Immature to life, ripe for death

Teenagers are not usually heard on issues under his own life, but his maturity can grow to be able to decide, for example, about his death. ¿Contradiction? Psychologists believe that, under a state of toughness, is widely able to take a mature decision. And the law gives them the reason.



In Spain there was an 'event Hannah' name was Marcos and was a Jehovah's Witness

The Constitutional recognized their right to refuse a transfusion

A child may have a question for trial and not for others

From age 12 there is a legal obligation to listen to the child

The images of Hannah Jones, age 13, surrounded by stuffed animals in his room and giving explanations of the reasons why they prefer to die surrounded by yours to undergo a heart transplant of dubious effectiveness, is colaron last Wednesday on houses Half the world through news. "There are too many risks. I could not do well and stay worse than I am now," he explained with amazing aplomb. "In addition, doctors can not ensure scientifically that if I accept the transplant to cure me," she added looking at the camera with his face Pecos.

The question would have been out of any discussion if it had been tried as an adult. The Council of Europe Convention on Human Rights and Biomedicine 1997 with the rank of law in all member countries, clearly states that any patient can refuse treatment suggested by doctors without having to justify its decision. It is an option that falls within the autonomy of each person and can be carried to the extreme, if, of course, is in full mental faculties.

What happens when a child? The refusal of patients to undergo a transplant "has occurred and occurs with some frequency in Spain," according to the director general of the National Transplant Organization, Rafael Matesanz, but there are no references to any teenager. Nor recalls Marcelo Palacios, president of the Scientific Committee of the Spanish Society of Bioethics, similar episodes abroad. For Hannah, sick of the heart due to the therapeutic arsenal that has been administered during the eight years of fighting leukemia, it has respected his desire to be deemed to have sufficient maturity to make decisions that affect their health and their lives. That is the question: to determine the extent to which a minor is a criterion for their opinion be considered.

Without being exactly the same as what happened with the British teenager, Spain had its own case Hannah. He was in 1994 and was named player Marcos Alegre Valles, a boy who lived in the town of Ballobar (Huesca). There are points in common between them: both were 13 years old and suffered from leukemia. However, there are also important differences: Marcos was a Jehovah's Witness, which is why it was reluctant to be transfused, and his case not only came to court, but that ended in the Constitutional Court.

The origin of everything was in the fall of the boy on a bicycle while walking in his village. As a result of the accident suffered a nosebleed that alerted her parents. After submitting it to various tests and was diagnosed with leukemia and was prescribed a transfusion, at which time the problems started since their religion forbids this practice categorically.

Faced with the refusal of parents, doctors at the hospital Arnau de Vilanova de Lleida sought judicial protection to combat the anemia of Marcos. His parents complied with the decision, but not the kid. He rejected the transfusion "with real terror, troubled and reacted violently in a state of great excitement," as recounted doctors, who preferred not to proceed with the risk of worsening their condition and cause a brain hemorrhage. Marcos's health was worsening gradually falling into a coma. After a new judicial authorization, was finally transfused, but the blood came too late. He died shortly afterwards.

After a long journey through the courts, the Constitutional ruled on the case in 2002. On the one hand, the Supreme overturned a conviction of two years against the parents for not having convinced his son to accept treatment. But most important was that the judges appreciated that the boy had a right to object to the medical act.

Marcos, according to the ruling, "clearly expressed" in exercising their religious freedom, a will that was not to accept blood transfusions. And he acknowledged trial enough to act in this way. Or, in the words of Yolanda Gomez Sanchez, a professor of constitutional law at the UNED and a specialist in biomedicine and human rights, the sense was of the opinion that "everyone has the right to personal autonomy and decide on their own physical reality." It also minors, whether they have enough criterion.

This thesis ties on the one hand, with the Convention on the Rights of the Child, adopted by the United Nations in 1989, which warns in its Article 12 to the States signatories to ensure the child "the right to express their views freely in matters that affect them, taking into account their views based on the age and maturity. " On the other hand, links with the Convention of 1997 and all regulations issued by the European directive, that increasingly gives more weight to the opinion regarding the treatment of a minor who has been to administer. But in addition, the ruling was ahead of Spanish law 41/2002 of Patient Autonomy, which embodies these concepts and was released months later.

First, in its Article 2.4, which recognizes that every patient "the right to decide freely, after the proper decision, among the options available clinics." And, later, in the section of informed consent, giving voice to children depending on their maturity. Below 12 years, the law presumes no choice. The decision is of their parents or guardians, "although it would have to ask the children, not because it is legally relevant position, but for parents to take it into account", according to Yolanda Gomez. Since 16 years, the prevailing view is that of the child, but her parents have parental rights. "It would be very strange that a judge would give the reason for their parents at these ages. Midlife is total; minors have even criminal liability," says this lawyer.

But between 12 and 16 years, ages which include Hannah and where Marcos was, the thing is complicated. At this age, the law says that the consent shall be given by the legal representative of a minor "after hearing their opinion if you have 12 years." The decision lies with the parents, but there is an obligation to listen to the children and assess their ability to trial.

Once again, and although the law says the age-something that does not make the UN declaration everything revolved around the maturity. But how that power is measured? For Gabaldon Sabel, chief of child psychiatry at the hospital Sant Joan de Deu de Barcelona, there is no maturity, but madureces. "You have to wonder what it is a trial child. You may be able to decide on a specific medical treatment that has sufficient knowledge and experience, but not on other facets of his life, sexuality, for example. Or lack of criteria for deciding on further health issues, "said Gabaldon, who also coordinates the ethics committee from its center.

In assessing the maturity, Maria Victoria del Barrio, a professor in the Department of Personality, Evaluation and Psychological Treatment of the School of Psychology, UNED, is set mainly in three aspects. Mastery of emotion, attitude when it comes to arise and solve problems and the ability to recognize their errors. This research on children's emotions argues that in general, most children between 12 and 16 years are immature. "They live between cottons, protected by their parents, do not accept the slightest inconvenience." For Sabel, who does not share this generalization, what you are looking for is to determine how the boy is able to assimilate the information transmitted, whether you can handle rationally and can anticipate the risks or benefits to be derived from it .

If in this age range, between 12 and 16 years, the view of