Consent, parental responsibility and mature-minor frameworks — formative SAQs

SAQ 1 — Mature-minor capacity and confidential care (10 marks)

A 15-year-old presents alone requesting a long-acting contraceptive implant. She is fearful of her parents finding out, speaks English well, and understands she is asking for a reversible method. ^{[4] [12]}

Questions

1. Name the four Appelbaum capacity domains and show how you would assess each at the bedside for this decision. (4 marks) ^[3]
2. Outline how you would approach confidentiality and the involvement of a trusted adult. (3 marks) ^[4]
3. State the principle that governs the operational threshold for adolescent contraception and explain why you would not quote a fixed age. (3 marks) ^[1]

Model answer

Capacity domains (4). Understand — ask her to restate, in her own words, what the implant is and how it works, using teach-back. Appreciate — confirm she grasps how it applies to her own life and relationships, not in the abstract. Reason — explore whether she can weigh the benefits, risks and alternatives and give reasons for her choice. Choose — confirm she can communicate a stable, voluntary preference and is not being coerced. ^[3]

Confidentiality and trusted adult (3). Explain honestly that confidentiality is upheld within its legal limits, and that safeguarding concerns would override it. Explore whether a trusted adult could be involved without forcing disclosure, and offer to support that conversation rather than dictate it. Document what was discussed about confidentiality and its limits. ^{[4] [12]}

Operational threshold (3). The governing principle is functional, decision-specific capacity rather than a fixed age: a capable minor can consent to the specific decision. The operational threshold is set by local statute, case law and hospital policy, so you direct the examiner to "check local statute and policy" rather than inventing an age or section number. ^[1]