| Course | NU677 PMHNP Diagnosis and Management Across the Lifespan III |
|---|---|
| Unit | Unit 3 |
| Paper type | Consent and assent analysis |
| Length | About 1,100 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU677 Unit 3
Three People, Three Answers: A Consent and Assent Analysis of Fluoxetine for a 14-Year-Old Whose Parents Share Custody and Disagree
[Student Name]
Purdue University Global
NU677: PMHNP Diagnosis and Management Across the Lifespan III
Unit 3 Consent and Assent Analysis
[Instructor Name]
[Date]
The family is composite; details are bracketed. Legal rules vary by state; the analysis names where they do.
The Case
[Maya], [14], has had a major depressive episode for [four] months: low mood, withdrawal from her soccer team, falling grades, poor sleep and passive thoughts of not wanting to be alive, without intent or plan. Her PHQ-9 modified for adolescents is [18]. Her parents divorced [three] years ago and share joint legal custody; she lives mainly with her mother and spends alternate weekends with her father.
After the evaluation, the clinician recommended cognitive behavioral therapy and fluoxetine. In a large trial in adolescents with major depression, the combination of fluoxetine and cognitive behavioral therapy produced the highest response rate, [71.0] percent, compared with fluoxetine alone, therapy alone or placebo (Treatment for Adolescents With Depression Study Team, 2004). Her mother agreed and signed consent. Her father, told by phone, objected to any medication, citing the warning about suicidal thinking. [Maya] said she would go to therapy but did not want to "be on pills."
Who Holds Legal Authority?
Minors generally cannot give legally valid consent to medical treatment; a parent or guardian consents for them, with exceptions that vary by state, such as emancipated minors or specific statutes allowing adolescents to consent to some mental health treatment. With joint legal custody, the rules on whether one parent's consent is enough also vary by state and by the terms of the custody order. In many jurisdictions either parent may consent to routine care, but when parents actively disagree about a significant treatment, clinicians commonly seek agreement, check the custody order, and consult legal counsel before relying on one parent's signature.
The first practical step is therefore to obtain a copy of the custody order. If it gives medical decision-making to both parents jointly, proceeding over one parent's objection may be unwise and possibly impermissible; if it gives either parent authority, the mother's consent may be legally sufficient, though not ethically the end of the matter.
What Is Her Assent Worth?
The American Academy of Pediatrics describes pediatric decision-making as involving parental permission together with the child's assent, in which the adolescent is informed in developmentally appropriate terms, her understanding is assessed, and her willingness to accept treatment is sought, with her view given increasing weight as she matures (Katz et al., 2016). At fourteen, [Maya] can understand her illness and the options. Her refusal of medication is not legally binding, but a medication she is unwilling to take is unlikely to be taken, and overriding a capable adolescent's refusal of a non-emergency treatment damages trust at the start of care.
Where Do the Three Agree?
All three agree on therapy. Her mother wants it as part of combined treatment, her father has no objection to it, and [Maya] has said she will attend. The one treatment all three accept is also an effective one, so therapy can begin today without anyone's authority being tested.
The Father's Concern
His concern is not unreasonable. When the FDA pooled the pediatric antidepressant trials, suicidal thinking and behavior were more common on active drug than on placebo, though no child in those trials died by suicide (Hammad et al., 2006). A fair response acknowledges that risk, explains how it is monitored, weekly contact in the first month, a safety plan and clear instructions for the family, and sets it against the risks of untreated depression, including suicide. A joint meeting with both parents, or a call with the father, gives him the information directly rather than through her mother.
Talking With Maya Alone
Part of the visit was spent with [Maya] without either parent. She said her reluctance about medication came partly from her father's views, which she had heard many times, and partly from a friend who had felt "numb" on an antidepressant. She also said she was tired of being the subject of her parents' arguments and did not want her treatment to become another one. When asked what she hoped therapy would help with, she named sleeping better and wanting to go back to soccer. These answers matter for assent in two ways. They show that her refusal is reasoned rather than impulsive, which is what developmentally appropriate assent asks the clinician to explore, and they give therapy concrete goals she chose. She agreed that if therapy did not help within about six weeks, she would talk about medication again, as long as she could be part of the conversation.
What Begins Today
1. Cognitive behavioral therapy, weekly, starting this week, with consent from both parents and [Maya]'s assent.
2. A safety plan with [Maya], shared with both parents, given her passive thoughts.
3. A request for the custody order.
4. A meeting or call with the father to discuss medication, its risks and monitoring.
5. A review in [four to six] weeks. If depression has not improved with therapy, medication will be revisited with all three; if [Maya]'s thoughts about suicide worsen, the urgency changes and so may the approach to consent.
What Would Change the Analysis
An emergency, such as active suicidal intent, would change the balance, since emergency treatment does not require the same consent process. A custody order giving the mother sole medical authority would make her consent legally sufficient, though assent would still matter. A change of mind by [Maya] would make combined treatment possible with her agreement.
Documentation
The note records each person's position in their own words, the date of the request for the custody order, the plan agreed by all three, and the conditions under which medication will be discussed again. Recording the father's objection and the clinic's response protects the family and the clinic if the disagreement escalates, and it shows that the decision to start with therapy was a considered one rather than a way of avoiding conflict. A copy of the safety plan is attached for each household, since she moves between two homes and each parent needs the same warning signs and the same numbers to call at any hour.
Conclusion
Legal authority, the adolescent's assent and the evidence each point somewhere slightly different. Starting with the treatment all three accept, while clarifying authority and addressing the father's concern with facts, respects each of them and gets [Maya] into care now.
References
Hammad, T. A., Laughren, T., & Racoosin, J. (2006). Suicidality in pediatric patients treated with antidepressant drugs. Archives of General Psychiatry, 63(3), 332-339. https://doi.org/10.1001/archpsyc.63.3.332
Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), Article e20161485. https://doi.org/10.1542/peds.2016-1485
Treatment for Adolescents With Depression Study Team. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA, 292(7), 807-820. https://doi.org/10.1001/jama.292.7.807
Reading the NU 677 Unit 3 instructions
For Unit 3 you analyze who can consent to treatment for a minor and how the young person's view should be weighed when the people involved disagree. The paper usually covers the case, the legal authority to consent and how it varies by state, the meaning and weight of assent, the evidence behind the proposed treatment, and a plan that respects the law and the people. Most submissions fill four to six pages, and graders reward analyses that separate legal questions from ethical ones, that take each person's concern seriously, and that find a way for care to begin. Naming what would change the analysis, such as an emergency, shows the limits of the conclusion.
Inside the NU677 Unit 3 example
The case section sets out her symptoms, the clinician's recommendation with the TADS response rates and the three positions. The authority section explains how consent for minors and joint custody vary by state and makes obtaining the custody order the first step. The assent section applies the AAP statement on pediatric decision making. A section on agreement identifies therapy as the shared ground, with a highlighted sentence. The father's concern is answered with the FDA analysis and a monitoring plan. A section records her private conversation, a five-step plan follows, then what would change the analysis, documentation and a conclusion that ties the three strands together.
Where the points sit in the NU677 Unit 3 rubric
The rubric for this analysis typically covers legal accuracy, ethical reasoning, use of evidence, fairness to each party and the plan. Legal accuracy earns full points when variation by state and the role of the custody order are stated rather than assumed. Ethical reasoning rewards a clear account of assent and why an adolescent's refusal deserves weight even when it is not binding. Evidence points go to treatment trials and safety data used to inform each position. Fairness is judged on whether each parent's view is represented accurately. The plan earns credit for starting care promptly on the agreed ground while the disagreement is addressed with facts and time.
NU677 Unit 3 help: mistakes that cost points
Students often assume that one parent's signature settles consent, without checking the custody order or state law. Another common error is treating the adolescent's view as irrelevant because she is a minor. Some papers dismiss the objecting parent's concern rather than answering it with evidence. Others delay all treatment until the adults agree, leaving a depressed teenager untreated. Many forget a safety plan when there are passive suicidal thoughts. And a paper that never says what would change the analysis, such as an emergency, reads as more certain than the law and the ethics allow in a case like this. Finally, remember that the young person's trust in the clinician is itself an outcome; an analysis that wins the legal argument but loses the teenager has not solved the case at all.
Get an NU677 Unit 3 example written to your instructions
Consent cases in NU677 Unit 3 hinge on who the guardians are and what the young patient wants, so include both from your case, with any state named, plus the rubric. The free first analysis returns within 24-48h, separating legal authority from assent, disclosing fully and starting whatever everyone has agreed to. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU677 Unit 3 questions, answered
Is a minor's refusal of treatment legally binding?
Usually not for non-emergency care, where parents or guardians hold legal authority, though some states let minors consent to certain services, such as outpatient counseling, on their own. Ethically, a refusal still carries weight, and overriding it needs a reason. State the governing law in brackets, note state variation and explain how the plan respects the young person's view.
What does assent involve in practice?
Explaining the condition and options in terms suited to the young person's development, asking what they understand and what they want, and taking their answer seriously. The American Academy of Pediatrics describes assent as part of shared decision-making with children and adolescents. Record their words, their concerns and how the plan responds, rather than noting only that assent was sought.
How should divorced parents who disagree be handled?
Start with the custody order, which may assign medical decisions to one parent, to both jointly, or leave them unaddressed, and with state law. Do not assume either parent's signature suffices. Meanwhile, look for options both support. An analysis should show those documents being checked and describe how communication with each parent will run.
Where can I find a free NU677 Unit 3 sample paper?
The complete NU677 Unit 3 consent and assent analysis appears here, covering legal authority, assent, the shared ground, the father's concern, her own view, the plan and what would change it, plus three references. An analysis for your own case can be requested.
Can one parent consent when the other objects in NU677 Unit 3?
It depends on the custody order and state law. Some orders let either parent consent to routine care; others require joint decisions. The paper makes the custody order the first step and starts with therapy, which both parents accept.