Post on 22-Apr-2023
Symbiosis Law School, Pune
MATURE MINOR’S CONSENT
VALUE IN THE EYES OF LAW
Authors:
Sameer Avasarala (Year I)
Shashank Kanoongo (Year I)
Abstract:
Treatment Refusal is a matter of right. It is so the case with minors. Minors were often treated not
competent to give consent from time immemorial. The authority to consent or refuse a treatment
was vested with the parent. It is based on the fact that the parents or guardians will act in the best
interest of their incompetent child. As parents vested various responsibilities on minors, they have
shown maturity in decision-making. Courts across the world have observed this and held that a
minor who shows maturity and competence deserve a voice in determining the course of their
medical treatment. This is the Mature Minor Doctrine. This paper shall explore the rights and
interests of mature minors vis-à-vis parents and the role of state in protecting such minors’
interests. This paper shall further explore the current situation in India and explore the scope of
application of this doctrine in India.
Introduction:
Symbiosis Law School, Pune Survey No 227, Plot 11, Rohan Mithila,
Opp. Pune Airport, New Airport Road,
Viman Nagar, Pune 411014
slspinfo@symlaw.ac.in
Medical Law is one of the most growing fields in the world. Medical Law is the branch of law
which concerns the prerogatives and responsibilities of medical professionals and the right of the
patients. The main branches of medical law are the law of confidentiality, negligence and torts in
relation to medical treatment, and criminal law in the field of medical practice and treatment. With
the ever growing cases in various countries of medical negligence and torts, new laws, principles
and doctrines have been developed by the medical professionals.
In the United States (U.S.), Smith v. Seibly1(1967), before the Washington Supreme Court proved
to be an important case for the existence of what today is known as “Mature Minor Doctrine.” It
established a precedent which made huge contribution and a thought for today’s people. Albert
G. Smith, the plaintiff, an 18 year old married father was suffering from myasthenia gravis. This
created a concern in the mind of Smith that his wife might become burdened in caring for him
and their children. On March 9, 1961, still at age 18 Smith requested a vasectomy. His doctor
required the written consent, which Smith provided, and the surgery was performed. Later, after
attaining an age of 21, Smith sued the doctor on the grounds that he had been a minor and thus
unable to grant surgical or medical consent. The Washington Supreme Court held rejecting the
claim that “Thus, age, intelligence, maturity, training, experience, economic independence or lack
thereof, general conduct as an adult and freedom from the control of parents are all factors to be
considered in such a case [involving consent to surgery].”
Except in very extreme cases, a physician has no legal right to perform a procedure upon, or
administer or withhold treatment from a patient without the patient's consent, nor upon a child
without the consent of the child's parents or guardian, unless the child is a mature minor, in which
case the child's consent would be required. Whether a child is a mature minor is a question of fact.
Whether the child has the capacity to consent depends upon the age, ability, experience, education,
training, and degree of maturity or judgment obtained by the child, as well as upon the conduct
and demeanor of the child at the time of the procedure or treatment. The factual determination
would also involve whether the minor has the capacity to appreciate the nature, risks, and
consequences of the medical procedure to be performed, or the treatment to be administered or
withheld. Where there is a conflict between the intentions of one or both parents and the minor,
the physician's good faith assessment of the minor's maturity level would immunize him or her
from liability for the failure to obtain parental consent. To the extent that Browning v. Hoffman2
(1922) and its progeny are inconsistent herewith, it is modified.
1 431 P.2d 719 (1967) 2 90 W. Va. 568 (1922)
In another case of Grannum v. Berard3, the court held that – “The mental capacity necessary to
consent to a surgical operation is a question of fact to be determined from the circumstances of
each individual case.” The court stated that a minor may grant surgical consent to the doctor even
without formal emancipation or parental consent.
As mentioned in the case of Cross v. Trapp4– “When a patient asserts that a particular method of
medical treatment, such as surgery, was performed by the patient's privately retained physician
without the patient's consent, the hospital where that treatment was performed will ordinarily not
be held liable to the patient upon the consent issue, where the physician involved was not an agent
or employee of the hospital during the period in question.”
The legal and medical communities have shown an increasing willingness to formally affirm
decisions made by young people even regarding life and death. As demonstrated by decades of
accumulated evidence, children are capable of participating in medical decision making in a
meaningful way. Since the 1970s, older paediatric patients especially sought to make autonomous
decisions regarding their own treatment, and sometimes sued successfully to do so.
The Supreme Court of Illinois in 1989, interpreted the Supreme Court of the United States on the
following aspects of mature minor doctrine, concluding
“Although the United States Supreme Court has not broadened this constitutional right of minors
beyond abortion cases, the [Illinois] appellate court found such an extension "inevitable."
...Nevertheless, the Supreme Court has not held that a constitutionally based right to refuse medical
treatment exists, either for adults or minors. ... [U.S. Supreme Court] cases do show, however, that
no "bright line" age restriction of 18 is tenable in restricting the rights of mature minors, [thus]
mature minors may possess and exercise rights regarding medical care... If the evidence is clear
and convincing that the minor is mature enough to appreciate the consequences of her actions,
and that the minor is mature enough to exercise the judgment of an adult, then the mature minor
doctrine affords her the common law right to consent to or refuse medical treatment [including
life and death cases, with some considerations].”
The Patient Self Determination Act was passed by the United States Congress in 1990 which acted
as the legislation advanced patient involvement in decision making, even though key provisions
apply only to patients over age 18. In Belcher v. Charleston Area Medical Centre5 (1992), The West
3 70 Wn.2d 304 (1967)
4 170 W. Va. 459 (1982) 5 422 S.E 2d 827 (1992)
Virginia Supreme Court defined a "mature minor" exception to parental consent, according
consideration to seven factors to be weighed regarding such a minor: age, ability, experience,
education, exhibited judgment, conduct, and appreciation of relevant risks and consequences.
The Supreme Court of Canada in A.C. v. Manitoba6 (2009) found that children may make life and
death decisions about their medical treatment; this annulled laws restricting capacity
determinations to those aged 16 and older.
A more recent delineation of the mature minor rule has come from the Supreme Court of
Tennessee in Cardwell v. Bechtol7. In that case, Tennessee's highest court adopted the mature minor
exception to the general common law rule requiring parental consent to medical treatment of
minors. In Cardwell, a young woman, seventeen years and seven months old, went to see the
defendant doctor on her own initiative, and without her parent's knowledge, seeking relief from
back pain. The defendant did not inquire about parental consent prior to rendering manipulative
therapy because he believed, based upon the young woman's demeanor, that she was of age, and
also that she had sought his treatment because he had previously treated her father. The parents
of the young woman brought an action against the defendant after complications from the
treatment arose. Following appeals from the lower courts, the Supreme Court of Tennessee held
that the defendant could not be held liable on a theory of battery for failing to obtain the consent
of the minor's parents.
Hence there are various more such cases that lead to what is today known as “Mature Minor
Doctrine.”
Cassandra C. Trial
The Connecticut Supreme Court on Thursday upheld that a 17-year-old cancer patient cannot
refuse chemotherapy treatment for Hodgkin’s lymphoma. The state argued that the teen does not
have the competency extended to maturity and that they did not believe she understood the
severity of her prognosis. Her mother and her mother’s lawyer expected to go back to trial court
to fully explore the mature minor argument. When “Cassandra C.,” as being identified in the court
was diagnosed with Hodgkin’s lymphoma in September, doctors at the Connecticut Children’s
Medical Centre (CCMC) recommended she receive chemotherapy. Cassandra C. ran away after
two treatments in November and, with the support of her mother, refused any more when she
returned. Temporary custody of the teen, and her mother was ordered to cooperate with medical
6 2009 SCC 30 (2009) 7 724 S.W.2d 739 (1987)
care administered under the agency’s supervision. The teen believed that the chemotherapy will
do more damage to her body than the cancer will. On the contrary, doctors have said that she has
an 80 to 85 per cent chance of living — with six months of chemotherapy treatment.
Cassandra mother after the arguments said she would not allow her daughter to die. The single
mother said she and her daughter want to seek alternative treatments that don’t include putting
the “poison” of chemotherapy into her daughter’s body. She said that “This is her decision and
her rights, which is what we are here fighting about. We should have choices about what to do
with our bodies.” The teen’s doctors testified at a trial court hearing after which the DCF was
authorized to make medical decisions on her behalf.
The teen and her mother appealed the ruling, claiming it violates their constitutional right and that
the state should recognize the “mature minor doctrine.” The doctrine permits a minor who
exhibits the maturity of an adult to make decisions reserved for those who attained the age of
majority, meaning 18. Cassandra turns 18 in September. The Supreme Court have to decide
whether to send the case back down to a lower court for another hearing to determine the
competency of the mother and of the child in terms of making the decision to halt treatment.8
Mature-Minor Doctrine as the name suggests is the doctrine which places importance on the
maturity of minor in cases relating to consent for diagnosis or treatment by a doctor. The Doctrine
has undergone considerable changes after its establishment in the Washington Supreme Court in
the case of Smith v. Seibly9. Mature Minor Doctrine emerges out of the fact that a minor can take
mature decisions about his or her health. Many aspects are to be considered when laying down a
principle regarding the doctrine. While it is understood to place emphasis on the mental maturity
of a minor, it also undermines some aspects of parental authority and the state.
What is the Mature Minor Doctrine?
The Mature Minor Doctrine propounds that a minor has to be given a say in the decision making
of his or her life and health and in absence of a guardian, an emancipated minor must be allowed
to independently take decisions. This view is generally not opposed. This doctrine extends to cover
all minors to bestow rights to all of them who while taking a decision regarding a procedure,
diagnosis or otherwise exhibits qualities which are becoming of a major or which show signs of
maturity and understanding of the consequences of his or her actions, such minor should be given
8 http://www.foxnews.com/health/2015/01/08/connecticut-supreme-court-upholds-rulingthat-teen-must-
undergo-chemo/ 9 431 P.2d 719.
the right to decide upon his health and life. The Supreme Court of Washington propounded this
doctrine first.
When the decisions of a minor conflict with those of a parent or a guardian, the court looks into
the matter. To determine competence of a minor, the court looks into age, experience, degree of
maturity, judgment skills, demeanour of the minor, evidence of separateness from parents and
other factors. The mature minor doctrine usually limits to an emancipated minor. It is generally
known that parents relinquish authority and responsibility and slowly start bestowing the same on
the children. They let the children take decisions and be a safety net for them. Adolescents are
caught in a limbo-like state between childhood and autonomy. Their cognitive ability and capacity
to reason is almost similar to that of an adult. When a minor is said to be mature enough to take a
decision, then the issue of understanding the treatment, short-term risks, long-term risks, benefits,
next best alternative to treatments should be understood. Also, the quality of life before and after
such treatment and the interests of the minor should be considering before terming a decision
taken by a minor ‘mature’.
Common Law and Mature Minor Doctrine
Under the common law, a minor, who is capable of making a reasonable assessment of the
advantages and disadvantages of a treatment advised by a physician is competent to give consent
for treatment. The Parliament of UK has also in the Family Law Reform Act, 1969
“The consent of a minor who has attained sixteen years to any treatment will obviate the necessity
to obtain any consent for it from his parents.”10
But in case of refusal of treatment by a minor, the court, in exercise of its inherent parens patriae
jurisdiction over minors, may override wishes of a minor if it finds objectively that refusal of
treatment would in all probability lead to the death of the minor or to permanent injury and such
treatment would be in the best of interests of the minor11. In furtherance, in Airedale NHS Trust v.
Bland12, the court held that a doctor is under no absolute obligation to prolong the life of the patient
regardless of the circumstances. If responsible medical opinion is of the view that it would be in
the patient’s best interests not to prolong his life because such continuance would be futile and
not confer any benefit on him, medical treatment must be withheld.
10 Section 8, Family Law Reform Act 1969 11 Re, W (a minor) (medical treatment), 1992 4 All ER 627 12 1993 1 All ER 821
Thus, common law recognizes the doctrine and has applied it. However, such doctrine is limited
in its use to mature minors. If the minor does not consent to the procedure, it is left to the
intelligence of the court to determine whether such an action by a mature minor is in furtherance
of the best interests of the minor as part of parens patriae jurisdiction of the court.
The Parens patriae Jurisdiction of Courts
Parens Patriae literally meaning the state is the protector of the citizens unable to protect themselves.
There are two tests
The Best Interests Test – This test requires the court to ascertain the course of action that
would serve the best interests of the person in question. It is important that the court’s
decision be based on the interests of the person alone and not society, parents or others.
Substituted Judgement Test – The application of this test requires the court to step into
the shoes of a person who is incapable and attempt to make the decision which the said
person would have made had he been competent to do so.
Applying the same test in the case of Mature Minor Doctrine, if a minor patient who is mature
enough and has exhibited signs of maturity in declining the treatment, the court must consider the
best interests of the minor in question, the quality of life if such treatment is opted, the
consequences of denial of such treatment and effectiveness of such treatment. Many such
questions need to be answered by the court before reaching a judgement based on the best interests
test. Secondly, it is important that the court also step into the shoes of the minor to understand
his or her feelings, priorities, reasons for denial, circumstances and the nature of the minor as
he/she is and not an ideal person and take a reasoned decision based on such criterion.
In the case of Re A(Children)13, there were conjoined twins who had to undergo a surgery to separate
them within three to six months. One of the twins (J) was capable of independent existence while
the other (M) was not. The operation would have resulted inevitably in the death of M but would
have enabled J to lead a normal life. The parents refused to give permission for the operation. The
hospital caring for them, applied for permission to operate. The Court of Appeal in Canada
confirmed the order for permitting the operation after carrying out a balancing exercise and
choosing the lesser of the two evils. The court exercised its Parens Patriae jurisdiction in this case.
Further in the case of Glass v United Kingdom14, it established that an arbitrary action on part of
doctors or persons or authorities not judicially clothed shall not be accepted if they go against the
13 2000 4 All ER 961 (CA) 14 2004 1 FLR 1019
desire of parents with respect to the medical treatment of a child without approaching a court of
law for permission of the same. In the current case, despite the mother’s strong disagreement, to
ease the pain the child was facing, the doctors administered diamorphine which almost proved
lethal. The mother successfully resuscitated the child and was awarded €10000 as non-pecuniary
damage.
USA & Canada on the doctrine
The USA regarded bodily integrity as a very important right and always held it high. In USA, the
mature minor doctrine has been established and is in force. The Supreme Court of United States
allowed mature minors to consent to abortions and treatments without parental authority or
consent in the case of In Re E.G a Minor 198915. Further in the United States of America, the
Emancipation of Minors Act, enables a mature minor to take a decision regarding his or her life
or health.
The Supreme Court of Canada ruled in A.C v Manitoba16 that children may take life and death
decisions about their medical treatment.
“If a mature minor does in fact understand the nature and seriousness of her medical condition
and is mature enough to appreciate the consequences of refusing consent to treatment, then the
state’s only justification for taking away the autonomy of that young person in such important
matters disappears”
Thus, the United States of America and Canada have introduced and brought into force the Mature
Minor Doctrine thus giving minors the rights to take mature decisions regarding their life and
death and all health matters.
The Gillick Competence and Fraser’s Guidelines
In Gillick v West Norflock and Wisbech Area Health Authority17, the House of Lords established the
test for competence of a minor to give consent. Gillick competency and Fraser guidelines refer to
a legal case which looked specifically at whether doctors should be able to give contraceptive advice
or treatment to under 16-year-olds without parental consent. But since then, they have been more
widely used to help assess whether a child has the maturity to make their own decisions and to
understand the implications of those decisions.
15 549 N.E.2d 322 (1989) 16 2009 SCC 30 17 1985 3 All ER 402
Gillick Competency Test assesses the maturity of a minor to take decisions. Lord Scarman’s
comments in his judgement of the case are referred to as the Gillick Competency Test
"...whether or not a child is capable of giving the necessary consent will depend on the child’s
maturity and understanding and the nature of the consent required. The child must be capable of
making a reasonable assessment of the advantages and disadvantages of the treatment proposed,
so the consent, if given, can be properly and fairly described as true consent."
The Fraser’s guidelines have been modified to suit all cases and not restricting to contraceptives
as the case was before the House of Lords
That the minor will understand his advice and has sufficient maturity to understand all
implications
That the minor cannot be persuaded to inform his/her parents about such advice.
That the minor’s mental or physical health or both might suffer unless he/she receives the
treatment so in question
It is in the minor’s best interest to receive the advice or treatment even without parental
or guardian’s consent
Informed Consent in Minors
Informed consent has been an integral part of the granting of consent in the United States as well
as in India. Along with the test of competency of minor to understand the procedure so conducted
upon him, it is important to analyse whether the minor is being briefed about the procedure, risks,
and benefits associated with it, alternatives available and risks with such alternatives. Hence, the
informed consent in minors is considered very important. Informed consent presumes respect for
patient autonomy and provision of full and accurate information to the patient to enable the
patient take a reasoned decision, both on the positive and the negative side. Informed consent was
established in Cantebury v Spence18 and includes
• An understandable explanation of the condition, treatment, risks and benefits of the
proposed treatment and alternatives.
• An assessment of the person’s understanding of the information provided;
18 464 F2D 772: 150 US App. DC 263 (1972)
• An assessment of the competence of the minor or surrogate to make medical decisions;
• Assurance that the patient or surrogate has the ability to choose freely between alternatives
without coercion.
All these principles of consent for medical procedures must apply to minors too to test their
understanding of their procedure, risks and all the alternatives associated with it. Such decision
taken by a mature minor must be backed with information regarding the procedure to ensure a
reasoned decision and a mature one.
An Indian Perspective
In India, Mature Minor Doctrine is not fully grown. Rule 7.16 of Chapter VII of the Code of
Medical Ethics Regulations, 200219 prescribe that the physician must obtain the consent of the
parent or guardian in case of a minor and does not explicitly provide any rules for a minor who
has attained enough maturity to understand consequences of his or her decision. Hitherto, a minor
is not eligible to give consent for medical procedures.
“Before performing an operation the physician should obtain in writing the consent from the
husband or wife, parent or guardian in the case of minor, or the patient himself as the case may
be.”
In Samira Kohli v Prabha Manchanda 200820, the Supreme Court held that while the patient herself
was a major and a competent person to give consent and there was no emergency situation, the
consent of the mother would not be relevant. The Supreme Court summated the principles relating
to consent and approved the Bolam Test21. In this case, the Supreme Court while summing the
guidelines observed
“A doctor has to seek and secure consent of the patient before commencing a treatment. The
consent so obtained should be real and valid, which means that; the patient should have the
capacity and competence to consent; his consent should be voluntary; and his consent should be
on the basis of adequate information…”
19 Rule 7.16 – Code of Medical Ethics Regulations, 2002 20 Samira Kohli v Prabha Manchanda (2008) 2 SCC 1 21 Bolam v Friern Hospital Management Committee [1957] 1 WLR 582
Mature Minor Doctrine was also used outside India to terminate pregnancy of unmarried minor
girls22. This is explicitly prohibited in India in The Medical Termination of Pregnancy Act 197123
by way of Section 4(a)
“No pregnancy of a woman, who has not attained the age of eighteen years, or who, having
attained the age of eighteen years, is a lunatic, shall be terminated except with the consent in writing
of her guardian”
A minor who is mature enough to understand the consequences of his/her acts is disabled from
consenting to any medical procedure for himself or herself. Further in case of organ
transplants/donations including blood.24 Section 3 of Transplantation of Human Organs Act 1994
applies which stipulates and defines donor as one who has attained majority along with other
conditions. Under Section 27, a minor is disabled from donating blood.
Further under the Indian Penal Code, also talks about the capacity of a guardian to take decisions
for the benefit of a child under Section 89 of the IPC25. “Consent of the Guardian should be taken
for an act to be done in good faith for the benefit of the child under 12 years of age or an insane
person”. However Section 87 of IPC allows a person aged 18 years or more to give consent to
suffer a harm.
The Doctor – Minor Patient Relationship
Doctor-Patient Relationship is based on certain principles of contract law in addition to fiduciary
and other types. A proposal, when accepted becomes a promise. The person making the promise
is the promisor or the doctor. The person who accepts the proposal is the patient. When at the
desire of the promisor, the promise does something or abstains from doing, or promises to do or
abstain from doing, something such act or abstinence or promise is called a consideration for the
promise. In this case, the consideration is the doctor’s fee. The patient should be in a position to
understand the nature and implication of the proposed treatment including its consequences, in
this regard, the law requires special considerations.
Summing up, in India, a person is said to have capacity to consent when he/she has understood
the information and is able to understand the consequences of his or her act and decision. There
are fixed guidelines in India that majority is achieved at 18 years and considered legal age for
consenting to a treatment as per Indian Majority Act and Indian Contract Act. A child between 12
22 Family Law Reform Act, 1969; Section 8 23 Medical Termination of Pregnancy Act, 1971 24 Transplantation of Human Organs Act 1994 25 The Indian Penal Code, 1860
and 18 years, however, is allowed to give consent only for medical examination or diagnostic
examination but not for any procedure26.
Scope for development of the doctrine in India
Minors in India cannot give consent to therapeutic treatment27. A doctor in India is obliged to
communicate and seek consent of the parent or guardian for treating a minor28. However, in India,
a child between 12 and 18 years of age, is allowed to give consent only for medical examination29.
Other factors in a minor like experience, maturity are not considered. The test laid down by the
Supreme Court with regard to patients’ consent should be extended to cover minors who are
mature enough to understand consequences of his or her own act. The Gillick Competence Test
& Fraser’s guidelines must be adopted to test the competence of a minor to consent for a medical
treatment. However, the tests are not fully conclusive. Assessing the competence of a minor can
be complex.
The Lord Scarman’s Test clearly highlight the importance of maturity. It is based on “consent shall
be treated valid when the child achieves a sufficient understanding and intelligence to enable him or her to understand
fully what is proposed”. This is the Gillick Competence Test. There are certain complications in
adoption of the guidelines. The first being the Fraser’s guidelines do not actually reflect Lord
Scarman’s Test completely. The level of understanding the minor is required to have of the
treatment is not reflected in the Fraser’s guidelines. However, there is ambiguity as to whether
actual understanding of proposed treatment or capacity to understand the treatment is the
competency test and further what is the threshold of understanding. Secondly, the best interests
of the minor should be taken care of by the doctor. When the minor is competent enough as
assessed by the doctor, then the minors interests should be considered. This is at some point
threatening the authority of the guardians and parents over the child. Therefore, who actually has
the legal right to decide whether advice and treatment is in the best interests of the child needs to
be clarified. When a minor patient consents to a treatment, the doctor assesses the mental capacity
and has the power to veto the child’s decision if deemed competent. This is arbitrary is nature and
very imposing on the child. Every such decision taken by a mature minor if brought before a court
26 Sharma RK. Consent. In: Sharma RK, editor. Legal aspects of patient care. New Delhi: Modern publishers;
2000: 3-6. 27 Capacity to Consent: Indian Contract Act Section 3 28 Code of Medical Ethics Regulations, 2002 29 Sharma RK. Consent. In: Sharma RK, editor. Legal aspects of patient care. New Delhi: Modern publishers;
2000: 3-6.
in the parens patriae jurisdiction if the child has refused the treatment is a very lengthy process.
There has to be certain regulatory and supervisory body for such consent.
The United Nations Convention on Rights of the Child (UNCROC) recognizes and ensures that the state
take note of the increasing autonomy of children as they mature, and also welfare of the child not
forgetting the fact that guardians of children will have their best interests as their basic concern.
India is a party to the convention. India must adopt the mature minor doctrine and frame rules
and tests for assessing the maturity of a minor to take decisions about his health and life.
India must ensure that the rights of its minors are voiced and its mature minors are given right to
consent or not to consent to medical treatments, life and death situations with respect to such
treatments. India must work on institutionalizing framework for dealing with issues of Mature
minor’s consent and set up a machinery which will allow minors to take decisions and check and
control the arbitrariness of medical practitioners in taking such decisions with veto while
understanding and supporting the best interests of the child with considering the interests of the
legal guardians of the minor.
Conclusion
Determining the competence of a minor to take decisions has been an unanswered question for
long. Fortunately, laws from various countries have devised tests to determine such competence
and provisions which help the mature minor participate in decision making. When a minor’s
decision and the parent’s decision contradict each other, the need for the court to intervene and
exercise its parens patriae jurisdiction occurs. In life-and-death situations, it becomes all the more
crucial for the court to consider the interests of the minor vis-à-vis the interests of the parents and
state. Measures must be adopted to ensure equal representation of a mature minor. On one hand,
it is difficult to measure the competence of a minor while his personal interests cannot be ignored.
Some tests need to be formed which may provide more accurate forms of measurement of the
maturity of the minor while taking such decisions and it must come within the purview of the
court to analyse such decision by methods it formulates and the ratio behind it. However, the
welfare of the child is of phenomenal importance when weighed against the state and that of the
community and such interests need to be preserved keeping in mind the welfare of the child.
References
1. Smith v. Seibly 431 P.2d 719 (1967)
2. Browning v. Hoffman 90 W. Va. 568 (1922)
3. Grannum v. Berard 70 Wn.2d 304 (1967)
4. Cross v. Trapp 170 W. Va. 459 (1982)
5. Belcher v. Charleston Area Medical Centre 422 S.E 2d 827 (1992)
6. A.C. v. Manitoba 2009 SCC 30
7. Cardwell v. Bechtol 724 S.W.2d 739 (1987)
8. Fox News: http://www.foxnews.com/health/2015/01/08/connecticut-supreme-court-
upholds-rulingthat-teen-must-undergo-chemo/
9. Section 8, Family Law Reform Act 1969
10. Re, W (a minor) (medical treatment), 1992 4 All ER 627
11. Airedale NHS Trust v. Bland 1993 1 All ER 821
12. Re A(Children) 2000 4 All ER 961 (CA)
13. Glass v United Kingdom 2004 1 FLR 1019
14. In Re E.G a Minor 549 N.E.2d 322 (1989)
15. Gillick v West Norflock and Wisbech Area Health Authority 1985 3 All ER 402
16. Cantebury v Spence 464 F2D 772: 150 US App. DC 263 (1972)
17. Rule 7.16 – Code of Medical Ethics Regulations, 2002
18. Samira Kohli v Prabha Manchanda (2008) 2 SCC 1
19. Bolam v Friern Hospital Management Committee [1957] 1 WLR 582
20. Family Law Reform Act, 1969; Section 8
21. Medical Termination of Pregnancy Act, 1971
22. Transplantation of Human Organs Act 1994
23. The Indian Penal Code, 1860
24. Capacity to Consent: Indian Contract Act Section 3
25. Code of Medical Ethics Regulations, 2002
26. Sharma RK. Consent. In: Sharma RK, editor. Legal aspects of patient care. New Delhi:
Modern publishers; 2000: 3-6.