CONNECTICUT - CONSENT ISSUES

January 1, 2008

State laws and regulations that affect your medical practice

1. What are the requirements for parental consent in the case of the treatment of minors?

In general, the treatment of minor patients requires parental consent. (Persons eighteen (18) and older are considered adults, for the purposes of these regulations.) However, there are several exceptions to the requirement of parental consent, as follows:

A. Married or Pregnant Minors

C.G.S.A. § 19a-285

B. Outpatient Mental Health Treatment

A psychiatrist, psychologist or social worker may provide mental health treatment to a minor without the consent or notification of a parent or guardian if requiring such consent would cause the minor to reject such treatment; or the provision of such treatment is clinically indicated; or the failure to provide such treatment would be seriously detrimental to the minor's well-being; or the minor has knowingly and voluntarily sought such treatment; and in the opinion of the provider of treatment, the minor is mature enough to participate in treatment productively. The provider must document the reasons for any determination made to treat a minor without the consent or notification of a parent or guardian, along with a written statement signed by the minor regarding his decision not to notify his parent or guardian. After the sixth session of outpatient mental health treatment, the provider must notify the minor that the consent, notification or involvement of a parent is required to continue treatment, unless such a requirement would be seriously detrimental to the minor's well-being.

C.G.S.A. § 19a-14c

C. Blood Donation

Any person who is seventeen years of age or older shall have the legal capacity, without written authorization of his or her parent or guardian, to donate blood or any component thereof and to consent to the withdrawal of blood from his or her body, in conjunction with any voluntary blood donation program.

C.G.S.A. § 19a-285a

2. What is the effect of a minor's emancipation?

An order that a minor is emancipated shall have the effect that the minor may consent to medical, dental or psychiatric care, without parental consent, knowledge, or liability;

C.G.S.A. § 46b-150d

3. What is informed consent and when should it be obtained?

Generally, informed consent is given by a patient to a physician who has informed the patient of the following:

A. The illness;

B. The treatment, including the risks and any side-effects;

C. Treatment alternatives; and

D. Likelihood of success.

Informed consent is a means to ensure that a patient is educated and informed about the decisions the patient is making regarding his or her treatment. Thus, the consent given should reflect the understanding the patient has concerning his or her own well-being. Further, informed consent is also a means to safe-guard against physicians who may otherwise be accused of substituting their judgment for that of their patient, perhaps in the interests of time and efficiency.

4. Should a physician have a standard written form to fulfill all informed consent requirements?

No. Informed consent generally involves four factors: (1) the nature of the procedure; (2) the risks and hazards of the procedure; (3) the alternatives to the procedure; and (4) the anticipated benefits of the procedure. Generally, it would not be advisable to have a standard written form to address blanket issues. Written informed consent, specific to certain patients and their circumstances, is recommended. It is always important that patients be informed of their situation, their condition, their options and their alternatives as that is the purpose of informed consent. Any conversations which address these issues should also be documented within the patient's medical records.

5. What obligations does a physician have if a patient refuses to consent to treatment based on religious grounds?

Obligations of physicians are generally based upon whether the patient is an adult or minor, whether the treatment is likely to require a blood transfusion and the necessity of a court order. Upon informed consent, the physician should discuss all possibilities with the patient or adult guardian(s) of the patient including the risks involved, the likelihood of necessity of a blood transfusion and whether the physician can perform the treatment within the limits defined by the patient or adult guardian of the patient.

In the case of minor patients, the courts have long held that "a parent's right to control his or her child is limited even when the parent bases the claim on religion or conscience." (Prince v. Massachusetts, 321 U.S. 158 (1944).)

In the case of adults, Connecticut case law has established a common law right of bodily self-determination entitled to respect and protection. Health care providers have no common law right or obligation to thrust unwanted medical care on a patient who, having been sufficiently informed of the consequences, competently and clearly declines that care. As long as a patient is sufficiently informed of the consequences of her decision, is competent to make such a decision, and freely chooses to refuse treatment, the health care provider is required to respect her choice.

Copyright Kern Augustine Conroy and Schoppmann, P.C. Used with permission.