What does the law say about a youth's right to make health-related decisions?
Kiran and her boyfriend Rick are fifteen years old and in grade ten. They have been dating for several months and spend most of their time together. They care about each other and trust each other very much. A few months into their relationship, Kiran and Rick felt ready to begin having a sexually intimate relationship.
Kiran has a lot of questions about sex and the emotions that she is feeling but she has only discussed her relationship with her peers at school. She has not told her parents or her doctor about her sexual relationship. She is afraid that if she tells her parents she will get in trouble. She also believes that she cannot see a doctor without her parents’ permission and if she does see a doctor, she is afraid they will tell her parents what they have discussed.
Since Kiran has not spoken with a doctor, she is not using any methods of birth control, (such as the birth control pill) other than condoms. Both Rick and Kiran are shy and embarrassed to buy condoms in the store, so they only use condoms when Rick asks his older brother.
This month Kiran missed her period and thinks she might be pregnant. She and her friend go to the pharmacy and purchase a pregnancy test. When she takes the test she sees a positive result, indicating that she is pregnant. Kiran is overwhelmed, scared and doesn’t know what to do next. What are her options? What are her rights?
There are two parts to Kiran’s decision-making about the pregnancy: medical decisions, and non-medical decisions (like adoption, involving Rick in the pregnancy, and supporting a baby). This week’s post covers Kiran’s medical rights and decisions – part two will talk about her non-medical decisions.
In Ontario, your age does not determine your ability to make decisions about medical treatment. Instead, you can make your own decisions about your health care as long as you are considered capable by your doctor or health-care provider. Being capable means that you can understand the information that you are given about treatment as well as the consequences of your decision (such as the risks and results of the treatment).
Your doctor might consider you capable with respect to some treatments and decisions, but incapable with respect to others, depending on how complicated or risky those treatments are. For example, the different treatments Kiran can expect to hear about at the doctor’s office might range from a second pregnancy test to an ultrasound (a test to look at the fetus and see if it is developing healthily) to an abortion (a procedure to end the pregnancy). All of these are treatments with different risks, so the doctor might decide that Kiran is capable of making some of those decisions and not others. In Ontario, you are presumed to be capable of making medical decisions unless the doctor has a reason to believe that you are not capable. Age can play a role in this decision, since the older you are, the more able you generally are to make independent decisions and understand the consequences of those decisions. It’s always a good idea to ask the doctor before you discuss something with them, in order to make sure that the doctor will respect your rights and not tell your parents what you have said.
Since Kiran is fifteen, the doctor will probably decide that Kiran is capable of making most or all of her medical decisions. Any decisions that Kiran makes cannot be disclosed to Kiran’s parents, unless Kiran gives her express consent. This means that the doctor must ask Kiran before telling Kiran’s parents about her health care information, decisions, and treatment, and Kiran must tell the doctor that it is okay to tell. Kiran would sign a “consent” form that states exactly what information the doctor may share, and who the doctor can share it with.
If the doctor decides that Kiran is incapable with respect to a certain treatment or medical decision, then the doctor will be able to disclose Kiran’s medical information to someone called a “substitute decision-maker.” Since Kiran is under 16 and lives with her parents, this person would be one of her parents. In this case, Kiran will be able to discuss her situation with her parents, but they will be responsible for making her health-care decisions for issues where the doctor has decided Kiran is incapable.
For more information about teen pregnancy, support, and health care options if you think you might be pregnant:
The June Callwood Centre is a multi-service centre for pregnant and parenting teens in Toronto. Their website contains links to other resources (if you are planning to have a baby or make a decision about a pregnancy), as well as information about the resources they provide.
Rosalie Hall provides services for young women who are going to have a baby or who are new parents, including education, counseling and outreach, child care, among other programs.
Planned Parenthood Toronto provides health care and health services to youth, including on sexual and reproductive health issues, and they will provide information and pregnancy-related medical treatment, including pregnancy tests, counselling on pregnancy options, and referrals to services to help pregnant women make an informed decision regarding pregnancy.
The Ontario laws that determine who can make medical decisions and how medical information can be released are the Health Care Consent Act and the Personal Health Information Protection Act.
Scenario by JFCY Volunteer Marsha Rampersaud. Legal information by JFCY.