We thank Sénécal and colleagues for addressing the important issue of the legal position of minors, involved in healthcare decisions, with particular attention to the context of next-generation sequencing.1 The authors conclude that the legal frameworks of the 28 Member States of the European Union and Canada differ on the minor’s right to provide consent for medical treatment. As to the latter, they identify three different approaches: 1) Legally-fixed age for capacity to consent to medical interventions; 2) competence-based approach; 3) mixed approaches. The Dutch legal framework fits within the first approach. In this respect, the authors further distinguish between frameworks using merely a fixed age threshold, from which minors should provide consent for medical treatment, and frameworks which include additional conditions and/or exceptions. According to the authors, the Netherlands fit within this first category. We would like to stress that this is not an accurate representation of Dutch law. On the basis of the Dutch Medical Treatment Contract Act of 1995, minors aged 16 and older are in principle capable to decide on their own about medical treatment. However, children aged 12–16 have the right to consent to medical treatment (unless they are not yet capable to do so, for instance, due to a cognitive impairment), but they cannot exercise this right independently: their parents need to consent too.2 This ‘dual consent system’ is not absolute, that is, situations could occur, in which a refusal by (one of) the parents can be ignored, for instance, if a refusal would have serious negative consequences for the health (prospects) of the child. We think it is important to add these principles to the article of Sénécal et al1 because they constitute a core element of the Dutch legal framework regarding the legal position of minors, both in care and research.
References
Sénécal K, Thys K, Vears DF, Van Assche K, Knoppers BM, Borry P : Legal approaches regarding health-care decisions involving minors: implications for next-generation sequencing. Eur J Hum Genet 2016; 24: 1559–1564.
Kranendonk EJ, Ploem MC, Hennekam RC : Regulating biobanking with children's tissue: a legal analysis and the experts' view. Eur J Hum Genet 2016; 24: 30–36.
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Kranendonk, E., Hennekam, R. & Ploem, M. The Dutch legal approach regarding health care decisions involving minors in the NGS days. Eur J Hum Genet 25, 166 (2017). https://doi.org/10.1038/ejhg.2016.159
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DOI: https://doi.org/10.1038/ejhg.2016.159
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