UNIT 3 - MEDICAL TREATMENT IN CASE OF MINORS.pptx

this ppt is about medical treatment in case of minors including conflict between parental rights and child's autonomy

1. MEDICAL TREATMENT IN CASE OF MINORS Ms. R. Yuvanaa Priyadharshini, SOL, SASTRA

2. INTRODUCTION A conflicting mix of central acts, judicial pronouncements, and professional ethical guidelines govern the medical treatment of minors in India. While children and adolescents pass through various stages of development from infancy to early adolescence, there are significant variations in each country’s legal set-up in relation to age of the child, maturation of the child, and the kind of medical procedure involved. The legal position consists of the interplay involving the Constitution of India, central legislations such as the Indian Medical Council Act, and judicial precedents laying down the rights of minors, duties of the providers, and of the guardian.

3. THE DEVELOPMENTAL STAGES AND AGE RANGES In legal terms, minors are generally broken down into one of three categories-wide: Infant / Babies (0 to 1 year), Children (1 to 12 years) and Adolescents (12 to 18 years). These categories include not only the physical and psychological processes of development, but also development in terms of the capacity to comprehend medical treatments and express informed consent.

4. Infancy (0 to 1 year) Medical decision-making now lies exclusively in the prerogative of the parent or authorized guardian. For emergencies or routine medical interventions such as required immunizations or treatments for congenital conditions, parental consent is required. In emergencies, however, the procedures could be done under the implied consent to save the life of a child or to prevent vast impairment to him or her. Childhood (1 to 12 years) In this stage, parental consent forms the very basis of all medical procedures. Although children in this age group may show some preferences about their treatment, the law normally does not hold them capable of independent informed consent. Instead, legal doctrines stress more on the agency of parents or legal guardians. Adolescence (13 to 18 years) The Supreme Court of India and different High Courts have recognized that, depending on maturity and understanding, adolescents might be permitted to express an opinion or even give an informed consent for some of the procedures. While Indian law states that the age of majority is 18, there are a few judicial pronouncements which incorporate the doctrine of mature minor, with relevant application in reproductive health, mental health treatment, and decisions concerning chronic conditions.

5. STATUTORY AND REGULATORY FRAMEWORK In India, the structure regulating medical procedures on minors operates on a combination of constitutional rights, statutory law, and judicial interpretation. CONSTITUTIONAL PROVISIONS:- Right to Life and Personal Liberty: Article 21 of the Constitution provides for the right to life and personal liberty. This right has been interpreted by the courts to mean a right to healthcare and dignified living conditions. All these medical procedures on a minor must be in line with the fundamental rights prescribed and the decision should be such that it does not violate any future autonomy and well-being of the minor. Protection of Children: Other constitutional directives further emphasize the duty of the state to protect the interests of children

6. The Indian Medical Council Act, 1956: This Act provides the relevant and regulatory framework for medical practitioners in India, encompassing guidelines on ethical conduct and professional responsibilities. While the Act is mainly applicable in regulating the conduct of physicians, its sections dealing with informed consent and professional ethics have a direct bearing on the handling of medical procedures involving minors. The Medical Termination of Pregnancy Act: In the case of minors who wish to undergo termination, both the statutory requirements of the procedure as well as case law decisions need to be considered which require the consent of a parent, barring exceptional instances. The Transplantation of Human Organs Act: Minors are strictly prohibited under this Act to donate their organs. With the consent of the deceased minor’s parents or guardian, the deceased minor’s organs can be donated.

7. CONSENT REQUIREMENTS FOR MEDICAL PROCEDURES ON MINORS The Principle of Informed Consent Informed consent is about making sure a patient, or their representative, understands a medical procedure. This means explaining the risks, benefits, and what other options are available, so the patient can make a smart choice. In case of minors: Parental or Guardian Consent: For babies and young children, the legal guardian must give consent. The doctor needs to clearly explain the procedure to the guardian in simple terms, keeping in mind what is best for the child. Adolescent Consent : Mostly, you need to be 18 to give consent, but sometimes older teens (who are seen as mature) can make these decisions themselves. It is important to keep a record of these decisions in case they need to be checked later. Emergency Situations : If there is an emergency and it’s not possible to get consent first, doctors can go ahead with treatment based on implied consent. But they must make sure they can justify what they did later.

8. B. Specific Considerations for Reproductive and Gender-Affirming Procedures Specific medical procedures like reproductive health services and gender-affirming treatments for transgender youth require special consideration. Legal questions may arise concerning how much a minor can consent or whether parental consent is always required: Reproductive Health: The MTP Act has provisions regarding consent for abortion procedures for minors, allowing it only through parental consent except in rare instances of legally recognized exceptions. Gender-Affirming Procedures: This is a developing scenario where legal recognition continues to get traction along with its counterpart, social acceptance, for giving rights to the adolescent transgender community. The intersection of medical necessity, parental rights, and evolving legal recognition of gender identity is still a matter of vigorous debate and judicial scrutiny.

9. C. Procedures Involving Experimental or Novel Treatments Medical research involving minors and including related experimental treatments or clinical trials is therefore strictly regulated. In addition to informed consent requirements across the board, these instances include: Ethical Committee Approvals: Experimental treatment involving a minor must gain clearance from an independent ethical committee because it must comply with the protocols and standards of safety internationally accepted. Increased Parental Scrutiny and Oversight: Because of the reproductive risks in these types of cases, parental consent in these cases is supported by enhanced disclosures and, in some instances, additional judicial oversight.

10. BALANCING PARENTAL AUTHORITY AND MINOR AUTONOMY In India, this balance is achieved to some extent through the interplay of legislation, judicial intervention, and ethical considerations. The Role of Parental Consent Traditionally, the responsibility for making decisions for minors has been conferred solely upon their parents or legal guardians. Courts have, at times, intervened when a parent’s decision regarding a minor was shown contradicting the best interest of that minor. This meant that such decisions by the parents would ordinarily prevail except in cases where it could be adjudged that as per the evidence available, the rights of a minor under Article 21 of the Constitution were being hampered. Recognizing Adolescent Autonomy In the context of reproductive health, mental health, and gender identity, wherein courts allow them to independently consent, if their decision-making capacities are duly tested. It does not vitiate the rights of parents, but supplements them with an understanding that, in the consent process, the minor’s voice becomes one of the crucial ingredients. The Intersection of Medical Ethics and Legal Standards It is not just a legal formality for the informed consent process; it is also an ethical obligation by virtue of the principles of autonomy and non-maleficence. Courts and statutory bodies in India have stressed that medical practitioners shall uphold the ethical rights of the patient, including minors.

11. CASE LAWS Court decisions have played an important part in determining a balance between parental authority and minor autonomy. Certain landmark judgments feature in cases that affect the understanding of legal consent and procedures relating to minors are: Madhukar v. Union of India: In this case, the court led to emphasize that the child’s interest must prevail before any dispute concerning medical processes; thus, establishing this concept of judicial oversight when, in some instances, the parental decisions may not be in the best interests of the child. S. Gasper v. State : In this instance, the court hinted that it would be possible for a minor to be recognized as competent under certain circumstances, mainly regarding non-invasive treatments that impact their lives extensively into the future. Along with these propositions, several judgments by the High Courts all over India have also explained certain issues about informed consent, especially in psychiatric cases and reproductive health. Legal practitioners must keep themselves updated regarding tendering of consent in view of statutory requirements and judicial expectation.

12. A. Kasthuri v. State of Tamil Nadu, 2025 SCC OnLine Mad 6340, decided on 18-09-2025]... In a recent ruling, the court directed a minor's kidney transplant to proceed without his father's consent, allowing the mother to provide consent, based on the minor's best interests and the father's desertion of the family. The petitioner contended that insistence for getting the consent of the petitioner’s husband is arbitrary, unreasonable and violative of the minor child’s right to life guaranteed under Article 21 of the Constitution. Taking into account the submissions and the urgency of the situation, the Court disposed of the petition with a direction to the Dean and the Head of the Nephrology Department of the Government Stanley Medical College and Hospital to provide appropriate treatment for renal transplantation to the minor child. The Court specifically instructed that no unreasonable demands, including the father’s consent, should be insisted upon. XYZ v. The Inspector of Police & Ors.  W.P.No.2237/2025  The petitioner, the mother of a 16-year-old minor girl, approached the court seeking permission for the medical termination of her daughter’s pregnancy. The petitioner stated that her daughter, who is currently in the 12th standard, wishes to terminate the pregnancy to continue her education and attend her upcoming board examinations. Upon evaluation, hospital authorities informed the petitioner that the pregnancy had exceeded 24 weeks and that an MTP could only be performed with specific court approval. the court prioritized the best interests, bodily autonomy, and reproductive rights of the minor girl while ensuring compliance with legal and medical considerations. Recognizing that the minor had unequivocally expressed her desire to terminate the pregnancy and that her mother, as her legal guardian, had consented, the court upheld her right to make decisions about her own body. 

13. THANK YOU