Jean Zermatten

ABSTRACT Switzerland is a country of 7.5 millions inhabitants, of whom about 1 million are children and youths from age 7 to 18. The political system is a Federation of States, each with important decentralized power. The States making up the Helvetica Confederation are called “cantons” and there are 26 of them.

ABSTRACT The Best Interests of the Child principle is an innovative concept introduced by the United Nations Convention on the Rights of the Child. It serves as a foundational element of the Convention and has been identified by the Committee on the Rights of the Child as one of the Convention's four general principles. Despite limited historical references to this idea in the late 19th and early 20th centuries, this is a distinctly contemporary legal concept. As a result, its content and functionality has been the subject of thorough academic study as well as systematic examination and elaboration in jurisprudential settings. The paper makes a significant contribution to this interpretive dialogue by providing a conceptual and literal analysis of the principle, including as it relates to other articles of the Convention. The political dimensions of the principle are also considered with a view to its practical implementation at the national level.

The purpose of this article is to provide policy guidance on how to assess the capacity of minor adolescents for autonomous decision-making without a third party authorization, in the field of clinical care. In June 2014, a two-day meeting gathered 20 professionals from all continents, working in the field of adolescent medicine, neurosciences, developmental and clinical psychology, sociology, ethics, and law. Formal presentations and discussions were based on a literature search and the participants' experience. The assessment of adolescent decision-making capacity includes the following: (1) a review of the legal context consistent with the principles of the Convention on the Rights of the Child; (2) an empathetic relationship between the adolescent and the health care professional/team; (3) the respect of the adolescent's developmental stage and capacities; (4) the inclusion, if relevant, of relatives, peers, teachers, or social and mental health providers with the adolescent's consent; (5) the control of coercion and other social forces that influence decision-making; and (6) a deliberative stepwise appraisal of the adolescent's decision-making process. This stepwise approach, already used among adults with psychiatric disorders, includes understanding the different facets of the given situation, reasoning on the involved issues, appreciating the outcomes linked with the decision(s), and expressing a choice. Contextual and psychosocial factors play pivotal roles in the assessment of adolescents' decision-making capacity. The evaluation must be guided by a well-established procedure, and health professionals should be trained accordingly. These proposals are the first to have been developed by a multicultural, multidisciplinary expert panel.