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.