ABSTRACT
Generally, the right to participate in healthcare decision-making is preconditioned on the capacity or competence to make informed decisions. Traditionally, due to age classification or immaturity, children are deemed incapable of having the requisite capacity for informed decisions in healthcare. Hence, proxies such as parents or, in some cases, the state authorises decisions on behalf of the minor in their interest or benefit. The legal restriction based on capacity is paternalistic and a social construct influenced by different childhood imagery. It describes the child as dependent, immature and lacking in experience to understand the procedures involved in healthcare decision-making. This paternalistic model of decisionmaking - which mirrors a protective approach -fails to recognise the child’s evolving capacities. The child’s evolving capacities have been applied under common law as the mature minor doctrine and expanded as a right to participation under the United Nations Convention on the Rights of the Child (CRC) 1989. The evolving capacities have become a threshold for ascertaining decisional capacity for minors. In healthcare decisions, the child’s evolving capacities, though not age-specific, are measured by the child’s understanding of the nature and consequences of healthcare treatment. The study evaluated the viability of legal and institutional frameworks on the application of the mature minor doctrine as a right of the mature minor to participate in healthcare decisions in Nigeria. The study through the postmodernism and social constructionism theory laid a theoretical foundation to assess the construction of the mature minor, participation rights and shared decision–making, and the role of law and policies as instruments of legitimacy. The study adopted a socio-legal approach that involved a mixed-method research methodology. The approach analysed the provisions of legislation, case laws, international and regional conventions, and opinions of authors in this field. In addition, based on scant literature and empirical findings on the application of the mature minor in Nigeria, the study employed an empirical research methodology consisting of quantitative and qualitative data collection and analysed methods for robust discourse of the mature minor doctrine. Based on the foregoing, the study found that the model of healthcare decision-making in Nigeria is paternalistic, which is evident in the legal and socio-cultural construction of childhood and capacity. Nevertheless, findings from the empirical research showed that the mature minor doctrine can find application through a relational autonomy model and casespecific model, which both capture the evolving capacities of mature minors and are a suitable framework to support minors’ health needs and concerns based on the peculiarities of the Nigerian society.
