Gerald R. Lacy
Charleston, West Virginia
Henry C. Bias, Jr.
Charleston, West Virginia
Attorneys for the Appellant
Ralph C. Dusic, Jr.
Karen Speidal Rodgers
Kay, Casto, Chaney, Love & Wise
Charleston, West Virginia
Attorneys for the Appellee
Charleston Area Medical Center
Stephen D. Annand
Paul L. Weber
Shuman, Annand & Poe
Charleston, West Virginia
Attorneys for the Appellee
M. B. Ayoubi, M.D.
CHIEF JUSTICE McHUGH delivered the Opinion of the Court.
1. "As a general rule, the conduct of trials and the
order of introducing testimony, subject to well established rules
of practice and procedure, rest within the sound discretion of the
trial court, and that rule is applicable to the admissibility of
evidence in rebuttal which could and should have been introduced by
the plaintiff in chief." Syl. pt. 9, Edmiston v. Wilson, 146 W.
Va. 511, 120 S.E.2d 491 (1961).
2. Under Rule 611(a) of the West Virginia Rules of
Evidence, a trial court has broad discretion in permitting or
excluding the admission of rebuttal testimony, and this Court will
not disturb the ruling of a trial court on the admissibility of
rebuttal evidence unless there has been an abuse of discretion.
3. "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." Syl. pt. 7, Cross v. Trapp, 170 W.
Va. 459, 294 S.E.2d 446 (1982).
4. 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.
Hoffman, 90 W. Va. 568, 111 S.E.2d 492 (1922) and its progeny are
inconsistent herewith, it is modified.
McHugh, Chief Justice:
This case is before the Court upon the appeal of Larry
Belcher, Sr., administrator of the estate of Larry Belcher, Jr.,
and plaintiff below, from the judgment of the Circuit Court of
Kanawha County.See footnote 1 The appellees, and defendants below, are
Charleston Area Medical Center (CAMC), Charleston Pediatric Group,
Inc., and M. B. Ayoubi, M.D.
On December 22, 1986, Ayoubi discussed with the
appellants the likelihood of Larry suffering another respiratory
arrest and also discussed his (Ayoubi's) concern that Larry would
become "respirator-dependent" if he were to remain on it.
Furthermore, long-term respirator support would cause Larry's
throat to swell shut, thus requiring a tracheotomy and feeding
through a tube. Ayoubi also asked the appellants about whether
they would want Larry subjected to resuscitative measures,
including reintubation, in the event he suffered another
respiratory failure.
The next morning, December 23, 1986, Ayoubi contends that
the appellants indicated that they had not yet decided on whether
Larry should be intubated and placed on a respirator again in the
event of another breathing failure. Later that day, December 23,
1986, at 10:30 a.m., Larry was taken off the respirator and was
extubated. Small doses of morphine sulphate were prescribed to
relieve Larry's pain and anxiety. Ayoubi observed Larry becoming
anxious and apprehensive as he was disconnected from the
respirator. Ayoubi advised Larry that he could be reintubated, but
Larry motioned his head "no," indicating that he did not want to be
reintubated.
Later that day, December 23, 1986, the appellants told
Ayoubi that they decided they did not want Larry reintubated or
resuscitated unless Larry requested it. Accordingly, Ayoubi had
the appellants sign a progress note stating that Larry was not to
be reintubated or resuscitated in the event of a respiratory
failure.See footnote 2 The progress note was formalized into a "Do Not
Resuscitate" order.See footnote 3
Larry was not involved in this decision because, as
Ayoubi contends: (1) he was emotionally immature due to his
disease; (2) he was on medication which diminished his capacity;
(3) involving him in the decision would have increased his anxiety,
thus reducing his chances of survival; and (4) Larry's parents told
Ayoubi that they did not want Larry involved.
At 3:00 a.m. on December 24, 1986, Larry had another
respiratory arrest, suffered cardiac failure, and died. The
hospital staff attempted, within the limits of the "Do Not
Resuscitate" order, to administer "precordial thumps," repositioned
his head, and attempted to blow oxygen into his mouth, all to no
avail.
The appellants filed this action for wrongful death,
alleging medical malpractice, on September 16, 1988, in the Circuit
Court of Kanawha County. Following trial, the jury returned a
verdict in favor of the appellees.
In this appeal, the appellants raise issues involving:
the circuit court's refusal to allow certain proffered rebuttal
evidence; and the circuit court's refusal to allow the case to go
to the jury on a theory that Larry should have been consulted prior
to the issuance of the "Do Not Resuscitate" order, thus,
recognizing the so-called "mature minor" exception to the common
law rule of parental consent.
Syl. pt. 9, Edmiston v. Wilson, 146 W. Va. 511, 120 S.E.2d 491
(1961). Professor Cleckley has spoken to this situation: "Here,
the plaintiff is merely requesting an opportunity to do in rebuttal
what should have been done in the case in chief. This is not true
rebuttal. Rather, it is analogous to a request to permit the
plaintiff to reopen its case." Franklin D. Cleckley, Handbook on
Evidence for West Virginia Lawyers § 3.1(A), at 55 (2d ed. 1986).
The United States Supreme Court has held the following
with respect to the trial court's discretion in permitting or
excluding rebuttal testimony:
The trial judge must meet situations as they
arise and to do this must have broad power to
cope with the complexities and contingencies
inherent in the adversary process. To this
end, he may determine generally the order in
which parties will adduce proof; his
determination will be reviewed only for abuse
of discretion. Goldsby v. United States, 160
U.S. 70, 74, 16 S. Ct. 216, 218, 40 L. Ed.
343, 345 (1895); United States v. Martinez-Villanueva, 463 F.2d 1336 (CA9 1972); Nelson
v. United States, 415 F.2d 483, 487 (CA5
1969), cert. denied, 396 U.S. 1060, 90 S. Ct.
751, 24 L. Ed. 2d 754 (1970). Within limits,
the judge may control the scope of rebuttal
testimony, United States v. Chrzanowski, 502
F.2d 573, 575-576 (CA3 1974); United States v.
Perez, 491 F.2d 167, 173 (CA9), cert. denied
sub nom., Lombera v. United States, 419 U.S.
858, 95 S. Ct. 106, 42 L. Ed. 2d 92 (1974);
may refuse to allow cumulative, repetitive, or
irrelevant testimony, Hamling v. United
States, 418 U.S. 87, 127, 94 S. Ct. 2887,
2912, 41 L. Ed. 2d 590, 626 (1974); Count of
Macon v. Shores, 97 U.S. 272, 24 L. Ed. 889
(1877); and may control the scope of
examination of witnesses, United States v.
Nobles, 422 U.S. 225, 231, 95 S. Ct. 2160,
2166, 45 L. Ed. 2d 141, 149 (1975); Glasser v.
United States, 315 U.S. 60, 83, 62 S. Ct. 457,
470, 86 L. Ed. 680, 706 (1942). If truth and
fairness are not to be sacrificed, the judge
must exert substantial control over the
proceedings.
Geders v. United States, 425 U.S. 80, 86-87, 96 S. Ct. 1330, 1334-35, 47 L. Ed. 2d 592, 598 (1976).
The components mentioned above by the United States
Supreme Court are now reflected in Rule 611(a) of the West Virginia
Rules of Evidence.See footnote 4 Rule 611(a) provides:
Rule 611. Mode and Order of
Interrogation and Presentation. (a) Control
by Court.--The court shall exercise reasonable
control over the mode and order of
interrogating witnesses and presenting
evidence so as to (1) make the interrogation
and presentation effective for the
ascertainment of the truth, (2) avoid needless
consumption of time, and (3) protect witnesses
from harassment or undue embarrassment.
The trial court's discretion in permitting or excluding
rebuttal evidence comes within the ambit of Rule 611(a).
"Reopening of a case, recalling of a witness, and the acceptance or
rejection of rebuttal testimony are . . . examples of situations in
which the trial judge must . . . determine how the aims of Rule
611(a) can best be implemented. . . . [H]is decision will rarely be
disturbed on appeal." 3 Jack B. Weinstein & Margaret A. Berger,
Weinstein's Evidence ¶ 611[01], at 30-31 (1991) (emphasis supplied)
(footnotes omitted).See footnote 5
Accordingly, we hold that under Rule 611(a) of the West
Virginia Rules of Evidence, a trial court has broad discretion in
permitting or excluding the admission of rebuttal testimony, and
this Court will not disturb the ruling of a trial court on the
admissibility of rebuttal evidence unless there has been an abuse
of discretion.See footnote 6
In this case, as we stated previously, we believe that
the testimony proffered as rebuttal by the appellants, in reality,
amounts to nothing more than an attempt to reopen their case. The
substance of the testimony by Dr. Schonberg that the appellants
attempted to have admitted as "rebuttal" was already testified to
by that witness during the appellants' (plaintiffs') case-in-chief.
Concerning the issue of whether there existed a national
standard throughout the United States for having a specific policy
on "Do Not Resuscitate" orders, Dr. Schonberg testified on direct
examination, as part of the appellants' case-in-chief, that not
including Larry in the decision to issue that type of order was
inappropriate for the following reasons:
Because that was the national standard,
that mature minors, 17 year olds, for any
major position, for an amputation, for
chemotherapy, for allowing them to die, if
they were mature, if they were capable, if
they could understand, they had to be part of
the discussion relative to their subsequent
care. To give other advice would be in
conflict with what is national standard, was
national standard in 1986.
As part of Dr. Schonberg's proffered rebuttal testimony,
he was asked: "[I]n 1986, did the national standard for physicians
and hospitals require that the parents and the minor, or the
parents or the minor, consent to any treatment or the withholding
of any treatment?" Dr. Schonberg replied that "[a] national
standard in 1986, that, in dealing with the mature minor, that that
mature minor would need to be informed, and one would need to
receive his assent to do any major procedure. Here again,
regarding Do Not Resuscitate as a major procedure or a
nonprocedure."
With respect to the testimony regarding whether the
morphine sulphate given to Larry harmed him, Dr. Schonberg, on
direct examination during the appellants' case-in-chief, testified
that "the administration of morphine to a patient with respiratory
compromise, a patient who has a high blood carbon dioxide level,
the administration of morphine under those circumstances, if you
don't intend to resuscitate the patient if they stop breathing,
that is contraindicated and that is a mistake." Furthermore, on
cross-examination during the appellants' case-in-chief, Dr.
Schonberg testified that because Larry was administered the
morphine sulphate when his carbon dioxide level was already very
high, it "decreased his ability to respond to that, and it was a
contributing factor in his downhill course. Now, that the morphine
sulphate was gone or, for pharmacologic purposes, gone five hours
later, doesn't excuse what it would have done to him
physiologically earlier on in the evening[.]"
Turning to the testimony concerning the consent of Larry,
and whether he was a mature minor so as to give consent to issuing
the "Do Not Resuscitate" order, Dr. Schonberg testified on direct
examination that the national standard of care was that a mature
minor must be involved in such discussions. On cross-examination,
Dr. Schonberg testified that a 17-year-old minor cannot be denied
his right to give consent to a surgical procedure.
Finally, regarding the testimony of whether long-term
respirator support would constitute a "reasonable alternative" to
the "Do Not Resuscitate" order, Dr. Schonberg testified on direct
and cross-examination that informed consent consists of
understanding the available alternatives and balancing risks
pertaining to such alternatives.
As can be plainly seen from the testimony above, which
was given during the appellants' case-in-chief, any attempt to
testify to these issues again, as proffered rebuttal, is in
reality, an attempt to reopen the appellants' case. We agree with
the ruling of the circuit court which was issued after hearing the
proffered rebuttal testimony. In that ruling, the circuit court
stated:
I find that during [Dr. Schonberg's]
testimony in chief regarding the consent
policy and so forth that he went into this
morning, proposed to go into regarding CAMC,
that that matter was presented by him to the
jury during his testimony in chief and that
what he proposed to tell the jury today was
not in rebuttal, nothing new, nothing
significant and new, and nothing that could
not have been explored originally if it was
felt necessary.
Based upon the above, the circuit court did not abuse its
discretion by refusing to allow admission of the appellants'
rebuttal testimony.
In Cross, we relied upon the holding of the Court of
Appeals of New York in Fiorentino v. Wenger, 280 N.Y.S.2d 373
(1967). In Fiorentino, the New York court stated that "it would
not be just for a court, having the benefit of hindsight, to impose
liability on a hospital for its failure to intervene in the
independent physician-patient relationship." 280 N.Y.S.2d at 379.
The appellants urge this Court to move away from this
principle. In support of their contention, the appellants cite the
case of Felice v. St. Agnes Hospital, 411 N.Y.S.2d 901 (N.Y. App.
Div. 1978) for the proposition that the holding enunciated in
Fiorentino has been left in doubt. We do not agree with this
contention.
In Felice, the court stated:
Present day hospitals, as their manner of
operation demonstrates, do far more than
furnish facilities for treatment. . . .
Whatever may have been the case in earlier
times, today the hospital takes an
increasingly active part in supplying and
regulating the purely medical care the patient
receives. The fact that certain doctors are
not employees of a hospital does not mean such
institution cannot be held liable for adverse
effects of treatment or surgery approved by
the doctors.
411 N.Y.S.2d at 907 (citation omitted).
However, as the appellants acknowledge, Felice does not
deal with the issue of a hospital's liability due to failing to
obtain informed consent, but with the general issue of a hospital's
liability for the acts of its physicians. The court in Felice says
nothing to indicate that the holding of Fiorentino has been left in
doubt.See footnote 7 See also Pauscher v. Iowa Methodist Medical Center, 408
N.W.2d 355, 362 (Iowa 1987) (Hospital has no "duty to inform a
patient of matters that lie at the heart of the doctor-patient
relationship."); Wilson v. Lockwood, 711 S.W.2d 545, 549 (Mo. Ct.
App. 1986) ("[H]ospital has no duty to inform the patient of risks
of surgery and alternative methods of treatment simply because it
furnishes a consent-to-surgery form."); Ritter v. Delaney, 790
S.W.2d 29, 32 (Tex. Ct. App. 1990) (Doctor ordering nurse to get
patient's signature on permit to operate does not make hospital the
doctor's agent, thus imposing upon hospital a duty to obtain
informed consent of patient.).
The appellee CAMC maintains that the reasoned logic
behind syllabus point 7 of Cross is as sound today as it was when
Cross was decided ten years ago. Specifically, the appellee CAMC
points to the special relationship between a patient and his or her
physician, asserting that a requirement to involve the hospital
personnel would be disruptive rather than facilitative to the
consent process.
In this case, the record is clear that the employees of
the hospital were aware of the discussions between Dr. Ayoubi and
Larry's parents, and that it was apparent that Larry's parents
consented to the treatment given. Furthermore, there is no dispute
that the appellee Ayoubi was privately retained, and the appellants
could have chosen to not seek his treatment for Larry.See footnote 8
We agree with the appellee CAMC on this point, and
therefore, we reaffirm our holding in syllabus point 7 to Cross v.
Trapp. Consequently, the judgment of the circuit court as to CAMC
is affirmed.
Fay A. Rozovsky, Consent to Treatment § 5.2 (2d ed. 1990).
The appellee Ayoubi asserts that the appellant is
attempting to improperly change the common law where there is no
legislative direction by statute. However, the appellee Ayoubi
concedes that under appropriate circumstances, the medical standard
of care requires that minors be consulted if they are mature and if
the circumstances of the particular case do not militate against
such consultation.See footnote 9
In Cross v. Trapp, 170 W. Va. 459, 294 S.E.2d 446 (1982),
we reiterated in syllabus point 1 thereto the well-established
principle concerning consent to medical procedures: "Except in
very extreme cases, a surgeon has no legal right to operate upon a
patient without his consent, nor upon a child without the consent
of its parent or guardian." Browning v. Hoffman, 90 W. Va. 568,
581, 111 S.E. 492, 497 (1922) (emphasis supplied).
In this case, the circuit court's instruction to the jury
on this point provided: "Ordinarily, a privately retained
physician has no legal right to render or withhold medical
treatment to a patient without his consent, nor upon a child
without the consent of his parents. Under West Virginia law a
child is any person under the age of 18 years." (emphasis
supplied) Obviously, the circuit court's instruction followed the
principle enunciated in Browning.
Although we believe that the Browning principle with
respect to the consent of minors remains a sound statement of law,
a more workable approach would be recognition that minors who are
mature may be involved in the medical decisions that affect their
livelihood. As Dean Pound has stated: "The law must be stable,
but it must not stand still." Roscoe Pound, Introduction to the
Philosophy of Law (1922).
One of the first reported cases involving a mature minor
exception to the general common law rule requiring parental consent
to medical treatment of minors was in the 1906 decision in Bakker
v. Welsh, 108 N.W. 94 (1906), wherein the Supreme Court of Michigan
held that a surgeon was not liable to a father for performing an
operation to remove an ear tumor on a seventeen-year-old boy where
the boy's father had not given consent and the boy died during the
administration of anesthetic. Although it is not clear exactly who
gave the consent to surgery, the boy was accompanied by an aunt and
a sister, and "they all understood an operation should be performed
the following day." Id. at 95.
A more recent delineation of the mature minor rule has
come from the Supreme Court of Tennessee in Cardwell v. Bechtol,
724 S.W.2d 739 (Tenn. 1987). 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.See footnote 10
In determining the capacity, and ultimately the maturity
of a minor, the court in Cardwell stated:
Whether a minor has the capacity to consent to
medical treatment depends upon the age,
ability, experience, education, training, and
degree of maturity or judgment obtained by the
minor, as well as upon the conduct and
demeanor of the minor at the time of the
incident involved. Moreover, the totality of
the circumstances, the nature of the treatment
and its risks or probable consequences, and
the minor's ability to appreciate the risks
and consequences are to be considered.
Cardwell, 724 S.W.2d at 748.
In adopting the mature minor exception, the Tennessee
court acknowledged that that state's legislature has enacted
several provisions concerning medical treatment of minors without
parental consent, such as treatment for drug abuse and venereal
disease.
Similarly, in this case, the appellee Ayoubi contends
that because this state's legislature has spoken to the same type
of exceptions, then this indicates a legislative intent to reject
the mature minor rule.See footnote 11 We do not agree. Rather, we agree with
the Tennessee Cardwell court's answer to this assertion. "We do
not think that the conclusion that these statutes are intended to
abrogate judicial adoption of an exception to the general common
law rule requiring parental consent to treat minors can be
supported by the express terms of any of these provisions." 724
S.W.2d at 744. Rather, that court found "no indication in any of
the statutes of any intent on the part of the Legislature to
establish a comprehensive statutory scheme to occupy the area of
medical treatment of minors in its entirety." Id. (emphasis
supplied) The court went on to point out that the statutes where
the legislature has expressly provided for only consent by the
minor "do no more than provide conditional immunities from certain
types of liability in specific situations (where such immunities
were not otherwise clear in the law) or promote certain social
purposes, such as treatment of drug abuse or venereal disease in
minors." Id.
We agree with the holding of Cardwell, and we believe
that the mature minor exception is part of the common law rule of
parental consent of this state. It is difficult to imagine that a
young person who is under the age of majority, yet, who has
undergone medical treatment for a permanent or recurring illness
over the course of a long period of time, may not be capable of
taking part in decisions concerning that treatment. See footnote 12 Clearly,
this would be a matter for the jury to decide, and not for this
Court to speculate.
However, we believe that this must also be tempered by a
recognition that there is no "hard and fast" rule that would
provide a particular age for determining a mature minor.See footnote 13
As the Tennessee court cautioned in Cardwell, "[a]doption
of the mature minor exceptions to the common law rule is by no
means a general license to treat minors without parental consent
and its application is dependent on the facts of each case. It
must be seen in the context of the tort in question." Cardwell,
724 S.W.2d at 745.
We are aware that this is a very difficult area of the
law when put into practice, especially in light of the age-old
principle that "hindsight is 20/20." Furthermore, it is obvious
that this places the doctor in the difficult position of making the
determination of whether the minor at issue is mature. We
recognize the delicate nature of this position, and that the
decision by the doctor on the maturity level of a minor will often
be second-guessed. Consequently, the doctor, as in every other
decision with which he or she is faced, must exercise his or her
best medical judgment.See footnote 14
However, in spite of the difficulty brought on by this
issue, we agree with the observation that "the answer will be found
in statutory laws of consent that incorporate an element of the
mature minor rule." Rozovsky, supra § 5.2.2, at 265 (emphasis
supplied). Accordingly, our holding in this case is nothing more
than a recognition that the mature minor exception to the common
law rule of parental consent in this state exists. The
legislature, of course, may, by statute, prohibit recognition of
the principles enunciated herein.See footnote 15
Obviously, application of the mature minor rule would
vary from case to case. The focus would be on the maturity level
of the minor at issue, and whether that minor has the capacity to
appreciate the nature and risks involved of the procedure to be
performed, or the treatment to be administered or withheld. "In
current practice, judicial application of the 'mature minor'
exception where an objective appraisal of the circumstances
indicates that the minor was informed and understood the nature and
consequences of the procedure in question." Lawrence P. Wilkins,
Children's Rights: Removing the Parental Consent Barrier to
Medical Treatment of Minors, 1975 Ariz. St. L. J. 31, 52 (1975).
Accordingly, we hold that 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.
Hoffman, 90 W. Va. 568, 111 S.E.2d 492 (1922) and its progeny are
inconsistent herewith, it is modified.
In this case, the appellee Ayoubi contends that the
question of whether Larry should have consented to the withholding
of treatment need not even be reached because there was expert
testimony that Larry was not mature enough to give such consent.
While we make no decision on whether such evidence was sufficient
to support the appellee Ayoubi's claim in this regard, the circuit
court's error was the failure to instruct the jury that it could
consider Larry's maturity level in deciding whether, as a matter of
fact, Larry was mature so as to consent to his medical treatment.
Accordingly, we reverse the judgment of the circuit court
on the liability of Dr. Ayoubi, and remand this case to that court
so that, consistent with our adoption of the mature minor exception
to the common law rule of parental consent to the medical treatment
of minors, it may try the issue of whether Larry came within this
exception so as to be entitled to consent to the treatment
involved.
Affirmed, in part,
reversed, in part,
and remanded.
rebuttal evidence. Cleckley, supra § 3.1(A), at 55 (citing Geders).
We note that the legislature has already spoken to the
treatment of minors in emergency situations where parental consent
is not obtained. W. Va. Code, 16-4C-17 [1984] provides, in
relevant part:
No emergency medical services personnel
may be subject to civil liability, based
solely upon failure to obtain consent in
rendering emergency medical services to any
individual regardless of age where the patient
is unable to give his consent for any reason,
including minority, and where there is no
other person reasonably available who is
legally authorized to consent to the providing
of such care or who is legally authorized to
refuse to consent to the providing of such
care.
Children today are more 'streetwise' and knowledgeable than children were even a few decades ago. Some children of very tender years exposed to continuous types of care are
able to give or refuse consent. They may be
far more skilled at discussing the pros and
cons, the risks and benefits of bone marrow
transplants or chemotherapy than a first-year
medical student. However, there are also
teenagers and young adults who lack the
maturity to understand the risks of pregnancy
from casual sex and the importance of
contraception.
Rozovsky, supra § 5.2.2, at 265.
Other states have legislation which actually provides the mature minor exception which we today recognize. See Ark. Code Ann. § 20-9-602(7) [Michie 1981]; Miss. Code Ann. § 41-41-3(h) [1984].