New Paper Series Explores Child and Youth Capacity, Participatory Rights, and Decision Making

Friday, December 12th, 2025

“Everyone needs one safe person, someone who will listen.” – Youth Engagement Participant 

SCY is excited to share the release of our new paper series examining the intersection of capacity and participation in important pieces of legislation pertaining to young people. These papers are the cumulative result of more than 2 years of research analysis, writing, and youth engagement. Each paper looks at a different area of legislation and combines academic research, legal analysis, and lived expertise to explore questions like “Who gets to make decisions about a young person’s life?”, “How do age and decision-making capacity relate?”, and “How does the capacity to be heard differ from that of being the decision maker?”.

3 papers are being released at this time:

1. Capacity: A Principled, Rights-Based Approach to Child Participation (backgrounder on the topic of capacity)
2. Child Capacity and Participation in Healthcare Decisions
3. Child Capacity and Participation in BC’s Mental Health System

An additional 2 papers are forthcoming, on the topics of family law and child welfare and adoptions. This work has been generously funded by the Office of the Representative for Children and Youth of BC. We are grateful to Dr. Jennifer Charlesworth and her team for their continued support and care for the young people of our province.

“Above all else, the clearest findings from this work have been that people of all ages deserve information about what is happening to them and meaningful mechanisms to voice their opinions. Knowing what is happening, and having an avenue to share what they think about it, makes a real difference in a young person’s long-term health and development,” said Margie Sanderson, Operations Manager at the Society.

“When a young person’s capacity is denied or taken away, it creates a negative cycle that can impact their ongoing ability to make decisions and their development of sense of self and autonomy. Whether or not a child’s opinion is deemed ‘good’ by decision makers, their right to express these views must be upheld.”

The youth engagement undertaken to inform each of these papers included surveys, interviews, and listening circles with young people on their experiences of capacity and participation in each context examined. This engagement process was one of the most valuable parts of this multi-year project, and brought invaluable insights to our reporting. We extend a heartfelt thank you to all of the courageous young people who spoke candidly about often difficult subjects with us throughout this process. One of the major emerging themes was the pain of not being listened to. We would like to say very clearly to all of the young people we engaged with: we are listening, and your voices have been critical. Thank you. 

For media inquiries please contact info (at) scyofbc (dot) org

Read the full papers and summaries of key findings below:

Capacity: A Principled, Rights-Based Approach to Child Participation

This paper provides a primer on the topic of child capacity in a participatory context that includes a discussion of multiple definitions, key themes emerging from research, and criticisms and limitations. The paper ends with suggesting examples of models to support effective child participation consistent with Article 12 of the United Nations Convention on the Rights of the Child (UNCRC).

KEY FINDINGS:

1. There is no universally agreed upon definition of capacity although there are recurring themes throughout social science.
2. Age alone is not a reliable indicator of capacity. Decision makers should not use age as the sole determinative factor of children’s capacity.
3. All children should be presumed to have capacity to express their views and preferences. Great harm is done to children who are not permitted to exercise their capacity to be heard in matters affecting them.
4. Capacity can be understood as both a function of cognition, as well as an ability or a right one possesses. What it is varies depending on its context or function. Capacity can be a legal right.
5. Capacity encompasses a variety of factors and develops at different rates. Children may possess more or less capacity in different contexts. The capacity to be heard is not the same as the capacity to be the decision maker.
6. The United Nations Convention on the Rights of the Child provides that a child need only be capable of forming a view in order for their view to be heard and considered. There is no further test of cognition or capacity that should stand in the way.
7. Children and youth must be equitably supported to express their views and desires on matters affecting them, using methods that meet their level of capacity.

Child Capacity and Participation in Healthcare Decisions

This paper provides an overview of the legal framework governing children and youth’s capacity and participation in healthcare decision-making within Canada. By contextualizing legal principles within a children’s rights framework informed by the UNCRC, this paper seeks to contribute to a deeper understanding of the complex dynamics shaping healthcare decision-making processes for minors and the importance of upholding children’s participatory rights.

KEY FINDINGS:

1. Regardless of their decision-making abilities, all children and youth have a right to be heard and to express their views in decisions concerning their healthcare.
2. As in adults, capacity of children and youth encompasses a variety of factors and develops at different rates. It is an evolving trait that may be more or less present in different contexts and can be assessed through a variety of models available to healthcare providers.
3. Healthcare must be patient-centred, with the views and interests of the young patient meaningfully considered in the provision of services. The onus must be on the healthcare provider to find an effective strategy to communicate and connect with their child or youth patient.
4. Dismissal and invalidation by healthcare providers, parents, and other adults contributes to significant negative impacts on children and youth including reduced self-esteem and confidence in their treatment plans.
5. Children and youth would greatly benefit from neutral, third-party support in medical settings that focuses only on their interests, needs, and views.
6. For many children and youth, making healthcare decisions can be an empowering experience, helping them develop individual agency.

Child Capacity and Participation in BC’s Mental Health System

This paper examines various pieces of mental health care legislation, including those pertaining to both voluntary and involuntary care, focusing on how these legislative schemes impact the participation rights of children and youth, and how the current and proposed legislative frameworks do or do not accord with the UNCRC and various other international treaties to which Canada is a signatory. 

KEY FINDINGS:

1. Although a child or youth’s mental or cognitive capacity may fluctuate depending on the nature of their mental illness or
   disability, this does not impact their legal capacity. Their legal rights do not go away because of their perceived lack of cognitive or mental capacity.
2. While children and youth with mental illness may not always make decisions deemed “good” by decision-makers and health care providers, their right to participate in decision making through the expression of their views should not be ignored.
3. It is important to work with a child and youth’s capacity—meeting them where they are at—rather than assuming they lack capacity.
4. When a child or youth’s capacity is denied or taken away, it can create a negative cycle that impacts their ongoing ability to make decisions for themselves and to maintain a sense of autonomy.
5. It is important for children and youth to express their capacity to be heard; to share their opinions and views on their treatment. A legislative framework that presumes a lack of capacity is not consistent with a child’s legal right to be heard.
6. To respect a child or youth’s capacity, it is essential that decisionmakers and care providers share appropriate information with them about their rights and communicate adequately with them about their treatment. This helps a child or youth to be able to understand, to the best of their abilities, the situation at hand and to use this information to form views and make appropriate decisions about their care.
7. Institutionalization can harm the physical, mental, and cognitive development of children and youth, with lasting effects into adulthood. Involuntary mental health detention should be used sparingly, for the shortest time possible, and in select cases.
8. Any proposed legislation and legislative amendments, such as the Mental Health Amendment Act and Safe Care Act, require thorough scrutiny for their impact on children and youth.