Possible questions to consider regarding each case:
- Is / would a minimum age in this scenario be in the child’s best interests? And if so, how?
- Whose rights need to be considered and what are those rights?
- What is the responsibility of the State in this scenario?
Case study A: Child labour and compulsory education
Ernesto is a 14-year-old boy from Bolivia who works at a bakery. His family income is low, so he wants to help financially. He goes to school like a regular student, and enjoys being among his friends, but his grades are average and he gets bored in class. He is over the legal age to be employed by others, but his salary is lower than the national minimum wage - though he does not complain about this out of fear that he will lose his job. Ernesto works around four hours every day - under the six-hour maximum legally allowed for over-14s. By the end of the day he’s very tired, and does not always have the energy to do his homework. Ernesto wants to run his own bakery when he’s older and has more experience.
Case study B: Hormone therapy and sex reassignment
Tom is an 8-year-old who was born a girl, but has identified as a boy from a young age. A psychologist has confirmed he has gender identity disorder, and he has been living as a boy full time for a year and a half. With regard to treatment, Tom has only received psychological support, but he wants to start hormone therapy before the onset of puberty. However the treatment, which is fully reversible, is only available once a person has reached puberty, and parental consent is required. In Tom’s case, his parents are fully supportive of his wishes. Sex reassignment surgery, which is irreversible, is only available to over-18s, and only after a person have lived in their chosen gender identity full time for at least a year. In some countries, however, surgery has been approved by courts for 16- and 17-year-olds.
Case study C: Autonomy in health matters
Mariko is a 12-year-old girl from Japan who was diagnosed with leukaemia three months ago. After receiving chemotherapy and being in remission for a month, the cancer returned, and she is receiving treatment again. From the start of her chemotherapy, Mariko has maintained she does not want the treatment because it makes her feel very sick and weak. She understands that people can die of cancer, as one other girl on the ward died not long ago. Mariko’s parents hate seeing her suffer, but the doctors insist that chemo offers the best chance of survival, yet it is not clear at this stage if the treatment will defeat the cancer.
Case study D: Access to reproductive health services
Sarah is a 14-year-old who wants to freeze her eggs. Her older sister and their mother are both unable to have children of their own as a result of ovarian cancer. Assuming that she is also at risk of reduced fertility, Sarah wants to keep her options open for the future. She read about egg collection services on the internet and knows they incur a high cost. The procedure is limited to women aged under 44 years, but it is not clear if egg freezing is available to under-18s. Sarah’s mother is apprehensive about her daughter going through the procedure or whether it is worth the cost.