When Can a Court Override a Mature Minor’s Decisions?
As we discussed in the first of this three-part Blog series, when it comes to a young person’s decision-making around their own health care, Canadian law recognizes that a “mature minor” can make medical decisions for him or herself. In the second part, we talked about what happens when parents and mature minors disagree – and what factors the court takes into account when called in to make a decision on the minor’s behalf.
In this last Blog of the series, we take a look at when a court may actually override the decision of a mature minor (and to be clear – this is even if the parent and the minor agree with each other).
Best Interests Test
First of all, the prevailing approach of Canadian law is that a mature minor’s decision can be overridden only in narrow circumstances. The power to do so arises either by court order, or under child welfare legislation which then hands the decision-making over to the provincial child-welfare authority.
Next, anytime it considers overriding a mature minor’s decision the court must be guided by what is in the minor’s best interests. This requires the court to examine a good deal of extrinsic medical and non-medical evidence from various sources, including medical experts and the government’s own public health directives. The latter source is presumed to reflect a culmination of accepted information that drives and informs the government’s public-protection mandate.
Where Mature Minor’s Decision Threatens Own Health
Since each case will vary according to its own facts, there are no hard-and-fast rules on when a mature minor’s decision will be overridden.
Courts seem most often willing to do so where, in the view of medical professionals, the mature minor’s decision will result in him or her not getting medical treatment, to the point that the minor’s life, health, and well-being are in jeopardy. In such cases, the mature minor may be legally deemed to be “in need of protection”; the decision-making on the specific issue will then be taken out of the hands of both the mature minor and his or her parents entirely, since they are not acting in the child’s best interests. This may occur even where the mature minor has made a decision that accords with his or her religious beliefs (e.g. the refusal to accept a blood transfusion), and where the court’s “override” authority might infringe on the minor’s constitutionally-protected rights.
Case Law Example
With these principles in mind, a recent Ontario case called A.C. v. L.L. illustrates how they might be applied in practice – notably in the context of receiving COVID-19 vaccinations.
The facts involved 14-year-old unvaccinated triplets of separated parents. Two of them lived with the father and were attending school virtually due to the COVID-19 pandemic. The third triplet lived with the mother and was able to attend school in-person even though he was unvaccinated.
The parents ended up in court over their differences around immunization and school attendance. The father and the two boys who lived with him were agreed on their getting vaccinated and attending school in person. However, the mother initially refused to supply the boys’ health cards or identification (which prevented them from doing either) and wanted all the children to physically attend school without being immunized. She pointed out that the government had not made vaccines mandatory for in-person attendance.
In this context, the court was asked to rule on two issues: 1) whether the children should get vaccinated; and 2) whether they needed their mother’s consent, either way.
Although the facts opened the door for the court to use its “override” power if necessary, in the end it did not need to do so. The parents were able to agree between themselves that the triplets were “mature minors” of sufficient age and maturity to make their own medical decisions.
Still, the court reviewed the law on mature minors in detail, noting that the Health Care Consent Act did not provide any minimum age for capacity to make medical treatment decisions. It clarified that in connection with the COVID-19 vaccine specifically, mature minors aged 12 to 17 did not require their parent’s consent to receive it.
In the end – and in view of the parents’ accord on the mature minors issue – the court ruled that the triplets should all get their vaccines and attend school in person, since this was in their best interests absent “compelling evidence to the contrary”. This was after reviewing the under-age-12 vaccine information provided by Toronto Public Health, the school board, and the Ontario Ministry of Health.
However, the court added that in this case each child could nonetheless make his or her own decision – which included the third triplet declining to get immunized if that was his wish. The mother also capitulated in the end: She withdrew her opposition to the vaccine, and agreed that each child should decide for themselves. She expressly promised to cooperate with their respective decisions.
For the full text of the decision, see:
A.C. v. L.L., 2021 ONSC 6530