Children And Young People : Ethical And Legal Considerations

Question 1

GMC 0-18 years : guidance for all doctors

Answer 1

Children and young people are particularly vulnerable and need to be protected from harm

They can find it difficult accessing services or defending their rights

May need help to make decisions

Individuals with rights that should be respected listening to them and taking into account what they have to say

Respect their decisions and confidentiality

Question 2

Making treatment decisions

Answer 2

For children under 16

If a child is gilick competent the consent of patient to treatment is sufficient

If not competent then consent from one person with parental responsibility is sufficient

Those with parental responsibility have a legal obligation to act in child’s best interests

If parents fail to consent for treatment that is in child’s best interests then courts should be involved unless

In case of emergency doctors should treat the patient

Question 3

Gilick competence

Answer 3

The parental right yield to the child’s right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision

Question 4

Parental autonomy and child welfare

Answer 4

Why should parents be allowed to make treatment decisions for their children - principle of parental autonomy

Grounded in the assumption that parents know their children best and that close parental bond motivated parents to do the best for their children

Question 5

However

Answer 5

A no of high profile cases demonstrate clearly that parental autonomy will be overruled in cases where a child’s welfare is at stake ( hence principle of parental autonomy can be overruled

Question 6

Making decisions for people aged 16 and 17

Answer 6

Presumed competent to consent at 16

Therefore consent must be obtained before treating someone 16+

But if under age of 18 and refuses the law at present seems to allow treatment to be given if approved by parents or the courts

Question 7

Compulsory immunisation

Answer 7

U.K. Childhood immunisation is not compulsory

However following low MMR vaccine uptake and measles cases - some argue it should be compulsory

Question 8

Compulsory public health intervention and the harm principle

Answer 8

State intervention justified only if necessary to prevent greater harm to the public then if state did not intervene

The only purpose for which power can be rightfully excersised over any member of a civilised community against his will is to prevent harm to others - harm principle

Question 9

Does harm principle justify a compulsory immunisation programme ?

Answer 9

• is compulsory vaccination necessary to prevent harm to others
• will compulsory vaccination even if necessary to prevent harm will prevent more harm that it causes

Question 10

Child protection - GMC

Answer 10

Your first concern is safety of children and young people . You must inform an appropriate person or authority promptly of any reasonable concern that children or young people are at risk of abuse or neglect when that is on a child’s best interests or necessary to protect other children or young people

Question 11

Children and confidentiality

Answer 11

Doctors owe children an obligation of confidentiality as much as they do to adults

For children who are competent this generally means a doctor should have the child’s permission before discussing his or her case with parents or other professionals /agencies

But obligation of confidentiality is not absolute

Question 12

Children , sexual health and confidentiality

Answer 12

A confidential sexual health service is essential for the welfare of children and young people

If a child or young person is involved in abusive it seriously harmful sexual activity you must protect them by sharing relevant information

Question 13

Sexual health continued …

Answer 13

You can provide contraceptive , abortion and STI advice and treatment without parental knowledge or consent to young people under 16 provided that

• they understand all aspects of the advice and its implications
• you cannot persuade them to tell their parents or to allow you tell them
• in relation to contraception and STI , the young person is likely to have sex with or without such treatment
• their physical or mental health is likely to suffer unless they receive such advice or treatment and
• it is in their best interests to receive the advice and treatment without parental consent or knowledge