By An Adolescent

Sometimes, a child wishes to refuse a treatment that the parent or legal guardian has requested. In most cases, depending on the child's age and maturity, courts do not allow a child to refuse medical treatment if it is necessary to save the child's life or preserve the child's health. Some jurisdictions have similar stipulations regarding alcohol or substance abuse treatment. The consultant must be aware of the relevant statutes in his or her jurisdiction. These issues may be pertinent when a child has religious beliefs that influence his or her opinions about medical treatment.

Coercive imposition of treatment on a minor should be resisted if possible. Interventions may be permitted legally if the minor is not mature or emancipated, the underlying condition is serious, the treatment is clinically necessary to preserve the child's health, and the parents consent to treatment. For example, the parents of an adolescent with anorexia nervosa can consent, against the adolescent's wishes, to the use of nasogastric tube feeding as part of an eating disorder protocol. If both the parents and the adolescent refuse a treatment that the clinician feels is important due to significant medical (or mental health) risks, then a court order should be obtained before proceeding. The consultant should consider involving state protective services if he or she feels that a parent or legal guardian is not acting in a child's best interest and is placing the child's health at risk.

Parents and legal guardians are usually limited in their ability to force an adolescent to participate in any outpatient treatment (e.g., day treatment mental health program, substance abuse counseling) unless not having treatment poses significant medical risks. When adolescents with eating disorders or chronic medical illnesses, such as diabetes or cystic fibrosis, are nonadherent with their home treatments and follow-up appointments, parents need to work closely with clinicians to develop treatment plans that facilitate the adolescents' participation. These plans may include developing treatment contracts between the patient, parents, and health care providers. If the parents are resistant or nonadherent to clinical recommendations, the care providers may need to consider protective services intervention.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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