The concept of autonomy in adolescent psychiatry healthcare: A philosophical, legal and medical perspective

French law does not make it obligatory to obtain the consent of minors for suggested treatments. This situation can put the practitioner in difficulty, especially when trying to work on the issue of autonomy with an adolescent. It is not just the adolescent's autonomy that is only partially recognised during their treatment - that of their parents may also be overlooked by the physician in the child's best interest. In this situation, what can the physician do when working on areas related to autonomy, which are of the utmost importance during adolescence, and which become even more important during any treatment for potential psychiatric disorders? This opinion paper provides a focus on the concepts of autonomy, discernment, and the child's best interest, using a triple philosophical, legal, and medical approach, in order to provide guidance to practitioners confronted in their clinical practice with this central, complex and paradoxical issue. The modern-day philosophical approach ties the concept of autonomy to that of vulnerability. The interplay between the free exercise of the subject's rights and their protection is at issue in French law, which proposes to gradually provide new rights, and thus progressive autonomy, to minors, according to an evaluation of their level of discernment. It is similar to clinical practice and biomedical research which tend to objectively evaluate the level of discernment of children and adolescents. This evaluation is partially influenced by the physician's own values, which they need to be conscious of, in order to better accompany patients.