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加拿大医疗环境中的青少年决策:整合神经科学与同意框架。

Adolescent decision-making in Canadian medical contexts: Integrating neuroscience and consent frameworks.

作者信息

Schwartz Yael, Williams Tricia S, Roberts Samantha D, Hellmann Jonathan, Zlotnik Shaul Randi

机构信息

Bioethics Department, The Hospital for Sick Children, Toronto, Ontario.

Department Psychology, University of Toronto, Toronto, Ontario.

出版信息

Paediatr Child Health. 2018 Sep;23(6):374-376. doi: 10.1093/pch/pxy037. Epub 2018 Apr 7.

Abstract

The primary objective of this commentary is to integrate current neuroscientific research on brain development during adolescence, with existing consent frameworks that do not designate a minimum age for eligibility to consent to, or refuse medical treatment. To reach this objective, the three consent frameworks used in health care settings are outlined: age-based framework; mature minor framework and capacity-based framework. This commentary draws on the Canadian health care system specifically to consider consent frameworks that grant young people with decision-making capacity. Next, a brief review of adolescent brain development findings is presented, particularly pertaining to the decision-making capacity of young people within medical contexts. Ultimately, the question of whether the stage of a young person's brain development impedes their capacity to consent to, or refuse medical treatment is addressed. This commentary provides reassurance as to the compatibility between capacity-based and mature minor frameworks to consent to treatment with current neuroscientific understanding of adolescent brain development.

摘要

本评论的主要目的是将当前关于青少年大脑发育的神经科学研究与现有的同意框架相结合,这些同意框架并未指定同意或拒绝医疗治疗的最低年龄资格。为实现这一目标,概述了医疗环境中使用的三种同意框架:基于年龄的框架、成熟未成年人框架和基于能力的框架。本评论特别借鉴加拿大医疗保健系统,以考虑赋予具有决策能力的年轻人同意权的同意框架。接下来,简要回顾青少年大脑发育的研究结果,特别是与年轻人在医疗环境中的决策能力相关的结果。最终,探讨了青少年大脑发育阶段是否会阻碍他们同意或拒绝医疗治疗的能力这一问题。本评论就基于能力的框架和成熟未成年人框架与当前对青少年大脑发育的神经科学理解之间在同意治疗方面的兼容性提供了保证。

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