Assessing maturity is one of the main ethical challenges for bioethics. It is even more complex when it comes to adolescents, as they are still in their maturing process. Three difficulties emerge: a conceptual difficulty as maturity is related to autonomy, competence and capacity; a methodological difficulty regarding which indicators should be used to assess it; and a practical difficulty in how to properly deal with it, as it is not easy to respect a maturity that only for a little (...) while now is being recognized and promoted. This paper begins by answering the question of why it is important to assess and promote maturity. Then, a chronology will be offered of the evolution of maturity attribution to minors as well as of the main variables that have been defined to asses it. Finally, some concepts will be clarified in order to develop an agglutinating proposal on indicators, requirements and conditioning factors of mature decision-making processes. (shrink)

According to a standard account of patient decision-making capacity, patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical c...

Reports of children participating in hunger strikes while detained in offshore detention centres raise interrelated ethical issues and recognizable challenges for the medical decision-makers at these sites. A composite case study, informed by reports in the public domain, is employed to explore the unique challenges of consent and decision-making in these circumstances and the perennial issues inherent in adolescents’ developing capacity and autonomy. We present an amalgamated case of a fourteen-year-old adolescent who refused to consent to medical reversal of her (...) hunger strike protest. The medical team became the final arbiter when her parents, who were also in detention, could not agree with each other even after mediation. The case explores the complexity of evaluating the adolescent’s capacity to provide informed consent while influenced by the opinions of co-detainees in this extreme setting. We argue that the parents and the child had compromised decisional capacity due to the effects of detention. The challenges to the medical team are recognized and discussed. The team members faced a difficult dilemma and considered the competing values of the multiple cultural and ethical factors. Each team member integrated his or her own roles, duties, and discipline-specific professional guidelines with the primary goal of mitigating potential harms. (shrink)