From whom should consent be obtained for a 15-year-old requiring a lumbar puncture?

From the Guidelines

For a 15-year-old requiring a lumbar puncture, consent should typically be obtained from both the patient and their parents, as the patient's capacity to consent should be assessed and they may be considered competent to give voluntary consent, but it is good practice to seek parental consent in any situation where doubt exists. The guidelines for obtaining valid consent for medical procedures in minors emphasize the importance of assessing the young person's ability to understand and weigh up options, rather than relying solely on age 1. In the case of a 15-year-old, while they may be considered competent to give voluntary consent, it is still important to involve their parents in the decision-making process and obtain their consent as well, as this is considered good practice, especially in situations where doubt exists about the patient's competence 1. The concept of Gillick competence, which is based on the idea that children who have sufficient understanding and intelligence to enable them to understand fully what is involved in a proposed intervention will also have the capacity to consent to that intervention, is relevant in this context 1. However, the law regarding consent for minors varies by jurisdiction, and healthcare providers should be aware of the specific laws and regulations in their area, as well as their institution's policies regarding consent for minors 1. In general, it is recommended that healthcare providers follow a approach that balances legal requirements with respect for the adolescent's developing autonomy, and involves both the patient and their parents in the decision-making process, as this approach is most likely to prioritize the patient's morbidity, mortality, and quality of life outcomes. Some key points to consider when obtaining consent from a 15-year-old and their parents include:

• Assessing the patient's capacity to consent and involving them in the decision-making process
• Obtaining consent from the parents, as this is considered good practice, especially in situations where doubt exists about the patient's competence
• Explaining the procedure, its purpose, risks, benefits, and alternatives to both the patient and their parents in age-appropriate language
• Documenting the consent process and any discussions with the patient and their parents
• Being aware of the specific laws and regulations regarding consent for minors in the relevant jurisdiction, as well as the institution's policies regarding consent for minors.

From the Research

Consent for Lumbar Puncture in Minors

The question of who should give consent for a 15-year-old requiring a lumbar puncture is addressed by considering the age of the patient and the legal requirements for informed consent.

• In the case of minors, the law typically requires that consent be obtained from a parent or guardian, as minors are not considered legally competent to make medical decisions on their own.
• However, as minors approach the age of majority (18 years), their ability to provide informed consent for medical procedures may be considered, depending on the jurisdiction and the specific circumstances.

Relevant Studies

Studies have investigated the process of obtaining consent for lumbar puncture in pediatric patients, including the concerns and understanding of parents 2, 3, 4, 5.

• A study published in 2021 found that most parents had little knowledge about lumbar puncture and that the most common parental concern was paralysis 2.
• Another study from 2010 found that risks, benefits, alternatives, and explanation of the LP procedure are not adequately documented on consent forms in the pediatric emergency department 3.
• A 2019 study demonstrated that an educational video can improve parent understanding and perception of the safety of lumbar puncture, addressing concerns such as pain, infection, and neurological injury 4.
• A qualitative study from 2012 identified fear of complications, perception that the procedure is unnecessary, and distrust of the motives behind the request for consent as reasons why some parents refuse consent for lumbar puncture on their child 5.

Application to the Scenario

Given the age of the patient (15 years), the correct approach regarding consent would involve both the patient and their parents, as the patient is considered a minor but is approaching the age of majority.

• The most appropriate answer is to take patient consent and parents' assent, as this reflects the principle of involving minors in decision-making about their healthcare while still requiring parental involvement for legal and ethical reasons 6.

Key Points

• For minors under 15, parental consent is typically required.
• For minors between 15 and 18, both patient consent and parental assent are often required.
• For individuals over 18, only patient consent is required.
• The process of obtaining consent should include a clear explanation of the procedure, its risks and benefits, and any alternatives, to ensure that the patient and their parents can make an informed decision.