Adolescence Flashcards
What is Gillick competence?
A framework allowing a child to consent to refuse treatment, depending on their maturity, understanding and the nature of the consent that is required.
They must be capable of making a reasonable assessment of the advantages and disadvantages .
If a child is gillick competent then no other consent is needed and their consent should be respected
How is capacity assessed in adolescents?
Mental Capacity act 2005
Criteria applies for those 16 and over - understand, retain, use and weigh up info, communicate decision
What do the GMC say about assessing maturity
Young people may be able to consent to straight forward procedures that are risk free but not high risk procedures.
Can also be affected by their physical and emotional development
What are the Fraser guidelines?
Specific to STIs, contraception, and other sexual health matters
BCUPS
B-BEST INTEREST
C-CONTINUE - they will continue to have sex anyway
U-UNDERSTAND- they understand the advice you are giving
P-PERSUADE - cannot persuade them to inform parents or allow you to inform parents
S-SUFFER- mental or physical health will suffer if you do not advise/offer treatment
What are the guidelines for refusal of consent in adolescents?
England and Wales:
There are other people who can consent for the patient under 18 including:
-young person themselves (>16 or <16 with gillick competence)
-somebody with parental responsibility
-a court
-somebody appointed by the court
Can you override a competent child’s refusal for treatment?
Yes - the law says we can override in certain circs - circumstances which will in all probability lead to the death of the child or to severe permanent injury
DOH says we must get court declaration for competent refusal to deem if it is lawful to override child
Ethical issues with young person refusal of consent?
Hard to protect their autonomy + also from harm + act in their best interests?
What does GMC guidance say about refusal of treatment for young people?
Must explicitly and carefully consider harms and benefits of respecting or overriding a persons refusal
What does the UN convention on the rights of the child say?
Article 3
Article 3
Best interests of the child shall be primary consideration
What does the UN convention on the rights of the child say ?
Article 12
Article 12
To the child.. the right to express views freely…and being given due weight in accordance with the age and maturity of the child
What does section 1 of the children’s act 1989 say?
Section 1 The Children’s Act 1989
‘The child’s welfare shall be the court’s paramount consideration’
