I. CASE REVIEW

SUBJECT: MINORS MATURITY TO BE DETERMINED BY A JURY.

CASE NAME: BELCHER V. CHARLESTON AREA MEDICAL CENTER

CASE CITE: W. VA. SUP. CT. APP., NO. 20481

STATE: WEST VIRGINIA

FACTS OF CASE: Larry D. Belcher, Jr., a seventeen year old patient with muscular dystrophy was admitted to the Charleston Area Medical Center after suffering respiratory arrest. After discussion with Dr. Ayoubi, a private physician, Belcher's parent's decided they did not want him reintubated or resuscitated unless he requested it.

Belcher's parents signed a note that their son was not to be reintubated or resuscitated in the event of another respiratory failure, which note was formalized into a "do not resuscitate order". According to accounts, Belcher was not involved in the decision because he lacked emotional maturity, was on medication that diminished his capacity, because involvement would have increased his anxiety and diminished his chances of survival, and because his parents did not want him involved.

Shortly after, Belcher suffered another respiratory arrest and died despite efforts of hospital staff to revive him within the limits of the DNR order.

Belcher's parents subsequently sued the hospital and Dr. Ayoubi for wrongful death allegedly resulting from medical malpractice. Following a jury verdict for the defendants, Belcher's parents challenged the Trial Court's refusal to allow the jury to consider whether Larry should have been consulted about the DNR order as a mature minor.

West Virginia law recognizes the "mature minor" exception to the common law rule requiring parental consent for medical treatment of children under the age of eighteen, the Court held. Although the parental consent principle is sound, "a more workable approach would be recognition that minors who are mature may be involved in the medical decisions that effect their livelihood," the Court said.

A minor's maturity is a factual question to be decided by a jury, the Court said. Factors considered in determining a minor's capacity to consent would include the minor's age, ability, experience, education, training, maturity of judgement, and conduct at the time of treatment. The minor's capacity to appreciate the nature and risks of the procedure to be performed or the treatment to be administered or withheld also should be considered, the Court added.

Thus, the Court determined that a mature minor's consent is required before a physician can perform or withhold treatment, but the maturity of a minor patient is a question of fact that must be decided by a jury, the West Virginia Supreme Court of Appeals held.

Parental consent remains the general rule for medical treatment of a minor, except in very extreme cases, "unless the child is a mature minor, in which case the child's consent would be required," the court held. "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."