The Issues of Underage and Transgender Children’s Rights Exercise When Receiving Health Care

  • S. B. Buletsa
Keywords: minor, child, medical care, transgender, age.

Abstract

This article explores the case law and problem theory that arise when exercising the right to medical care for minors and transgender children. The necessity of increasing the age to 16 years of underage children in an independent application for medical care is substantiated. The rights of transgender children are analyzed and their rights to receive medical care are identified. The participation of children and adolescents (10-18 years - defined by the Ministry of Health of Ukraine) in medical decision making should be offered in proportion to their developmental opportunities, to understand the nature and consequences of their medical problem, and to understand the foreseeable risks and benefits of the treatment offered. Amendments to the legislation on the right to child health care are proposed. The rights of the child in the field of medical care are extremely relevant, since the problem of researching the age from which a minor child is entitled to receive medical care is not in doubt, given that in practice the norm of Part 2 of Art. 284 of the Civil Code of Ukraine is not implemented. We consider age issues controversial. Because, in practice, a 14-year-old child is treated by parents, not alone. Any child (including transgender) is a patient from the time they see a doctor or healthcare facility. However, Part 2-3 of Art. 284 of the Civil Code of Ukraine a natural person who has reached the age of fourteen and who has sought the provision of medical care, has the right to choose a doctor and to choose the methods of treatment in accordance with his recommendations. The provision of medical care to an individual who has reached the age of fourteen is carried out with his or her consent. The question is how often do children at the age of 14 choose a doctor or treatment?

It should be noted that the legal structure of informed voluntary consent of a child in legal relations for providing her medical care in the legislation of Ukraine consists of the following provisions:

  1. Informed voluntary consent to medical care for a child under the age of 14 must be provided by the parents or other substitute persons in accordance with the law, that is, they only sign the relevant documents.
  2. Upon reaching the age of 14, a minor shall, inter alia, be entitled to informed consent for medical intervention. Appropriate written consent must be signed by both the child's representative and the child himself.
  3. An 18-year-old person acquires all civil rights and obligations, including in the field of medical care. The same applies to minors who have acquired full civil capacity before - on the grounds provided for in Art. 34 and 35 of the CCU.

Therefore, providing informed consent to a medical intervention by a minor under the age of 14 years is inconsistent in Ukrainian civil law. On the one hand, the legislature granted such persons the right to consent to medical intervention, on the other - to deprive them of the right to information about their health status and to refuse medical intervention. Apparently, the legislator should consistently “tie” the age of a minor patient to a certain amount of his or her legal capacity in the context of medical care, and in my opinion, this should be 16 years of age.

Contradictions also arise in the child's right to choose a doctor and obtain information about his or her health status. Art. 38 of the Law of Ukraine "Fundamentals of the legislation of Ukraine on health care" (hereinafter - the Law "On health care") gives the right from 14 years to the free choice of a doctor, if the latter can offer his services, and the choice of treatment methods according to his recommendations , and Art. 39 only gives adults the right to full information about their health. This legal conflict is proposed to be eliminated by amending Art. 39 of the Law on Health, stating: "A patient who has reached the age of fourteen is entitled to receive reliable and complete information about his health status, including access to relevant medical records concerning his health" I". you can agree with this, but given that this right would arise from the age of 16.

Substantiating the provision that a child at 14 years old can not make informed decisions when applying to a doctor and choose the methods of treatment, you should

turn to medical psychology, psychiatry.

Generally, adolescence is associated with the restructuring of the child’s body - puberty. The latter aspect is determined on the basis of the concept of puberty (from the Latin pubeszere - hair coverage). The puberty period is the stage when a person reaches puberty. The lines of mental and physiological development do not go in parallel, because of which the individual limits of entry into puberty vary greatly. Some children enter puberty earlier, others later.

It should be noted that major structural and functional changes in the brain are completed by the age of 14 when it reaches its final volume and weight. The ratio between gray matter and neurons acquires its final stage of development at about 18 years.

Children 16 years and older are generally considered Gillick-competent. Gillick competence is a term that originated in England, is used in medical law and addresses the question: Can a child under the age of 16 consent to medical care without parental permission?

In Canada, in 10 provinces and 3 territories, the right to receive medical assistance for minors is different, for example in the Yukon, East-West and Nunavut territories, the right to medical assistance arises with the age of 19. In other provinces of 18 or 16 years old, if they can agree to medical treatment and are able to understand the nature and consequences of treatment, their decision is in their own interest, health and well-being. Over the last decade, more and more children and adolescents have been identified as transgender and gender diverse (TGD). Often, they and their parents first seek primary care paediatrician for guidance and support. Therefore, in 2018, the American Academy of Pediatrics (AAP) released a policy statement on youth health issues with TGD. AAP recognizes that many paediatricians are under-trained in the field and therefore need to build up their knowledge base and expertise to provide medically competent care.

Although most sexual and gender minorities are healthy and well-adjusted, some TGDs are at increased risk for mental health, including anxiety, depression, and abuse.

References

Щирба М. Право на інформовану згоду при медичному втручанні неповнолітнім пацієнтам. Підприємництво, господарство і право. 2017. № 12. С. 212–216 (Shhyrba M. Pravo na informovanu zgodu pry medychnomu vtruchanni nepovnolitnim paciyentam. Pidpryyemnycztvo, gospodarstvo i pravo. 2017. No 12. S. 212–216).

Резнік Г. О. Правo дитини на охорону здоров’я. Приватне право і підприємництво. 2014. Вип. 13. С. 87–90 (Reznik G. O. Pravo dytyny na ohoronu zdorov'ya. Pryvatne pravo i pidpryyemnycztvo. 2014. Vyp. 13. S. 87–90).

Антропова М. В. Анализ некоторых методик изучения общей умственной работоспособности школьников в возрастном аспекте. Новые исследования возрастной физиологии. 1977. № 9. С. 109–114 (Antropova M. V. Analyz nekotoryh metodyk yzuchenyya obshhej umstvennoj rabotosposobnosty shkolnykov v vozrastnom aspekte. Novye yssledovanyya vozrastnoj fyzyologyy. 1977. No 9. S. 109–114).

Криволапчук И. А., Сухецкий В. К. Психофизиологическая характеристика функционального состояния подростков на разных стадиях полового созревания в условиях напряженной информационной загрузки. Физиология человека. 2005. Т. 31. № 6. С. 13–25 (Kryvolapchuk Y. A., Suheczkyj V. K. Psyhofyzyologycheskaya harakterystyka funkcyonalnogo sostoyanyya podrostkov na raznyh stadyyah polovogo sozrevanyya v uslovyyah napryazhennoj ynformacyonnoj zagruzky. Fyzyologyya cheloveka. 2005. T. 31. No 6. S. 13–25).

Фарбер Д. А. Физиология подростка. Москва, 1988. 167 с. (Farber D. A. Fyzyologyya podrostka. Moskva, 1988. 167 s.).

Судаков К. В. Эмоциональный стресс. Новое в физиологии. 1983. № 11. C. 34–36 (Sudakov K. V. Emocyonalnyj stress. Novoe v fyzyologyy. 1983. No 11. C. 34–36).

Дубровинская Н. Е., Фарбер Д. А., Безруких М. М. Психофизиология развития : психофизиологические основы детской валеологии: учебное пособ. Москва, 2000. 144 с. (Dubrovynskaya N. E., Farber D. A., Bezrukyh M. M. Psyhofyzyologyya razvytyya : psyhofyzyologycheskye osnovy detskoj valeologyy : ucheb. posob. Moskva, 2000. 144 s.).

Вікова та педагогічна психологія: навч. посіб. / О. В. Скрипченко та ін. Київ: Просвіта, 2001. 416 с. (Vikova ta pedagogichna psyhologiya: navch. posib. / O. V. Skrypchenko ta in. Kyjiv: Prosvita, 2001. 416 s.).

Булеца С. Б. Надання медичної допомоги неповнолітнім: цивільно-правовий аспект. Порівняльно-аналітичне право. 2013. № 1. С. 88–92. URL: http://www.pap.in.ua/1_2013/Buletsa.pdf (дата звернення: 17.01.2020) (Bulecza S. B. Nadannya medychnoyi dopomogy nepovnolitnim: cyvilno-pravovyj aspekt. Porivnyalno-analitychne pravo. 2013. No 1. S. 88–92. URL: http://www.pap.in.ua/1_2013/Buletsa.pdf (data zvernennya: 17.01.2020)).

Judgment of the European Court of Human Rights in the case «N. B. v. Slovakia» on June 12, 2012 (Application No 29518/10). URL: http://hudoc.echr.coe.int/rus?i=001-111427 (дата звернення: 17.01.2020).

Judgment of the European Court of Human Rights in the case «Pretty v. the United Kingdom» on April 29, 2002 (Application No 2346/02). URL: http://hudoc.echr.coe.int/rus?i=001-60448 (дата звернення: 17.01.2020).

Judgment of the European Court of Human Rights in the case «A. K. and L. v. Croatia» on January 8, 2013 (Application No 37956/11). URL: http://hudoc.echr.coe.int/rus?i=001-115868 (дата звернення: 17.01.2020).

Булеца С. Б. Надання медичної допомоги неповнолітнім. Науковий вісник Ужгородського національного університету. Серія: Право. 2012. Вип. 18. С. 74–76 (Bulecza S. B. Nadannya medychnoyi dopomogy nepovnolitnim. Naukovyj visnyk Uzhgorodskogo nacionalnogo universytetu. Seriya: Pravo. 2012. Vyp. 18. S. 74–76).

Wheeler R. Gіllіck or Fraser? A plea for consіstency over competence іn chіldren. BMJ. 2006. Vol. 332(7545). URL: https://www.bmj.com/content/332/7545/807.full (дата звернення: 17.01.2020).

Права підлітків у сфері охороні здоров’я: МОЗ України ініціює важливі зміни. URL: https://moz.gov.ua/article/news/prava-pidlitkiv-u-sferi-ohoroni-zdorov%e2%80%99ja-moz-ukraini-inicijue-vazhlivi-zmini (дата звернення: 17.01.2020) (Prava pidlitkiv u sferi ohoroni zdorovya: MOZ Ukrayiny iniciyuye vazhlyvi zminy. URL: https://moz.gov.ua/article/news/prava-pidlitkiv-u-sferi-ohoroni-zdorov%e2%80%99ja-moz-ukraini-inicijue-vazhlivi-zmini (data zvernennya: 17.01.2020)).

Family Law Reform Act 1969. UK Public Acts. URL: http://www.legislation.gov.uk/ukpga/1969/46 (дата звернення: 17.01.2020).

Lov om pasient- og brukerrettigheter (pasient- og brukerrettighetsloven). 07.02.1999. Helse – og omsorgsdepartementet. URL: https://lovdata.no/dokument/NL/lov/1999-07-02-63 (дата звернення: 17.01.2020).

Smith J., Swallow V., Coyne I. Involving parents in managing their child’s long-term condition-a concept synthesis of family-centered care and partnership-in-care. Journal of Pediatric Nursing. 2015. Vol. 30. Issue 1. URL: https://www.ncbi.nlm.nih.gov/pubmed/25458112 (дата звернення: 17.01.2020).

Aarthun A, Øymar KA, Akerjordet K. Parental involvement in decision-making about their child’s health care at the hospital. Nurs Open. 2018;6(1):50–58. Published 2018 Jul 30. doi:10.1002/nop2.180. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279730/ (дата звернення 18.01.2020).

Kevin W Coughlin. Medical decision-making in paediatrics: Infancy to adolescence. Bioethics Committee. Paediatr Child Health. 2018. 23(2). 138–146. URL: https://www.cps.ca/en/documents/position/medical-decision-making-in-paediatrics-infancy-to-adolescence (дата звернення 18.01.2020).

Quebec Civil Code, Articles 14–18. URL: http://legisquebec.gouv.qc.ca/en/ShowDoc/cs/CCQ-1991 (дата звернення 18.01.2020).

Medical Decisions for Children 14 to 17 Years Old. URL: https://www.educaloi.qc.ca/en/capsules/medical-decisions-children-14-17-years-old (дата звернення 18.01.2020 р.)

Judgment of the European Court of Human Rights in the case «P. and S. v. Poland» on October 30, 2013 (Application No 57375/08). URL: http://hudoc.echr.coe.int/rus?i=001-114098 (дата звернення: 17.01.2020).

Несовершеннолетние больше не могут вступать в брак. Yle. 2019. https://yle.fi/uutiset/osasto/novosti/nesovershennoletnie_bolshe_ne_mogut_vstupat_v_brak/10811730 (дата звернення: 17.01.2020) (Nesovershennoletnye bolshe ne mogut vstupat v brak. Yle. 2019. https://yle.fi/uutiset/osasto/novosti/nesovershennoletnie_bolshe_ne_mogut_vstupat_v_brak/10811730 (data zvernennya: 17.01.2020)).

Salas-Humara C., Sequeira G.M., Rossi W., Dhar C.P. Gender affirming medical care of transgender youth. Current Problems in Pediatric and Adolescent Health Care. 2019. Vol. 49. Issue 9. URL: https://www.ncbi.nlm.nih.gov/pubmed/31735692 (дата звернення: 17.01.2020).

Mehringer J., Dowshen N. Sexual and reproductive health considerations among transgender and gender-expansive youth. Current Problems in Pediatric and Adolescent Health Care. 2019. Vol. 49. Issue 9. URL: https://www.ncbi.nlm.nih.gov/pubmed/31735693 (дата звернення 18.01.2020).

Булеца С. Б. Вік при наданні медичної допомоги: цивільно-правовий аналіз. Право України. 2011. № 5. С. 212–217 (Bulecza S. B. Vik pry nadanni medychnoyi dopomogy: cyvilno-pravovyj analiz. Pravo Ukrayiny. 2011. No 5. S. 212–217).

Published
2020-02-25
How to Cite
Buletsa , S. B. (2020). The Issues of Underage and Transgender Children’s Rights Exercise When Receiving Health Care. Medicne Pravo, (1(25), 17-28. https://doi.org/10.25040/medicallaw2020.01.017
Section
Articles