We appreciate the comments provided by Kranendonk et al.1 on our published article describing the existing legal approaches regarding the rights of minors to consent to health-care interventions,2 including how laws in the 28 member states of the European Union and in Canada consider competent minors. We are in agreement with the nuances provided by Kranendonk et al. concerning minors aged 12–16 years in the Netherlands. As a matter of fact, this nuance was clearly included in the Supplementary Information that accompanies our manuscript, and available online since the publication of the manuscript. (http://www.nature.com/ejhg/journal/vaop/ncurrent/suppinfo/ejhg201661s1.html). These nuances are also found in a 2015 article to be published in the November/December 2016 issue of IRB: Ethics & Human Research.3
In our EJHG article, the objective was to present the general approaches that state the question of whether, and from what age, minors can generally provide lawful consent to health-care interventions. We have taken the Dutch law as an example to demonstrate that the fixed age of capacity to consent to medical care is sometimes set at a different age than the age of legal majority. In no case did we intend to over-simplify the Dutch law. However, presenting an in-depth analysis of all legal complexities surrounding the concept of mature minors in each of the countries under study was not possible. Well aware of the importance of these nuances and exceptions, we did include them in our publication by attaching them to our analysis tables that contain such legal nuances and exceptions. We invite the readers to refer to the Supplementary Information and to note that our article aims to present the general legal approach, but not an exhaustive legal analysis for each country included in this research.
The other point raised by Kranendonk et al. concerning parental refusal which would have serious negative consequences for the child, describes a situation foreseen in most child protection legislation around the world and would constitute reportable ‘medical neglect’. The EJHG article neither included a systematic review of this subject nor of such legislation.
Kranendonk EJ, Hennekam RC, Ploem MC : The Dutch Legal Approach Regarding Health Care Decisions Involving Minors in the NGS days. Eur J Hum Genet 2016.
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.
Knoppers BM, Sénécal K, Boisjoli J et alon behalf of the P3G International Paediatric Research Program: Recontacting pediatric research participants for consent when they reach the age of majority. IRB Ethics Hum Res 2016; 1–9.
The authors declare no conflict of interest.
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Sénécal, K., Thys, K., Vears, D. et al. Reply to Kranendonk et al. Eur J Hum Genet 25, 166–167 (2017). https://doi.org/10.1038/ejhg.2016.160