Taking into Account the Child's Own Views in the Field of Medical Care: International Standards and Experience of Ukraine

  • H. A. Myronova
Keywords: The Convention on the Rights of the Child (UN), taking into account the child's thoughts, the child's competence to consent to medical intervention.

Abstract

The patient's right to participate in decision-making about medical intervention has existed relatively recently - less than a hundred years. Informing the patient and obtaining his or her consent are responsibilities that are not inherent in the medical ethics and practices of the past. Gradually, there have been radical changes in doctrinal approaches to the legal regulation of medical care, and now the basic rule of European private law in the field of legal personality of patients is that no one can be subjected to medical intervention without his consent. The transition from paternalism to autonomy in personal decision-making has led to the institutionalization of the principle of consent to medical intervention and the development of appropriate legal mechanisms for exercising the right to choose in health care, both at international legal standards and in national legislation.

However, individuals with age-related disabilities are among the most vulnerable groups in society and need special civil law tools to protect and defend their autonomy. After all, clinical situations involving minor patients are the most difficult, both in ethical interpretation and application of the rule of law. Legal relations between medical institutions, patients and other stakeholders in the absence of the patient's full ability to consent are not always successfully regulated by Ukrainian law and need to be reviewed and refined, both at the doctrinal and regulatory and law enforcement levels.

In connection with the above, the scientific task of developing the conceptual framework and legal mechanisms for the implementation of international legal standards in national legislation, which lay down important principles for regulating private law relations with the child, in particular in the field of medical care. Given Ukraine's international legal obligations, it is necessary to assess the compliance of domestic regulations with international legal standards and identify adequate ways to address gaps and inconsistencies, both in national doctrine and legislation, in terms of the implementation of new legal means to ensure adequate private law regulation of relations in the field of medical care with the participation of minors.

 That is why the object of the initiative study, some results of which are presented in the article, the author chose private law relations regarding the consideration of the child's opinion in the field of medical care, and the subject - analysis of legal regulation of the child's opinion in providing medical care according to international standards and legislation of Ukraine.

The Convention on the Rights of the Child (UN) 4 has introduced far-sighted changes in the concept of the legal personality of the child, based on the provision that children are born with independent legal status, but the exercise of specific rights is legitimate as and depending on as children grow older and become ready to realize their own interests and make adequate choices. That is why the Convention on the Rights of the Child uses a comprehensive criterion, which includes, on the one hand, reaching the age of 18, on the other - the ability to perform certain actions or functions. In its final form, the original doctrinal rule was formulated in Article 12 in such a way that both the state and the family are obliged to respect the child's ability to develop, with due regard to the child's views according to his or her age and maturity. This principle is presented as universal, and therefore should apply to all legal relations involving the child, including decision-making in the field of medical care.

The legislation of Ukraine in general meets international legal standards and contains relevant norms. Both the civil capacity of an individual and his ability to have civil rights and responsibilities, including in the field of medical care, arises at the time of his birth (Article 25 of the Civil Code of Ukraine). But the amount of civil capacity, as the ability of an individual to exercise their rights independently, depends on the age and mental state of the subject of law. A minor commits transaction with the consent of parents (adoptive parents) or guardians (paragraph 2 of Article 32).

These norms also apply to the regulation of private law relations in the field of medical care: the child's legal capacity is tied to the age criterion. That is, the child (minor individual) is the owner and holder of all personal non-property rights in the field of medical care, including the right to free choice of doctor, treatment methods, health information, etc. However, children exercise these rights through persons with parental responsibility. In particular, there is no legal possibility for a minor child to participate in the choice of treatment for her. Also, medical workers cannot accept refusals of medical intervention from a minor. The child's treatment plan, including the necessary examinations and the procedure for applying medical interventions to patients under the age of 18, is discussed with the child's parents or other legal representatives.

The legislation of Ukraine reproduces the norm of applicable international law that a child has the right to be heard. Thus, Article 171 of the Family Code contains a direct instruction of the legislator on the need to take into account the views of the child when deciding on matters concerning his life. Article 171, paragraph 1, formulates a rule-principle according to which a child has the right to be heard by parents, other family members, officials on matters concerning him or her personally, as well as family matters. Article 171, paragraph 2, clarifies that this right should apply to a child who can express his or her opinion. Doctrinally, the context of the child's right to be heard on all matters concerning his or her life should extend to the issues of his or her medical care and, in particular, decision-making on the choice of treatment. After all, the list of legally defined areas of a child's life in respect of which he or she has the right to be heard is not exhaustive. However, the legislator does not explain in what legal way it can be carried out in practice of listening and taking into account the child's opinions.

Thus, the analysis of the comparison of the norms of international legal acts in force for Ukraine and domestic legislation shows that almost all relevant principles, standards and norms are reflected in the norms of national legislation of Ukraine. However, in the current legislation there is a certain declaratives of legal requirements, which manifests itself through the so-called "dead" norms - those that are not actually enforced due to their abstractness and lack of real mechanisms for law enforcement. That is why these norms are practically not used in the practice of legal regulation of relations in the medical sphere with the participation of minors and minors.

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Published
2020-09-29
How to Cite
Myronova , H. A. (2020). Taking into Account the Child’s Own Views in the Field of Medical Care: International Standards and Experience of Ukraine. Medicne Pravo, (2(26), 67-75. https://doi.org/10.25040/medicallaw2020.02.067
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Articles