Emancipated minors are treated as adults and are no longer under the supervision/control of their parents

3. Who is permitted to make medical decisions for a minor child?  Natural (i.e., biological) parents This includes children conceived by artificial insemination  Adoptive parents Either parent in an “intact” family has the right to make medical decisions and consent to treatment; exceptions exist when parents are separated or divorced.

4. Who is permitted to make medical decisions for a minor child?  Either parent, when they are separated or divorced and there is no custody order  The parent given the right to make decisions in any legal custody order  An adult who is standing in place of parent, by having taken on parental obligations, particularly the burden of support

5. Who is permitted to make medical decisions for a minor child?  Legal guardian A legal guardian for a minor must be appointed by the Clerk of Court A legal guardian may be appointed only when there are no natural or adoptive parents alive (limited exceptions in juvenile delinquency cases) No legal validity to a parent “giving” guardianship to another adult

6. Who is permitted to make medical decisions for a minor child?  Stand-by guardian A person appointed to “stand by” to assert parental authority in a case when the parent has a seriously chronic or terminal illness Appointment must be made by the Clerk of Court Can exist in situation where a natural parent is living

7. Who is permitted to make medical decisions for a minor child?  Department of Social Services If DSS has removed the child from the home and obtained a court order making it the legal custodian, but only for routine or emergency medical or surgical care or treatment If the child has no parents or has been abandoned, until the appointment of a legal guardian  Foster parent, if DSS has authorized  Note: Parents retain right to consent to elective care, even if child is in DSS custody

8. Who is permitted to make medical decisions for a minor child?  Legal custodian Anyone who has a court order granting that person custody of the minor child  Grandparent  Other relative  Non relative For someone other than parent to be given custody, parent must be shown to have acted in a way that is contrary to his right to care and control of the child

9. Who is permitted to make medical decisions for a minor child?  A person who has been appointed by the parent (or other person with the right to make health care decisions for the child) to make decisions  Health Care Power of Attorney for a Minor is a formal document; informal documents are valid  Exception: a parent may not delegate the power to consent to the withholding or withdrawal of life sustaining procedures

10. Who is permitted to make medical decisions for a minor child?  The minor, him or herself, for Contraception Treatment of STD’s Abuse of controlled substances or alcohol Emotional disturbance Pregnancy and prenatal care Care for the minor’s child Abortion, but only when accompanied by consent from appropriate adult, unless such consent is waived by a court

11. When may a physician provide information to a minor’s parent?  Physician is prohibited from notifying parent (or other adult allowed to consent) of provision of medical services if minor is permitted to consent to them -- Except, when in the opinion of the physician, notification is “essential to the life or health of the minor.”  Physician may share information, in his/her discretion, with the parent (or other adult) if the physician is contacted by the parent.

12. Who is NOT permitted to make health care decisions for a minor?  A parent whose parental rights have been terminated by the court  A parent whose custodial rights to make decisions have been taken away by court order  A step-parent, unless the step parent has taken on parental obligations, particularly support

13. Ways to establish decision-making power in a non-parent  Parent gives another adult a power of attorney to make decisions  Non-parent adult obtains custody  Seek establishment of legal guardianship if parents are deceased

14. When can a physician treat a minor without consent?  Adult with authority cannot be located when minor needs treatment;  Identity of minor is unknown;  Efforts to locate adult would cause delay that would seriously worsen condition or be life-threatening  Parent refuses treatment and two physicians conclude that withholding treatment would endanger child’s life or seriously worsen his condition

15. Additional information  Health Care for Pregnant Adolescents – A Legal Guide for Health Care Providershttp://www.sog.unc.edu/si tes/www.sog.unc.edu/files/HCP9190 1.pdfhttp://www.sog.unc.edu/si tes/www.sog.unc.edu/files/HCP9190 1.pdf

16. Medical-Legal Partnership  New Website: http://www.law.duke.edu/partnership forfamilies/index.html