A child who is a mature minor may make their own health care decisions independent of their parents’ or guardians’ wishes.
In B.C., there is no set age when a child is considered capable to give consent.
https://www.healthlinkbc.ca/healthlinkbc-files/infants-act-mature-minor-consent-and-immunization
It’s important that parents are aware of, and understand the implications of, The Mature Minor Doctrine, also known as the Infants Act. These policies were introduced by all provincial governments in Canada to enable children under the legal age of consent (18 years) to access birth control, and later abortion services, without the knowledge or consent of their parents.
The scope of this doctrine has been expanded in recent years to enable minor children to receive vaccinations and other life-altering treatments, including gender-altering counselling, puberty blocking hormones, and mutilation surgery without the knowledge or consent of their parents. Discussion is currently underway in our federal parliament to include medically assisted dying (MAID) as a medical decision that mature minors can choose.
The age of a ‘mature minor’ varies by province with many provinces having no specified age.
In many provinces a minor is automatically considered a “mature minor” at age sixteen. When a child is deemed a “mature minor”, parental/legal guardian consent is not required, and consent given by a mature minor cannot be overturned by parents/legal guardians.
Furthermore, a minor under the age of 16 is capable of giving consent to a medical treatment if an attending medical practitioner determines that the minor understands the nature and consequences of a medical treatment.
In Ontario, the Health Care Consent Act requires that appropriate consent be obtained before a medical treatment, such as vaccination, is provided. A person does not have to be a certain age in order to be considered capable of providing his or her own consent. The law states that a person is capable of consenting to medical treatment if he/she is able to understand the information regarding the medical treatment, including the benefits, risks and side effects, and the consequences of consenting or not consenting to the treatment. The responsibility for determining if a minor is capable of consenting to a medical treatment rests with the health professional providing the treatment.
Children as young as nine years have been deemed by health professionals mature enough to make life-altering medical decisions without the knowledge or consent of their parents. In recent years, the deemed age of a ‘mature minor’ has gotten younger, even as the medical decisions have gotten more complex.
VCC’s Position
VCC defends the right and responsibility of parents to make decisions for their minor children under the age of consent (18 years). We believe that policies such as the Mature Minor Doctrine undermine parental authority and erode the integrity of the family unit.
With regards to vaccination, we hold that vaccination is too complex a medical decision to permit minor children to consent without the guidance of their parents or legal guardians. Children do not have the maturity and life experience to weigh the potential harm and benefits of a medical treatment, and to consider the contraindications to vaccination which may include individual and family medical history; prior history of adverse reactions; emerging scientific evidence; and natural immunity due to a previous exposure, which a child may not be aware of.
We hold that the Mature Minor Doctrine/Infants Act undermines parental authority and their right and responsibility to make medical decisions for their children.
We have also found that our medical authorities have acted inconsistently in that they have deemed a child mature enough to consent to vaccination, but not mature enough when the child refuses vaccination. This would suggest their basis for determining maturity is ideological rather than evidence based.
The Supreme Court of Canada has already ruled that providing medical treatment to minors without parental consent can only be done in emergency situations and that the use of the mature minor doctrine is “not to be exaggerated”. Vaccination is not an emergency, and as such, parents must always be involved in the decision.
In spite of this ruling, vaccine clinics are increasingly located in our children’s schools and children are being vaccinated at school without the knowledge or consent of their parents. We believe vaccine clinics in schools undermines parental authority and subjects children to unacceptable coercion from school administrators and teachers, public health authorities, and peer pressure. It is the position of VCC that vaccine clinics do not belong in our schools.
Vaccination is a complex medical decision that needs to involve the parents, and ought to be considered in discussion with one’s primary health care practitioner who knows the medical history of the child and the family. Public health nurses administering vaccinations in schools do not have sufficient knowledge of the child’s medical or family history to be administering these life altering medications to our children without parental knowledge and consent. They also have a financial and ideological conflict of interest.
Article 12 of the Convention on the Rights of the Child and Children’s Participatory Rights in Canada
F. PROCEEDINGS ABOUT HEALTH CARE
In Canada, children’s decision-making about health care issues occurs within a complicated legal framework. First, there is the common law “mature minor” doctrine. Generally, parents are entitled to make treatment decisions on their children’s behalf. The mature minor doctrine, however, allows children who are sufficiently mature to make their own treatment decisions. Second, there is provincial and territorial legislation governing consent to medical treatment. These statutes often provide a specific age at which children are presumed competent to consent to treatment. Third, there is child protection legislation. These provincial and territorial statutes allow a child protection agency to apply to a court to order treatment for a child where either the child or parent is refusing to consent. Finally, there are cases interpreting how these sources of law interact and which rules will ultimately govern health care decision-making for children.
In Canada, the definition of a minor child varies according to province.
1. British Columbia: Person under 19 years.
2. Alberta: Person under 18 years.
3. Saskatchewan: Unmarried person under 16 years.
4. Manitoba: Person under 18 years.
5. Ontario: Person under 18 years.
6. Quebec: Person under 18 years.
7. Nova Scotia: Person under 19 years.
8. New Brunswick: Person under 19 years.
9. Newfoundland: Person under 16 years (youth defined as a person who is 16 years or older, but under the age of 18)
10. Prince Edward Island: Person under 18 years.
11. Northwest Territories: Person under 19 years.
12. Yukon: Person under 19 years.
13. Nunavut: Person under 19 years.
What is the Infants Act?
The Infants Act states that children may consent to a medical treatment on their own as long as the health care provider is sure that the treatment is in the child’s best interest, and that the child understands the details of the treatment, including risks and benefits. It is up to the health care provider to assess and ensure the child’s understanding of the treatment.
What is “mature minor consent”?
A child under the age of 19 is called a “minor”. “Mature minor consent” is the consent a child gives to receive or refuse health care after the child has been assessed by a health care provider as having the necessary understanding to give the consent. A child who is assessed by a health care provider as being capable to give consent is called a “mature minor”. A child who is a mature minor may make their own health care decisions independent of their parents’ or guardians’ wishes. In B.C. there is no set age when a child is considered capable to give consent.
How does “mature minor consent” relate to immunization?
In B.C., immunizations for school-aged children are routinely given in grade 6 and grade 9 (and other grades if children are behind in immunization or at risk for certain vaccine-preventable diseases). Although there is no set age for when a child becomes capable, common practice is for parents or guardians of children 12 years of age and younger to give consent for their child to be immunized. However, there may be extenuating circumstances in which a child of this age may provide their own consent.
INFANTS ACT [RSBC 1996] CHAPTER 223
https://www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/96223_01
The Infants Act, Mature Minor Consent and Immunization
https://www.healthlinkbc.ca/healthlinkbc-files/infants-act-mature-minor-consent-and-immunization
Mature Minor
A Minor who can understand and appreciate the nature, risks and consequences of a proposed Treatment/Procedure can provide consent without the input of their Legal Representative. The Mature Minor’s Legal Representative cannot override the Mature Minor’s decision.
Age alone will not determine a Minor’s Capacity to provide consent. In exceptional circumstances, a Minor under the age of 14 may be deemed a Mature Minor.
The Minor’s ability to understand the nature, benefits, risks, consequences and alternatives to medical care and treatment. The Minor’s decision making capability and understanding and appreciation of critical information is important.
Procedure: Consent to Treatment/Procedure(s): Minors/Mature Minors (October 25, 2010) https://www.albertahealthservices.ca/assets/info/hpsp/if-hpsp-phys-consent-summary-sheet-minorsmature-minors.pdf
Consent Policy Resources for Practitioners https://albertahealthservices.ca/info/Page3084.aspx
Policy B: Mature minor consent directives – Immunization
Background: In Saskatchewan, a person under 18 years of age who is assessed and deemed capable of providing informed consent for treatment (as a mature minor) is legally allowed to make health directive decisions.
Mature minors who are at least 13 years old up to and including 17 years of age can legally provide consent directives pertaining to immunizations.
Notes:
• The mature minor must approach the PHN with this request; the PHN should not approach the student to seek consent directives.
• A parent, guardian, or social worker cannot override consent directives given by a competent mature minor. If a PHN identifies any current or potential issues of this nature, their supervisor should be consulted immediately, and the PHN MUST bring this request to the attention of their supervisor and/or the jurisdictional Medical Health Officer (MHO) for a case-by-case consultation.
• When a student is 12 years of age or younger and is actively seeking immunization information and/or actively identifies herself/himself to a PHN as requesting to receive a vaccine(s), the PHN MUST bring this request to the attention of their supervisor and/or the jurisdictional MHO for consultation.
Saskatchewan Health Authority – Immunization – Clinical Resources
Provincial School Immunization Policy (August 2023)
https://www.ehealthsask.ca/services/resources/Resources/PSIP%202023-24.pdf
Consent generally requires both a capacity to consent and that the consent be informed. The mature minor doctrine holds that any young person, regardless of age, may have such a capacity to make health care decisions. The minor must be able to understand information relevant to a health care decision, appreciate the reasonably foreseeable consequences of that decision and be able to communicate the health care decision.[1]
As the Supreme Court of Canada has explained: … the right to make those decisions varies in accordance with the young person’s level of maturity, with the degree to which maturity is scrutinized intensifying in accordance with the severity of the potential consequences of the treatment or its refusal. [2]
The existence of current medical ethical guidelines and policies does not preclude the adoption of a parental consent law, and in fact, there is much to support the position of parental involvement in minors’ healthcare decisions.
1. The Health Care Directives and Substitute Health Care Decision Makers Act, SS 1997, c H-0.001, s 2(b)
2. AC v Manitoba (Director of Child and Family Services), 2009 SCC 30, para 46 [“AC v Manitoba”] https://www.canlii.org/en/ca/scc/doc/2009/2009scc30/2009scc30.html
ParentalConsent.ca
http://sk.parentalconsent.ca/?start=3
Position Paper: Parental Consent Reconciled with the Mature Minor
A. Criteria for valid consent for immunization
Before obtaining consent, the immunization provider administering a vaccine or biologic must ensure that the patient or person authorized to consent on the patient’s behalf is informed, orally or in writing, of:
a) the expected benefits and risks of the vaccine or biologic;
b) the risks of the disease in the absence of vaccination;
c) The benefits to the community of immunization programs and, the risks to the community of not being immunized;
d) any other information (ex: common side effects, contraindications, route of administration) that a reasonable person in the same circumstances would require in order to make a decision about the immunization; and
e) the importance of immediately consulting with the person administering the vaccine or biologic, or with another health care professional, if a reportable adverse event occurs following immunization.
D: Consent if client is a child
If the patient is a child, the information from section A must be given to the child’s parent or guardian if the child:
• is under 16 years of age, unless the immunization provider reasonably believes the child is able to understand the nature and effect of the information and is able to appreciate the consequences of a decision; or
• is 16 years of age or older, if the immunization provider reasonably believes the child is not able to understand the nature and effect of the information or able to appreciate the consequences of a decision.
Documentation of Informed Consent
The process for obtaining informed consent (including refusal of immunizations) must be documented.
Manitoba Health – Immunization (Vaccination)
https://www.gov.mb.ca/health/publichealth/cdc/div/index.html
Manitoba’s School Immunization Program: Questions & Answers for Health Care Providers (UPDATED August 2021)
https://www.gov.mb.ca/health/publichealth/factsheets/mb_school_imms.pdf
Informed Consent Guidelines for Immunization (ARCHIVED: April 2015)
Informed Consent Guidelines for Immunization (Amended: September 2023)
https://www.manitoba.ca/health/publichealth/cdc/protocol/consentguidelines.pdf
Excerpts from: Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A
https://www.ontario.ca/laws/statute/96h02#BK12
1. The purposes of this Act are,
(iii) requiring that wishes with respect to treatment, admission to a care facility or personal assistance services, expressed by persons while capable and after attaining 16 years of age, be adhered to;
(e) to ensure a significant role for supportive family members when a person lacks the capacity to make a decision about a treatment, admission to a care facility or a personal assistance service;
Consent to Treatment
No treatment without consent
10 (1) A health practitioner who proposes a treatment for a person shall not administer the treatment, and shall take reasonable steps to ensure that it is not administered, unless,
(a) he or she is of the opinion that the person is capable with respect to the treatment, and the person has given consent; or
(b) he or she is of the opinion that the person is incapable with respect to the treatment, and the person’s substitute decision-maker has given consent on the person’s behalf in accordance with this Act. 1996, c. 2, Sched. A, s. 10 (1).
Excerpts from: Child, Youth and Family Services Act, 2017, SO 2017, c 14, Sch 1
https://www.canlii.org/en/on/laws/stat/so-2017-c-14-sch-1/latest/so-2017-c-14-sch-1.html
Consents and agreements
4 (1) In this section,
“nearest relative”, when used in reference to a person who is younger than 16, means the person with lawful custody of the person, and when used in reference to a person who is 16 or older, means the person who would be authorized to give or refuse consent to a treatment on the person’s behalf under the Health Care Consent Act, 1996 if the person were incapable with respect to the treatment under that Act.
Consent, etc., of minor
(5) A person’s consent or withdrawal of a consent or participation in or termination of an agreement under this Act is not invalid by reason only that the person is younger than 18.
Child in need of protection
(2) A child is in need of protection where,
(e) the child requires treatment to cure, prevent or alleviate physical harm or suffering and the child’s parent or the person having charge of the child does not provide the treatment or access to the treatment, or, where the child is incapable of consenting to the treatment under the Health Care Consent Act, 1996 and the parent is a substitute decision-maker for the child, the parent refuses or is unavailable or unable to consent to the treatment on the child’s behalf.
Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A
https://www.ontario.ca/laws/statute/96h02#BK12
Child, Youth and and Family Services Act, 2017, SO 2017, c 14, Sch 1
https://www.canlii.org/en/on/laws/stat/so-2017-c-14-sch-1/latest/so-2017-c-14-sch-1.html
Children 14 and over can give their own consent to being vaccinated. If they refuse but the vaccine is required by their state of health, a court can order their vaccination.
https://educaloi.qc.ca/en/capsules/getting-vaccinated
Children 14 to 17 years old (but under 18) can make decisions on their own about care necessary for their health. This agreement is legally called “consent”.
A child 14 to 17 can refuse any type of health care: either necessary or not necesssary to the child’s health.
However, if the child’s parents or tutor don’t agree with the refusal, and want the child to receive the care anyway, they need a judge’s permission.”
https://educaloi.qc.ca/en/capsules/medical-decisions-for-children-14-to-17-years-old
Getting Vaccinated
https://educaloi.qc.ca/en/capsules/getting-vaccinated
Medical Decisions for Children Under 14
https://educaloi.qc.ca/en/capsules/medical-decisions-for-children-under-14
Medical Decisions for Children 14 to 17 Years Old
https://educaloi.qc.ca/en/capsules/medical-decisions-for-children-14-to-17-years-old
Age of majority
2 (1) Every person attains the age of majority, and ceases to be a minor, on attaining the age of nineteen years.
Mature Minors
PHIA recognizes the common-law principle of “mature minors,” which recognizes that the capacity to consent is incremental and situational. The capacity of each individual minor must be considered in the context of each episode of care. A 17-year-old may have the capacity to consent to (or withhold) disclosure of information related to one issue while lacking the capacity to consent to disclosure related to another.
Age of Majority Act
https://nslegislature.ca/sites/default/files/legc/statutes/agemajor.htm
CONSENT, CAPACITY, AND SUBSTITUTE DECISION-MAKERS
Personal Health Information Act
How old do I have to be to consent to treatment?
Generally, the law assumes that everyone 19 years and older is mentally capable and legally competent to consent to treatment unless proven otherwise.
In New Brunswick, for the purpose of receiving medical treatment, the Medical Consent of Minors Act gives a teenager who is 16 or older the same right to consent to health care treatment as a person who has reached the age of majority (19 years). This would include consenting to dental treatment, surgery and so on. The law also says that a child under 16 may be able to consent to treatment where the attending medical professional (doctor, dentist, nurse practitioner or nurse) decides that the child is capable of understanding the nature and consequences of the treatment, and that the treatment is in the best interests of the child and his or her well-being and continuing health.
Consent of persons under age of sixteen, when consent not required
3 (1) The consent to medical treatment of a minor who has not attained 16 years of age is as effective as it would be if the minor had attained the age of majority if, in the opinion of a legally qualified medical practitioner, dentist, nurse practitioner, nurse, licensed practical nurse or midwife attending the minor,
(a) the minor is capable of understanding the nature and consequences of the medical treatment, and
(b) the medical treatment and the procedure to be used is in the best interests of the minor and the minor’s continuing health and well-being.
When a child is sufficiently mature to be considered competent to make a medical decision and the parent/guardian refuses consent, the child can choose to be vaccinated.
Patients’ Rights
https://www.legal-info-legale.nb.ca/en/index.php?page=patients_rights
Medical Consent of Minors Act
https://www.canlii.org/en/nb/laws/stat/snb-1976-c-m-6.1/latest/snb-1976-c-m-6.1.html
Mature Minor Consent for COVID-19 Immunization (Archived 2021-05-28)
(d) “child” means a person actually or apparently under the age of 16 years;
Teen Consent or Refusal of Immunization
Although it is preferable that consent or refusal be obtained from a parent, any teenager 16 years of age and older may sign consent or refusal for his or her own immunization, provided that the nurse feels that the teenager has the capacity to understand the risks and benefits of immunization, and the risks associated with acquiring disease.
Where a teenager has the capacity but does not consent to immunization, regardless of his or her age, the public health nurse cannot administer immunization even if the parent consents. When a teenager under the age of 16 refuses immunization parents are advised.
In a situation where a teenager 16 years of age or older consents to a vaccination but the parent does not, it is important that the public health nurse clearly document the information provided to the teenager and that some document be contained in the file recognizing the teenager’s consent.
The “emancipated minor rule “ states that a child who has adopted a life style which indicates that he or she has assumed responsibility for own life (left home, married, entered work force) or in other ways has indicated that he/she has withdrawn from parental control and is making his/her own decisions can sign consent.
Parental consent is not necessary if the child is considered a “mature minor” ; a child who has the capacity to understand the nature of the medical complaint or illness, treatment available, the foreseeable risks and benefits of the treatment, as well as the consequences of inaction.
Child, Youth and Family Services Act, SNL 1998, c C-12.1
https://www.canlii.org/en/nl/laws/stat/snl-1998-c-c-12.1/latest/snl-1998-c-c-12.1.html
Government of Newfoundland and Labrador – Immunization Manual
https://www.gov.nl.ca/hcs/files/publichealth-cdc-s1-routine-guidlns-schedules.pdf
1. Definitions
(h) “child” means a person under the age of 18 years;
7. Capacity with respect to treatment
(1) Subject to the criteria prescribed pursuant to section 10, a patient is capable with respect to treatment if the patient is, in the health practitioner’s opinion, able
(a) to understand the information that is relevant to making a decision concerning the treatment;
(b) to understand that the information applies to his or her particular situation;
(c) to understand that the patient has the right to make a decision; and
(d) to appreciate the reasonably foreseeable consequences of a decision or lack of a decision
20. Capacity of maker
(1) Every person over the age of sixteen years who is capable may execute a directive.
CHILD PROTECTION ACT
https://www.canlii.org/en/pe/laws/stat/rspei-1988-c-c-5.1/latest/rspei-1988-c-c-5.1.html
Consent to Treatment and Health Care Directives Act
https://www.princeedwardisland.ca/en/legislation/consent-to-treatment-and-health-care-directives-act
People under the age of 19 may be mature enough to make their own decisions about their health information. The custodian must determine if a person has the capacity to understand his or her rights and the consequences of exercising these rights. If someone under the age of 19 has the capacity to make routine decisions about his or her personal health information, custodians may consider this person to be a mature minor. Keep in mind that the HIA refers to the collection, use, and sharing of personal health information, not treatment decisions.
A custodian who has reasonable doubt that a patient is a mature minor can assume that the patient’s guardian or parent will be making decisions on the patient’s behalf. The custodian should discuss this with the patient before sharing the patient’s information.
Health Information Act Guide
In Yukon, the Care Consent Act applies to people of all ages. That means anyone can consent to their own health care as long as they are capable of understanding and appreciating the consequences of that decision (s.6 (4) CCA). If a minor presents with or without parent/representative consent, it is your professional responsibility as a health care provider to assess their ability to consent and inform them about their right to provide consent on their own behalf despite the consent or refusal to consent by the parents.
Consent is based on capacity, not age, but adolescents do have varying levels of capability. A minor is considered capable of providing informed consent to their own health care if they demonstrate the ability to understand the benefits of vaccination, the risks of not getting a vaccines, and other standard information.
6 How incapability is determined
(1) A person’s incapability to give or refuse consent to care shall be determined by the care provider proposing to provide the care.
(2) When deciding whether a person is incapable of giving or refusing consent to care, a care provider must base the decision on whether or not the person demonstrates that they understand
(a) the information provided under paragraph 5(e); and 12 of 15
(b) provided under that the information applies to the situation of the person for whom the care is proposed.
(3) Subsection (2) applies whether or not the person has attained the age of 19 years.
(4) A person’s way of communicating with others is not, by itself, grounds for deciding that they are incapable of understanding anything referred to in subsection (2).
7 Duty to communicate in appropriate manner
When seeking a person’s consent to care or deciding whether a person is incapable of giving or refusing consent, a care provider
(a) must communicate with the person in a manner appropriate to the person’s skills and abilities; and
(b) may allow the person’s spouse or any relatives or friends, who accompany the person and offer their assistance, to help the person to understand or to demonstrate an understanding of the matters mentioned in subsection 6(2).
12 Choice of substitute decision-maker
(2) A person described in subsection (1) may give or refuse consent to care only if they
(b) are 19 years or age or older, unless they are the care recipient’s parent or spouse;
Guidance for the consent of minors – Yukon immunization manual
https://yukon.ca/en/guidance-consent-minors-yukon-immunization-manual
https://yukon.ca/sites/yukon.ca/files/hss/hss-imgs/16_-_minor_consent_for_hcp_final.pdf
Yukon Legislation
Care Consent Act, SY 2003, c 21, Sch B
https://laws.yukon.ca/cms/images/LEGISLATION/PRINCIPAL/2003/2003-023B/2003-023B.pdf
https://www.canlii.org/en/yk/laws/stat/sy-2003-c-21-sch-b/latest/sy-2003-c-21-sch-b.html
“adult” means a person who has attained the age of 18 years;
Presumption of capability
1.1. For the purposes of this Act, every adult is presumed, until the contrary is demonstrated, to be capable of making decisions about his or her own health care, personal care and well-being and his or her own financial affairs.
Mature Minors and Informed Consent
The common law also recognizes a category of minor called the “mature minor”. A mature minor is typically between the ages of 15-18 years and has the necessary capacity to fully understand the consequences of treatment or refusing treatment.
Mature minor status is always decided on a case-by-case basis and requires a judgment call by the immunization provider. A mature minor can override the medical decisions made by his/her parents and can either give consent or refuse immunizations.
Minors can also apply to the Court to receive a declaration under the Children’s Law Act that they are capable of managing their own lives, including their medical treatment. This is sometimes referred to as being an “emancipated minor”.
Guardianship and Trusteeship Act, SNWT (Nu) 1994, c 29
https://www.canlii.org/en/nu/laws/stat/snwt-nu-1994-c-29/latest/snwt-nu-1994-c-29.html
Nunavut Immunization Manual
https://www.gov.nu.ca/sites/default/files/immunization_manual.pdf
Informed consent is a process in which a patient or client is given essential information prior to partaking in a medical procedure or treatment or participating in a clinical trial. The basis of informed consent is that all individuals have free will, and thus the right to accept or reject any medical treatment.
According to the Canadian Medical Protective Association (CMPA), this principle is applicable not only to surgical operations, but also to all forms of medical treatment and diagnostic procedures that involve intentional interference with the person.
Informed consent is considered the most important principle of an ethical medical system and the principle is found in the Code of Ethics of every health profession and has both moral and legal implications for those administering a medical treatment.
Informed Consent – The Foundation of an Ethical Medical System
By Ted Kuntz
Uninformed Consent – A Metador Films Picture
By Vaccine Choice Canada & Librti.com
The contents of this website are for informational purposes only. Opinions expressed should not be construed as medical advice.
The particulars of any person’s concerns and circumstances should be discussed with a qualified health care practitioner prior to making any decision which may affect the health and welfare of that person or anyone under his or her care.
