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Sexual, Womens And Paeds > Competence and consent in a minor > Flashcards

Competence and consent in a minor Flashcards

1
Q

Define: Consent

(code of practice definition)

A

Voluntary and continuing permission of a patient to receive a particular treatment based of adequate knowledge of the purpose, nature, likely effects and risks of that treatment, including likelihood of success and any alternatives.

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2
Q

What criteria needs to be met for informed consent?

A
  1. competence to understand and to decide
  2. voluntary decision making
  3. disclosure of material information
  4. recommendation of a plan
  5. comprehension of 3 and 4
  6. decision in favour of plan
  7. authorisation of plan

in summary - competence to understand, have the ability to decide, agree and go through with a recommended plan

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3
Q

What is informed refusal?

A

Person reject plan whilst meeting all other aspects of informed consent

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4
Q

Capacity vs Consent?

A

Capacity is the ability and comes in degrees

Competence is a personal possession and is allow nothing - a legal term

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5
Q

Definitions

Capacity vs Consent?

A

capacity - the degree one is able to understand…
consent - being able to understand…

…information relevant to treatment decision and to appreciate the reasonably foreseeable consequences of a decision or lack of a decision

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6
Q

When can competence be presumed?

A

When over 16

can be presumed in law to be competent to give consent for medical treatment and to release information in England, Scotland and Wales.

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7
Q

Can someone under 16 be competent?

A

yes, should be assessed case-by-case

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8
Q

What year did Mrs Gillick go to court?

and why?

A

1982

stop doctors contraceptive advice or treatment to under 16 year olds without parental consent

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9
Q

What year did the courts dismiss Mrs Gillick’s claim?

And what did the house of lords rule?

A

1985

upheld that doctors could give contraceptive advice and treatment to a young person under 16 based of Fraser Guidelines

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10
Q

What are Gillick competency and Fraser guidelines?

A

A child giving consent depends on:

  • maturity
  • understanding
  • nature of consent

a child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed

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11
Q

Difference between Gillick competence and Fraser guidelines?

A 
GC = determining a childs capacity to consent 
FG = decide if a child can consent to contraceptive or sexual health advice and treatment
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12
Q

How are Fraser Guidelines applied?

A

A doctor can give advice and treatment if he is satisfied with the following criteria:

  1. girl will understand advice
  2. can’t persuade her to tell parents or allow him to tell parents she is seeking contraceptive advice
  3. very likely to continue having sex with or without contraception
  4. without contraceptive advice her mental and physical health will suffer
  5. her best interest requires she is given contraceptive advice, treatment both with or without parental consent
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13
Q

When did Fraser Guidelines coverage change and what does it now apply to?

A

Originally related to contraceptive advice and treatment

in 2006 it changed and now applies to decisions about treatment for STI’s and terminations of pregnancy

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14
Q

When are there grounds to break confidentiality?

A

if the conditions aren’t all met

reason to believe the child is under pressure to give consent or is being exploited

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15
Q

How to assess competence?

A
  • understand there are choices and choices have consequences
  • can weigh information and arrive at decision
  • willingness to make choice
  • understand nature and purpose of intervention
  • understand proposed risks and side effects of intervention
  • understand alternative interventions and risks
  • freedom of undue pressure
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16
Q

Who should assess competence?

A

HCP who:

  • have known pt a long time
  • have skilled and experience interviewing young ppl and can elicit views without distortion
  • have close rapport with pt
17
Q

What is the 2005 Mental Capacity Act?

A

Legal framework for making decisions on behalf of those who lack capacity to make their own decision

Applies to those 16 and over

For people with impairment or disturbance in the functioning of mind or brain

18
Q

What are the two stages of testing capacity?

A

Impairment or disturbance of:

  1. functioning of mind/brain
  2. sufficient enough for a person unable to make the decision
19
Q

Which factors would you consider when assessing capacity?

A 
cognitive development 
emotional development 
mental illness
medication/drugs/alcohol
relations and peer influences 
cultural and political pressure
20
Q

Who has parental responsibility?

A 
Children act 1989:
- mum and dad married at the time of child's birth 
- not married: 
always mum 
dad can acquire it
21
Q

how can parental responsibility be acquired?

A

Dad:

  • married to mum at time of birth
  • named on birth certificate
  • legally acquired:
    a. apply to court
    b. make agreement with mum
    c. being appointed guardian
22
Q

True of false:

If more than 1 person has parental responsibility for a child, each of them cancan alone and without the other in meeting that responsibitly

A

True

23
Q

Sexual activity with a child of what age is considered a criminal offence?

And what would the next step be?

A

Sexual activity with children under 13 is considered a criminal offence and should always result in a child protection referral

24
Q

What is the reasoning behind the age of consent?

A

Protect children from abuse or exploitation

25
Q

Is child safeguarding an issue if there are two under-16’s participating in mutually consenting sexual activity?

A

No, the age of consent does not apply to two consenting under-16’s

26
Q

Can someone under 13 ever consent to sexual activity?

A

No, under 13’s can never legally give consent.

It will always result in a child protection referral.

27
Q

What protection has been put in place for under 18’s that are over the age of consent?

A

For under 18’s over the age of consent it is illegal to:

  1. take, show or distribute indecent photos of a child
  2. pay or arrange sexual services
  3. a person of trust to engage in sexual activity with anyone under 18 who is in the organisation of their care
28
Q

Examples of a person in a position of trust?

A

Teacher

Care worker

29
Q

What sentence can a person be charged with if they partake in sexual activity with a person 12 and under?

A

Life imprisonment for rape, assault by penetration and causing or inciting a child to engage in sexual activity

30
Q

True or false:

Only a man can be convicted of rape.
Women cannot be convicted of rape.

A

True
Rape is defined by penile penetration.

If a man intentionally penetrates with his penis in to the mouth, vagina or anus of another boy or girl without consent or under 13 it is rape.

Women can be charged with other offences.

31
Q

What can a women be charged with in-terms of non-consensual sexual activity?

A
  • Causing a person to engage in sexual activity without consent
  • Sexual coercion or assault
  • Assault by penetration
32
Q

What approach should be taken with 13-15 year olds involved in sexual activity?

A

consideration should be taken with every case as to whether there should be a discussion with other agencies and whether a referral should be made to children’s social care.

In this age range, the younger the child the stronger the presumption must be that the sexual activity is a matter of concern and refer to child social care

33
Q

Case study:

Girl aged 15 asks for contraception
The boyfriend is 15

What are the issues?
What questions will you ask?

A
  • Fraser guidelines

- Competence and capacity

34
Q

Case study:

Child aged 16 attends the clinic, asks for contraception

What are the issues?
What questions will you ask?

A
  • Assumed competence age 16
  • Capacity?
  • Learning difficulties?
  • Age of partner, relationship to patient (their teacher/ social worker)
35
Q

Case study:

Girl aged 13, attends alone asking for contraception

What are the issues surrounding this case?
What questions will you ask?

A
  • Over 13 - not statutory rape
  • Below legal consent age - age of partner, parents awareness, role of partner
  • Gather info, assess competence - Fraser
  • Gather info, assess capacity
  • Ref to child SS usually needed
  • Consider informing patients
36
Q

What is the cut off age for Gillicks competence or Fraser guidelines?

A

There is no lower age limit.
But, it would rarely be appropriate or safe for a child less than 13 to give consent to a treatment without the parents involvement.

Sexual, Womens And Paeds (2 decks)

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