Adolescents and children (Law and Ethics) Flashcards
Define Gillick competence
A child under age 16 can give consent if:
They have sufficient maturity and understanding of what is involved
Make a reasonable assessment of advantages and disadvantages
Gve the reasons that breaches of confidentiality are permissible
-Overriding public interest
-Best interest of an incompetent child
- Disclosure required by law (notifiable diseases)
- Risk of harm to themselves of someone else
Explain a 16/17 year olds right to consent or refuse treatment and to confidentiality
- 16 year old are presumed to have capacity
- Technically cannot refuse, but it is a grey area. Refusal can be overridden by consent from parents/courts.
- Entitled to full confidentiality
Explain a Gillick competent 15 year olds right to consent and refuse treatment, and to confidentiality
- Can consent to but cannot refuse treatment
- Refusal can be overridden by parents/courts
-Generally entitled to full confidentiality
Explain a non- Gillick competent 15 year olds right to consent and refuse treatment, and to confidentiality
- Cannot consent to treatment
- Decision must be made by parent or guardian in the best interests of the child
- Cannot refuse treatment (best interest decision making by parent/guardian/court)
- According to GMC same duties of confidentiality as adults in terms of use, sharing and disclosing of information
According to the capacity act, all competence decisions must be:
-Case by case basis
- Competence is dynamic
- Decision specific
- An unwise decision is not an incompetent decision
What are the criteria for the Fraser guidelines?
- Applies to Contraception
- Patient understands the advice
- Doctor cannot persuade patient to inform the parents/allow doctor to inform parents
-Patient likely to engage in risky behaviour anyway
- Patient’s mental/physical health is likely to suffer
- Advice/treatment is in the patients best interests
What does the Children’s Act say about the consent and refusal of treatment
Persons with “Parental responsibility” have the right to consent to or refuse treatment on behalf of the child
Who has parental responsibility?
- Birth mother (can be lost through adoption)
- Birth father IF married to mother at time of conception/birth OR obtained via join birth registration/written agreement with mother/court ordered
- Same sex parents (if in civil partnership at birth or parental agreement issued
- Adoptive parent/guardian (once adoption/court agreements in place)
- Step parent if acquired by agreement
- Local authority via court order
IN EMERGENCY: Dr can act under DOCTRINE OF NECESSITY in emergency situations without parental consent
How to handle disagreement between doctor and parent/child
Court application + best interest decision making
- Open communication
- Mediation
- Shared decision making
A DOCTOR CANNOT BE FORCED TO MAKE DECISIONS THEY DO NOT JUDGE TO BE CLINICALLY INDICATED
How to handle disagreement child vs parent
Gillick competent child can consent but not refuse
- Open communication
- Mediation
- Shared decision making
How to handle disagreement between two parents
The consent of one parent is considered sufficient
But consider the issues this may raise for the child
- Open communication
- Mediation
- Shared decision making
Factors to consider when assessing best interests of the child
- Current/previous wishes of the child
- Views of parents and others close to the child
- Child’s physical and emotional needs and potential for harm suffered
- Consider the cultural and religious needs of the child and parents
- Consider the views of other healthcare professionals involved in care
Describe a doctors role in assessing bests interests
- Advocate for patients
- Practise with respect to life and care
- Remain alert to influence of own views/biases/beliefs
- Recognise that intervention might be abusive or harmful
- Play close attention to the process AND the content of the decision
