Children and Young People Flashcards
True or False: Recognise the developing autonomy of young people and the impact that has on medical decision-making.
True.
State the age at which it is legally assumed that young people can make decisions about their care (i.e. NOT children and young people).
People at the age of 18 and above in England, Wales and Northern Ireland
People at the age of 16 and above in Scotland
In Scotland, under what conditions may people under the age of 16 legally consent to treatment ?
A person under the age of 16 years shall have legal capacity to consent on his own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending him, he is capable of understanding the nature and possible consequences of the procedure or treatment.
In the case of a child who lacks capacity, how are decisions made ?
- Parents but decisions are constrained by best interests of the child
- If they are not seen to be making a decision that promotes the welfare of the child, then their wishes can be overridden
- Note: if the child’s assent can be given, it should be sought
Describe the principle of best interests in relation to medical decision-making in children.
As well as clinical best interests, should consider:
a. the views of the child or young person, so far as they can express them, including any previously expressed preferences
b. the views of parents
c. the views of others close to the child or young person
d. the cultural, religious or other beliefs and values of the child or parents
e. the views of other healthcare professionals involved in providing care
to the child or young person, and of any other professionals who have an interest in their welfare
f. which choice, if there is more than one, will least restrict the child or young person’s future options.
Describe the case of Re S (A Minor) (Medical Treatment). Which medical ethical issue is this relevant to ?
-S was 4 1⁄2 years old with T-cell leukaemia
-Undergoing chemotherapy – blood transfusion would improve recovery.
-Parents were Jehovah’s Witnesses, and refused (religious and safety reasons)
-Refusal overruled “Parents may be free to become martyrs themselves. But it does not follow that they are free, in identical
circumstances, to make martyrs of their children…”
Relevant to children who lack capacity + their best interests
Describe the case of Re A (conjoined twins) [2001] 2 WLR 480 (aka Jodie and Mary), and explain why the case was particularly complicated with regards to the best interests test.
- If they remained together, they would both die rapidly
- If separated, Jodie would live, but Mary would die
- Doctors wanted to act to separate, parents, devout Catholics, couldn’t decide for one to die to save the other
- High Court, then Court of Appeal
- Both Courts agreed with doctors, but no clear reasoning:
1) Johnson J (High Court) used reasoning from Airedale NHS Trust v Bland (acceptable to remove life support), so ruled that separation would not be murder but a case of “passive euthanasia” in which food and hydration would be withdrawn.
2) CoA rejected this analysis, but the three judges sitting gave very different reasons why it was okay. Ward LJ invoked the concept of self-defence suggesting that “If [Gracie] could speak she would surely protest, ‘Stop it, [Rosie], you’re killing me’.” Brooke LJ relied upon the defence of necessity. Walker LJ focused upon the intention of the surgeons in concluding that surgery could go ahead (doctrine of double effect).
Describe what is meant by a Gillick-competent young person.
A young person under 16 with capacity to make any relevant decision is often referred to as being ‘Gillick competent
What are the requirements of competence, in Gillick competence ?
As per adults: understand, retain, use/weigh this
information, and communicate decision BUT ALSO must also have a sufficient maturity to understand what is involved (assess maturity and understanding on an individual basis and with regard to the complexity and importance of the decision to be made. You should remember that a young person who has the capacity to consent to straightforward, relatively risk-free treatment may not necessarily have the capacity to consent to complex treatment involving high risks or serious consequences. The capacity to consent can also be affected by their physical and emotional development and by changes in their health and treatment).
Can parents and courts override the refusal of a child, if he/she is competent to consent to the treatment ?
Parents and courts have been allowed to override the refusal of a child, even if s/he would be competent to consent to the treatment.
Explain, using either the lock/key or flak jacket analogy, why treatment can go ahead, even if a young person does not give their consent.
• Consent is often more easily accepted than refusal, because:
1) Lock and key analogy:
-3 keys potentially exist in the case of the mature minor:
• Mature minor
• Parents (right co-exists)
• Courts
-Doctor needs only 1 key to unlock “consent”
2) Flack-Jacket analogy:
“…protects from claims by the litigious whether [the doctor] acquires it from his patient who may be a minor over the age of sixteen, or a … competent child under that age or from [a] person having parental responsibilities which include a right to consent to treatment of the minor. Anyone who gives him a flak jacket (i.e. consent) may take it back, but the doctor only needs one and so long as he continues to have one he has the legal right to proceed.’
Identify cases where a mature minor refused treatment, stating the outcome.
1) Refusal of life-saving blood transfusion on religious grounds:
- 15 year old Jehovah’s witness, refused blood transfusion for his leukaemia
- Not enough to know he would die, but must understand the “manner of his death and the extent of his and his family’s suffering” (higher standard than adults?)
- Refusal OVERRULED
2) Hannah Jones (refusal of heart transplant after long term illness)
- PCT sought court order for heart transplant for 13 yr old girl (she had refused to undergo the transplant – her parents agreed with her decision)
- Child protection officer said Hannah was adamant
- Refusal respected (refusal UPHELD)
Identify cases of a child who lacked capacity, with the doctors and parents disagreeing, and the outcomes of the situations.
1) Jehovah’s witness child needing blood transfusions for chemo (parents’ refusal overruled)
2) Conjoined twins, separation would save one, otherwise death for both (parents’ refusal overruled)
Outline the legal status and clinical issues of organ donation in children and young people.
- In Scotland anyone under 16 (competent or not) cannot be a living donor
- In England, Wales, and NI, solid organ donation by living children is permitted
- BMA were opposed, now supports so long as young person is competent to give valid consent and is not under coercion.
-Issue: how much pressure is put on young person from other family members (especially since donation often to relatives)
Outline the legal status of euthanasia in children and young people.
- In the Netherlands, euthanasia legal for those over 12 (with permission of parents), but now Dutch Pediatric Association called for age limit to be lifted altogether
- Belgium has lifted all age restrictions
