In practice, it's exactly what I said in my initial answer. It's an incredibly specific thing. It's specific to the procedure, treatment or whatever else that's being offered. It can be as simple as taking antibiotics for an infection, versus consenting to a surgical procedure. It's really about whether this person understands what is being offered. Do they understand the risks and benefits? Do they understand the alternatives?
Sometimes it's really obvious. If a six-year-old shows up and and says, “I want to cut off my leg” or something ridiculous like that, without any good kind of understanding, it's fairly obvious. In the case of a mature minor who is talking about a very serious condition, it's about getting to the root of whether the person in front of you understands.
In my long-term practice, I'm fortunate that I've watched a lot of these kids grow for many years now. I can say that five years ago, I don't think this person could have shown up in the office, made a request for x, y or z and really understood what they were talking about, but today I think they can.
I speak not as a specialist physician. I speak as a generalist physician—