Virginia: 14 is old enough to decide on medical treatment

The governor hopes "Abraham's Law" will be a model for other states.

By Kevin B. O'Reilly, AMNews staff. May 7, 2007.

Virginia amended its child abuse law in late March to allow parents and children 14 or older to refuse medical treatment for a life-threatening condition. Most physicians and ethicists say the law is an appropriate acknowledgment of teenagers' role in medical decision-making, but some argue that it ultimately might limit adolescent rights.

The new law says parents cannot be charged with medical neglect if the decision to refuse a particular treatment for a life-threatening condition is made jointly and in good faith by the parents and a child who is 14 or older and "sufficiently mature to have an informed opinion on the subject of his medical treatment." The bill passed the Senate 29-10 and the House of Delegates 93-1 in late February.

Douglas S. Diekema, MD, MPH, director of education at Treuman Katz Center for Pediatric Bioethics at the University of Washington School of Medicine, said the law recognizes the changing view of children's medical autonomy.

"There are data that support 14 as the age at which most children acquire the ability to make reasoned decisions regarding medical issues," Dr. Diekema said. "If a child who is 14 or older and that child's parents agree that further aggressive treatment of a cancer or that a third liver transplantation, for example, is not in his or her best interests, that decision should be respected."

Dr. Diekema said the proper role for the courts in such cases is to ensure that the child freely decided to refuse the treatment and understands that the likely consequence is death.