Involving Minors in Decisions about Medical and Mental Health Care: 

Legal, Ethical, Developmental and Clinical Considerations 

Recorded on November 2, 2022

Mary Ann McCabe, Ph.D., ABPP

1.5 CE credits 
$30/MPA Members  $55/Non Members

Gives you 1.5 of the 3 CE for the MD Licensing Requirement for Laws/Ethics or Risk Management 

Requirements for completion: This is considered a home-study course for reporting purposes, and in order to get CE credit you must pass the post-test (75%) and submit a completed evaluation. You will receive your CE certificate via email 7-10 business days after course completion. 

Level: Intermediate

Many states afford minors legal autonomy for decision-making in some areas of health (e.g., reproductive or mental health care). However, there are other situations where clinicians need to determine how much to include minors in decision-making, and work with families where parents and minors do not agree on their role in decision-making or the decisions themselves. Minors’ capacity for decision-making is situation-specific, and not all medical and mental health decisions are alike. Moreover, health care decision-making itself should be viewed on a continuum of involvement, ranging from information and preparation for treatment - to shared decision-making with parents - to autonomous decision-making (McCabe, 1996). Developmental competencies, ethical principles (i.e., autonomy, self-determination), and opportunities to promote development and treatment adherence provide impetus for involving minors to the greatest extent possible in health care decisions.

APA Ethical Principles (2002, 2010) support the premise of psychologists seeking to involve minors’ in their understanding of, and goals for, psychological services. Other organizations have explicit policy recommendations to involve minors in health care decisions to the greatest extent appropriate (e.g., AAP, 1995; Canadian Paediatric Society, 2004, United Nations Committee on the Rights of the Child, 2013). However, research suggests that this is complicated to carry out in practice (Lee, Havens, Sato, Hoffman and Leuthner, 2006; Vaknin & Zisk-Rony, 2011). The Institute of Medicine has issued reports documenting concern about the unique challenges of adolescent health services (IOM, 2009) and decisions (IOM, 2011). Yet science in the areas of adolescent brain development, decision-making, mental health, and health promotion is progressing and can inform practice in this area. There have been important advances in understanding developmental aspects to decision making (e.g., Halpern-Felsher, 2009; Reyna & Farley, 2006) and risk-taking (e.g., Casey, Getz and Galvan, 2008; Steinberg, 2012).

This workshop for psychologists will present an update of an original framework for considering legal, ethical, developmental, and clinical factors for determining the appropriate level of involvement of minors in health care decisions. The presenter will spend part of the workshop reviewing the legal and ethical issues involved in health care decision making, as well as the science relevant to adolescent development, decision making, risk-taking, and adherence to medical regimens. 

By the end of this presentation, attendees will be able to

  • Assess and enhance their framework for the determination of minors’ appropriate level of involvement in mental health care decisions
  • Recognize adolescent competencies relative to the standard for informed consent.
  • Differentiate the relative importance of ethical, developmental, and clinical considerations for involving minors in health care decisions.

Mary Ann McCabe, Ph.D., ABPP, is a clinical psychologist in independent clinical practice and Associate Clinical Professor of Pediatrics at George Washington University School of Medicine. She is a member of the National Academy of Science, Engineering and Medicine Forum on Promoting Children’s Wellbeing. She was previously the Director of the Office for Policy and Communications of the Society for Research in Child Development (SRCD), and Director of Training in Psychology, and Director of Health Psychology at Children’s National Medical Center. Dr. McCabe is an APA Fellow and currently serves on the APA Council of Representatives and Chair of the Interdivisional Task Force on Child and Adolescent Mental Health. She has just completed her term on the Board of Educational Affairs (BEA) and served previously as Chair of the Board of Professional Affairs (BPA), Member of the Workgroup on Expanded Advocacy, and Chair of the Committee for Professional Practice and Standards (COPPS). Dr. McCabe received her BA in psychology from Clark University and doctorate in clinical psychology at the Catholic University of America. She completed her clinical internship and fellowships in Child Psychology and the Law and Pediatric Psychology through Harvard Medical School at Judge Baker Children’s Center, Children’s Hospital of Boston, and Dana-Farber Cancer Institute.