Children and adolescents

Question 1

Who can consent to medical treatment for young people?

Answer 1

A person with ‘parental responsibility’ has decision making authority, including health-care decisions (eg biological mother, plus other parent if married or born after Dec 2003) if named on birth certificate
This person could also be a legal guardian/ after a court order
Consent is only legally required from one person with parental responsibility but best practice to involve both parents
Child minders/teachers cannot give consent for treatment but should do ‘what is reasonable’ to promote the child’s welfare
Social workers have parental respsonsibility

Question 2

What happens if parents disagree with each other about consent for a treatment of their child?

Answer 2

The clinician goes with the child’s best interests

Question 3

When should consent be taken by BOTH parents?

Answer 3

Non therapeutic male circumcision

Immunisations

Question 4

What happens when parents disagree with the clinician about treatment for their child?

Answer 4

A court order should be obtained before any treatment is given (if there is time to do so)
Degree and likeihood of harm should be assessed (eg necessary blood products are usually given)
A presumption in favour of respecting the parent’s decision can be overrules if the child is at risk of significant harm

Question 5

What happens in an emergency when the parents are uncontactable?

Answer 5

Decisions are made in the child’s best interests

Question 6

Should children be told about their diagnoses/prognosis when it would upset them?

Answer 6

GMC says wellbeing includes ‘treating children and young people as individuals and respecting their views, as well as considering their physical and emotional welfare’
Decisions about treatment should be in child’s best interests. The views of children should be given ‘due weight’ says the UN
Consequentialist theory weighs up pros and cons-> maximise beneficence
Not telling would be seen as ‘overly paternalistic’ as we should respect the patient’s autonomy
Risk of child finding out and not trusting parents in future
Deontologically truth-telling is one of the fundamental duties of a doctor
Honest and open versus not causing serious psychological harm

Question 7

When can a young person consent to treatment?

Answer 7

-An 18 yr old is an adult and presumed to have capacity
-16-17yr olds are presumed to be competent to give effective consent to surgical, medical and dental treatment, however there is no presumption of consent for organ donation, non-therapeutic procedures or research (capacity must then be assessed)
-Under 16yr olds can consent if they can demonstrate Gillick competence (without the knowledge or consent of their parents)
So competence is related to psychological maturity and experience of illness than biological age

Question 8

When can clinicians provide under-16s with contraception without parental consent?

Answer 8

When the young person understands the health professionals advice
If the health professional cannot persuade the young person to inform his/her parents or allow the Dr to inform parents
If the young person is very likely to begin/continue having intercourse with or without contraception
Unless he/she receives contraceptive advice/treatment the young person’s physical/mental health will suffer
If the young person’s best interests require the healthcare professional to give contraceptive advice/treatment without parental consent
= Fraser guidlines

Question 9

Is the contraceptive advice/treatment confidential if the child is under 16?

Answer 9

Yes, unless the child is at risk

Question 10

How can risk to the underage sexually-active girl be assessed?

Answer 10

Info about sexual partner (nature of relationship, how long have they known eachother, where they meet up, what joint interests are)
Power imbalance in relationship?
Offence if man is having sex with someone under 16
If similar ages, ‘normal’ teenage relationship, no need to inform services

Question 11

When are people unable to give consent to sexual activity?

Answer 11

If under 16, with someone over 16
If 16-17 and the adult is in position of trust or a family member
If under 13

Question 12

Can a minor refuse medical treatment?

Answer 12

The courts have said it is their duty to ‘ensure as far as it can that children survive to attain’ the age of 18
Human rights to personal autonomy and the right to life may contradict eachother
Therefore the right to life may outweigh the right to personal autonomy and they may not refuse treatment if refusal would probably lead to death or severe permanent injury
If the patient refuses, a parent could give consent (may need court declaration)

Question 13

Who has parental responsibility when a child is in foster care?

Answer 13

Mother still has parental responsibility for consent

Question 14

What rights are important in child safeguarding?

Answer 14

Right to survival
Right to health and healthcare
Right to develop to fullest
Right to freedom from violence

Question 15

Is hitting of children allowed?

Answer 15

Yes as long as no damage done, no marks left

No implements or weapons can be used

Question 16

What is a section 47?

Answer 16

Worried child is at risk, social services are investigating

Question 17

Risk factors for child abuse

Answer 17

Domestic violence
Alcohol/drug misuse
Mental illness
Parent/child with disability
Children in care
Social isolation
Poor housing/homeless
Unemployment

Question 18

Types of abuse

Answer 18

Physical
Neglect
Sexual
Emotional

Question 19

Does the intended mother or the surrogate mother have parental responsibility when the baby is born? What about the surrogate/intended mum’s husbands?

Answer 19

Surrogate mother and her husband have parental responsibility at birth until they officially hand over parental responsibility and the baby and sign the forms.