COSAs and Psychopharmacological Interventions: Informed Consent and a Child’s Right to Self-Determination

Abstract

Clinical and social science research indicates that minor children of substance abusers (COSAs) have an increased risk of behavioral or psychological disorders. When these disorders are identified or diagnosed by professionals, psychopharmacological interventions may often be recommended as a component of treatment. In the United States, a minor child may not legally consent to such treatment. Instead, parents (or other court-appointed persons or entities) must substitute judgment for a child. The exercise of "substituted judgment" implicates ethical and legal standards of "informed consent" and "consent-by-proxy." Despite extensive commentary, however, the needs and interests of adults, as well as beneficiaries of the economic investment in such medications, may deny vulnerable children protection from unnecessary or ineffective interventions. The author suggests that "substituted judgment," if undergirded in the United States by constitutional notions of due process, should require: (1) objective and compelling evidence that a parent's exercise of substituted judgment is independent and unimpaired; (2) that consent respects the child's right to self-determination; and (3) the child's present and future health is enhanced by the intervention.