Stakeholders’ perception of the participation rights of the mature minor in healthcare decision-making: a pilot study in Benin City, Nigeria

The mature minor doctrine allows children under eighteen who demonstrate sufficient maturity to consent to healthcare without parental authorisation. Despite the growing international recognition of this doctrine, there is little application in Sub-Saharan Africa, particularly in Nigeria, where it remains practically non-existent. This is because age-restrictive laws and paternalism assume children lack decision-making capacity, excluding them from participating in healthcare decisions. A paucity of empirical research in Sub-Saharan Africa, particularly in Nigeria, underscores the need for this pilot study, conducted in Benin City, to assess the doctrine’s viability from the perspectives of stakeholders, including children (aged 13–17 years), parents, and doctors. Using a mixed-method approach and multi-stage sampling, the researchers collected quantitative data from 225 participants and qualitative data from 40 interviewees through semi-structured questionnaires, in-depth interviews, and focus group discussions. According to the findings, age-graded informed decision-making capacities among children aged 13–17 years indicate that age is not a criterion for assessing a child’s capacity to make healthcare decisions. Results revealed that chronological age alone does not determine a child’s capacity to make informed healthcare decisions. Stakeholders consistently acknowledged that children’s decision-making abilities evolve with the complexity of the ailment or treatment. Parents and doctors alike identified situations in which mature minors could competently consent to specific interventions without parental approval. Based on these findings, the study recommends shifting from rigid age thresholds toward a case-by-case functional capacity assessment. Legislative reforms should establish a participatory model of healthcare decision-making that recognises evolving capacities while preserving supportive parental involvement.