Medical decisions for a minor child in Peru: how far does parental authority go?

The mistaken idea: “parents decide everything”

Many parents think their signature is the final word on their child’s health. Peruvian law does give parents the power to decide. But that power exists to protect the child. Article 418 of the Civil Code puts it this way:

“Por la patria potestad los padres tienen el deber y el derecho de cuidar de la persona y bienes de sus hijos menores.”

(Through parental authority, parents have the duty and the right to care for the person and property of their minor children.)

Duty comes first. The Código de los Niños y Adolescentes (article 74) lists among parents’ duties “velar por su desarrollo integral” (looking after the child’s overall development) and representing the child “mientras no adquieran la capacidad de ejercicio” (until they acquire legal capacity).

Who consents for a minor

The Ley General de Salud (Ley 26842) starts from a simple rule in article 4:

“Ninguna persona puede ser sometida a tratamiento médico o quirúrgico, sin su consentimiento previo o el de la persona llamada legalmente a darlo, si correspondiere o estuviere impedida de hacerlo.”

(No one may undergo medical or surgical treatment without their prior consent, or that of the person legally entitled to give it when the patient cannot.)

For a minor, that person is whoever holds patria potestad (parental authority) or guardianship. Article 5 of the regulation of Ley 29414 (Decreto Supremo 027-2015-SA) says:

“Así también los menores de edad serán representados por quienes ejerzan la patria potestad y tutela.”

(Minors are represented by those who hold parental authority and guardianship.)

A parent’s consent must be as informed as any patient’s: before you sign, they must explain the diagnosis, the alternatives and the risks. See informed consent and medical records.

Teenagers aged sixteen and seventeen

The Civil Code separates two groups. Children under sixteen are listed as lacking legal capacity (article 43). Sixteen- and seventeen-year-olds are in article 44, which since Decreto Legislativo 1384 is headed “Capacidad de ejercicio restringida” (restricted legal capacity). Either way, the teenager still has representatives: their parents or guardian.

A technical point: article 4 of the Ley General de Salud still refers to “los numerales 1 al 3 del Artículo 44 del Código Civil”. Decreto Legislativo 1384 repealed items 2 and 3. For minors, the item that matters is item 1: “Los mayores de dieciséis y menores de dieciocho años de edad” (those over sixteen and under eighteen).

Not deciding alone does not mean not counting. Article 9 of the Código de los Niños y Adolescentes says:

“El niño y el adolescente que estuvieren en condiciones de formarse sus propios juicios tendrán derecho a expresar su opinión libremente en todos los asuntos que les afecten y por los medios que elijan, incluida la objeción de conciencia, y a que se tenga en cuenta sus opiniones en función de su edad y madurez.”

(A child or teenager able to form their own views has the right to express their opinion freely on all matters that affect them, including conscientious objection, and to have it taken into account according to their age and maturity.)

The article does not name health, but it speaks of “all matters that affect them”. Our reading is that doctors and parents should listen to the child and weigh their opinion, more so the older and more mature the child is.

The limit: when parents say no

This is the part that surprises people. Article 4 of Ley 26842 continues:

“En caso que los representantes legales de los absolutamente incapaces o de los relativamente incapaces, a que se refieren los numerales 1 al 3 del Artículo 44 del Código Civil, negaren su consentimiento para el tratamiento médico o quirúrgico de las personas a su cargo, el médico tratante o el establecimiento de salud, en su caso, debe comunicarlo a la autoridad judicial competente para dejar expeditas las acciones a que hubiere lugar en salvaguarda de la vida y la salud de los mismos.”

(If the legal representatives of a minor refuse consent to medical or surgical treatment, the treating doctor or the facility must notify the competent court so that action can be taken to protect the minor’s life and health.)

An adult can refuse treatment for themselves, and that refusal releases the doctor from liability. But when a parent refuses on behalf of a child, the doctor cannot stop there: they must notify a judge.

Article 17 of the regulation adds two rules:

“En caso de menores de edad o de personas cuyas condiciones particulares le impidan ejercer este derecho, se realiza conforme a lo señalado en el artículo 5 del presente Reglamento, con la participación del Ministerio Público, teniendo en cuenta que los que no gozan de autonomía plena requieren protección. La negativa a recibir o continuar el tratamiento no procede cuando la persona usuaria del servicio de salud se encuentre en estado de emergencia o esta decisión ponga en riesgo la salud pública.”

(For minors, a refusal follows article 5 of the regulation, with the involvement of the prosecutor’s office, bearing in mind that those without full autonomy need protection. A refusal of treatment is not allowed when the patient is in an emergency or when it puts public health at risk.)

First, a refusal on behalf of a minor goes through the Ministerio Público. Second, in an emergency a refusal does not apply.

When the State steps in (a judge, the prosecutor’s office), it must be guided by the best interests of the child (article IX of the Preliminary Title of the Código de los Niños y Adolescentes):

“En toda medida concerniente al niño y al adolescente que adopte el Estado a través de los Poderes Ejecutivo, Legislativo y Judicial, del Ministerio Público, los Gobiernos Regionales, Gobiernos Locales y sus demás instituciones, así como en la acción de la sociedad, se considerará el Principio del Interés Superior del Niño y del Adolescente y el respeto a sus derechos.”

(Every measure the State, the courts, the prosecutor’s office or society takes concerning a child must consider the principle of the best interests of the child and respect for their rights.)

In an emergency, no parental signature is needed

The Ley General de Salud makes the emergency exception in three places: article 4 (“Se exceptúa de este requisito las intervenciones de emergencia”, emergency interventions are exempt), article 15.4 and article 40:

“Ningún establecimiento de salud o servicio médico de apoyo podrá efectuar acciones que correspondan a actos que no hayan sido previamente autorizados por el paciente o por la persona llamada legalmente a hacerlo, si correspondiere, o estuviere impedido de hacerlo, de conformidad con lo que establece el reglamento de la presente ley. Se exceptúa de lo dispuesto en el párrafo precedente la atención de emergencia destinada a enfrentar la situación que pone en peligro inminente la vida o la salud del paciente.”

(No facility may carry out acts not previously authorized by the patient or the person legally entitled to do so. Emergency care aimed at a situation that puts the patient’s life or health in imminent danger is exempt.)

If your child arrives at the emergency room and you cannot be reached, they are treated anyway. Your other rights in an emergency are in emergency care.

If no one is there to decide

What if it is not an emergency, but neither the parents nor the guardian can be found? Article 5 of the regulation answers:

“Ante la ausencia de las personas que ejercen la representación de los incapaces absolutos o relativos, el médico tratante dejará constancia de tal hecho en la Historia Clínica de la persona usuaria y el representante legal de la IPRESS dispondrá las medidas necesarias para garantizar la protección de la salud de dichas personas, debiendo comunicar el hecho al Ministerio Público dentro de las veinticuatro (24) horas de conocido el hecho.”

(If the representatives are absent, the treating doctor records this in the medical record, and the facility takes the steps needed to protect the patient’s health and must notify the prosecutor’s office within 24 hours.)

The parents’ absence does not leave the child without care or protection.

When parents disagree

Article 419 of the Civil Code says:

“La patria potestad se ejerce conjuntamente por el padre y la madre durante el matrimonio, correspondiendo a ambos la representación legal del hijo. En caso de disentimiento, resuelve el Juez del Niño y Adolescente, conforme al proceso sumarísimo.”

(During marriage, father and mother exercise parental authority jointly and both are the child’s legal representatives. If they disagree, the family judge decides in a summary proceeding.)

If one parent wants the treatment and the other does not, the final decision belongs to a judge, not to whoever gets to the hospital first. If the parents are separated or divorced, who holds parental authority depends on other rules; see child custody and visitation.

What this page does not cover

• Mandatory vaccines and what happens if parents do not vaccinate their children.
• Teenagers’ sexual and reproductive health, confidentiality from parents, and special rules for teenagers who already have children.
• Teenagers who gain full capacity through marriage or an official professional title: the regulation mentions this, but we did not verify the current Civil Code rules on it for this page.
• Mental health and psychiatric admission of minors, clinical trials, organ donation and palliative care, which have their own rules.
• The specific court procedure and time limits once the doctor reports a refusal to a judge.
• Court rulings on transfusions or other treatments refused by parents.