Clinical Report—Consent by Proxy for Nonurgent Pediatric Care

Minor-aged patients are often brought to the pediatrician for nonurgent acute medical care, physical examinations, or health supervision visits by someone other than their legally authorized representative, which, in most situations, is a parent. These surrogates or proxies can be members of the child’s extended family, such as a grandparent, adult sibling, or aunt/uncle; a noncustodial parent or stepparent in cases of divorce and remarriage; an adult who lives in the home but is not biologically or legally related to the child; or even a child care professional (eg, au pair, nanny). This report identifies common situations in which pediatricians may encounter “consent by proxy” for nonurgent medical care for minors, including physical examinations, and explains the potential for liability exposure associated with these circumstances. The report suggests practical steps that balance the need to minimize the physician’s liability exposure with the patient’s access to health care. Key issues to be considered when creating or updating office policies for obtaining and documenting consent by proxy are offered. Pediatrics 2010;126:1022–1031 BACKGROUND INFORMATION Before providing nonurgent medical care to a minor patient not accompanied by a legally authorized representative (LAR), important questions regarding informed consent and the delegation of parental responsibilities need to be asked and answered. These questions include: 1. Who has a legal right to delegate consent to health care decisions for a child? 2. To whom can the power to consent to health care for a child be delegated? 3. In what circumstances can the power to consent to health care for a child be delegated? 4. What are the limitations on the right to delegate the power to consent to health care for a child? 5. How is authorization of proxy consent verified and documented? 6. When or how often does information on proxy consent need to be updated? Many aspects of informed consent in pediatrics have been set forth in previous policy statements from the American Academy of Pediatrics (AAP). Some of these statements addressed informed consent in broad terms, and others addressed narrowly focused situations. The AAP statement on informed consent1 noted that, unlike Gary N. McAbee, DO, JD, COMMITTEE ON MEDICAL LIABILITY AND RISK MANAGEMENT