Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Israel Journal of Health Policy Research
Published in: Israel Journal of Health Policy Research 1/2018

Open Access 01-12-2018 | Original research article

Treatment of unaccompanied minors in primary care clinics - caregivers' practice and knowledge

Authors: Maya Peled-Raz, Michal Perl, Manfred S. Green

Published in: Israel Journal of Health Policy Research | Issue 1/2018

Login to get access

Abstract

Background

By law, the provision of medical treatment to minors in the State of Israel is conditional upon the consent of their parents. In 2004, the Head of the Medical Administration Unit in the Ministry of Health issued Circular No. 4/2004 regarding the treatment of un-accompanied minors in primary care clinics. This circular aims to expand on the law, and permits the treatment of certain minors without parental attendance or consent. The circular does indicate that parents should be notified of the treatment retroactively, and provides cases in which it is possible to avoid notification altogether.
The objectives of this study were: (a) to examine the scope of treatment of unaccompanied minors in primary care clinics; (b) to examine caregivers’ knowledge of the provisions of the law and of the circular; and (c) to examine the implementation of the law’s and the circular’s provisions relating to the treatment of unaccompanied minors in primary care clinics in the community.

Methods

In a cross-sectional study, we surveyed 158 doctors and nurses from primary care clinics of the Haifa and Galilee districts of “Clalit Health Services”. Respondents were selected via a snowball method, with attention to ensuring a heterogeneous clientele and geographic dispersion.

Results

Treatment seeking by unaccompanied minors is an existing and even widespread phenomenon. The vast majority of unaccompanied minors were in effect treated without parental consent. The main reason for minors’ solitary treatment seeking was parents being busy. In 40% of the cases, where minors were treated without the presence and consent of their parents – parents were not notified of the fact. None of the respondents correctly answered all questions regarding the relevant provisions of the law and circular, and only 10% answered all the questions regarding the circular’s parental notification requirements.

Conclusions

The Israeli legal arrangement, pertaining to the provision of treatment to minors without the consent of their parents, is vague, unclear to medical and nursing practitioners and limited in terms of the needs of the minors themselves, as well as the needs of the medical system.
There is a need for methodical and coherent regulatory thinking on the subject, as well as more thorough education of both nurses and physicians, in order to ensure the rights and interests of minors as well as the rights of their parents.
Appendix
Available only for authorised users
Footnotes
1
For example, In the UK, Minors older than 16 years old may consent to their own medical care. Also, according to common law, there are circumstances in which minors under 16 years of age could consent to their own medical treatment. In order to do so, the child or young person must have a ‘sufficient understanding and intelligence to enable him or her to fully understand what is proposed’. The level of maturity required to provide consent will vary with the nature and complexity of the medical treatment. (Gillick v West Norfolk and Wisbech Health Authority [1986] 1 AC 112.). These principles, as established in Gillick, were also endorsed as part of Australian common law (Secretary, Department of Health and Community Services v JWB and SMB (1992) 175 CLR 218). See also Bird S., Consent to medical treatment: the mature minor, Australian Family Physician 2011; 40(3): 159.
 
Literature
1.
Legal Capacity and Guardianship Act 1962, Article 14.
2.
3.
4.
Detection of HIV in Minors Act 1996, Article 1.
5.
Morag T., New Challenges in Defining the Limits of Childhood and Adolescence in light of the International Covenant on the Rights of the Child, Social Security 1995, 44: 108.
6.
Kaplan YST. The right of a minor in Israel to participate in the decision making process concerning his or her medical treatment. Fordham Int Law J. 2001; 25(5): 1085-1168
7.
Niv-Yagoda A. The ability to obtain informed consent from minors is treated, and in particular by a dying patient. Harefuah. 2007;146:459–64.PubMed
8.
Committee of the National Council of Pediatrics On the subject of "Medical Treatment of Minors - Age of Consent and Communicating Issues", Final Report, December 1st 2010.
9.
The Israeli Society for Adolescent Medicine and the Association of Pediatrics: Pediatrics: The medical encounter with youth, guidelines and recommendations. Ramat Gan, The Israeli Medical Association, 2000.
10.
Patient Rights Bill (Amendment - Informed Consent of a Minor) 1997 (P/1401/14).
11.
Patient Rights Bill (Amendment - informed consent of a minor in pregnancy) 2014 (P/2628/19).
12.
Patient Rights Bill (Amendment - Informed Consent of a Minor), 2014 (P/2423/19).
13.
14.
Treatment of Mental Illness Act 1991, Section 4a.
15.
16.
Hildesheimer G, Orkin A, Biderman B. Visits of minors (ages 14-18 years) at an initial clinic without accompanying a guardian: positions of primary care physicians in the Southern District of the Clalit Health Services. Harefuah. 2010;149:214–8.PubMed
17.
Orkin Y, Limoni Y, Barak N, Grossman T. Is it permissible to examine a minor who approaches the clinic without a parent? Using an algorithm to examine the Ministry of Health's 2004 circular. Harephua. 2005;144:397–401.
18.
Department of Medical Administration circular 8/2017 professional indications for the treatment of girls who apply to pregnancy-termination committees.
19.
De Lourdes Levy M, Larcher V, Kurz R. Statement of the ethics working Group of the Confederation of European specialists in Paediatrics (CESP). Informed consent/assent in children. Eur J Pediatr. 2003;162(9):629–33.CrossRefPubMed
20.
Katz AL., Webb SA., Informed Consent in Decision-Making in Pediatric Practice COMMITTEE ON BIOETHICS, Pediatrics 2016; 138(2).
21.
Bravender T, Price N., English A., Primary care providers' willingness to see unaccompanied adolescents - Journal of Adolescent Health 2004; 34:30–36.
22.
AC v Manitoba (Director of Child and Family Services), 2009 SCC 30, [2009] 2 SCR 181.
23.
See for example: Medical Consent of Minors Act, SNB 1987, c M-6.1.
Metadata
Title
Treatment of unaccompanied minors in primary care clinics - caregivers' practice and knowledge
Authors
Maya Peled-Raz
Michal Perl
Manfred S. Green
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Israel Journal of Health Policy Research / Issue 1/2018
Electronic ISSN: 2045-4015
DOI
https://doi.org/10.1186/s13584-018-0217-0

Other articles of this Issue 1/2018

Israel Journal of Health Policy Research 1/2018 Go to the issue

Original research article

The tip of the iceberg: postpartum suicidality in Israel

Perspective

Research in government and academia: the case of health policy

Original research article

Patient demands for ethnic–based separation in public hospitals in Israel: patients’ and practitioners’ perspectives

Commentary

What’s in an eye roll? It is time we explore the role of workplace incivility in healthcare

Integrative article

The evolution of Israeli public policy for drug-using backpackers

Commentary

Reflections of the quality of primary care in Canada and Israel