Consent In Children

Question 1

What case is important to this lecture?

Answer 1

Guidelines allow doctors to provide contraceptive advice to girls under 16 years w/o advising parents although they should seek the girl’s to persuade to girl to involve the parent but Gillick did not want contraception to be provided to her daughter w/o her knowledge or consent - she lost

Question 2

What was the 2 related issues in the Gillick case?

Answer 2

Confidentiality

Consent

Question 3

What is the relationship between confidentiality and consent in the case of children?

Answer 3

Doctors have a duty of confidentiality towards child but they do not have the capacity to consent to allow their information to be shared HOWEVER, parents have legal responsibility for child which they cant exercise if they are not told the relevant information

Question 4

As childs age, what transition occurs in terms of this?

Answer 4

Parental authority and responsibility changes to developing capacity and autonomy

Question 5

How do rights/interests of children change as they age?

Answer 5

Children: protection

Older: degree of capacity and participation

Adult: self-determination and autonomous decision making

Question 6

What is the legal definition of a child?

Answer 6

UNCRC: people < 18 years old unless under law applicable to the child, majority is attained earlier so parents have responsibility until this age (Scotland is 16)

Question 7

What are the rights of a child under the United Nations Convention on the Rights of the Child (UNCRC)?

Answer 7

Right to life, survival and development
Protection rights from violence, kidnapping and child labour
Participatory rights

Question 8

What are participatory rights?

Answer 8

When adults make decisions that affect children, children have the right to say what they think should happen and have their opinions taken into account BUT falls short of giving them power to decide matters for themselves e.g. consent/refuse treatment

Question 9

When does a child obtain the power to consent?

Answer 9

IF they have capacity - this might not apply equally to refusal

Question 10

What Common Law is important?

Answer 10

Gillick v West Norfolk and Wisbech Health Authority (R (on the application of Axon) v The Secretary Of State For Health)

Question 11

What Statute is important?

Answer 11

Mental Capacity Act
Children Act
Sexual Offences Act

Question 12

What does the Mental Capacity Act state?

Answer 12

Those aged 16 years and over and assumed to have capacity can decide matters concerning them for themselves e.g. consent to treat unless they demonstrate lack of capacity; the person does not have to demonstrate capacity - parental responsibility remains in place until age of majority so they can consent and make decisions for their child

Question 13

What are the 3 elements of consent?

Answer 13

Information
Voluntariness/freedom from coercion
Capacity to understand

Resulting in decision that patient is able to communicate

Question 14

What is Gillick competence?

Answer 14

No fixed age at which a child can consent to treatment w/o parental consent, it depends on the degree of maturity, the ability to FULLY understand the nature, purpose and implications of decision to make (i.e. decision-specific)

Question 15

What is the difference between capacity in adults and children?

Answer 15

Children must FULLY understand the nature, purpose and implications of the decision is greater than that required for adult capacity in which they must just UNDERSTAND

Question 16

What must the child do to demonstrate capacity?

Answer 16

1. FULLY understand the information given to them
2. Retain it
3. Weigh up the risks and benefits
4. Communicate by any means

Question 17

What are the Fraser guidelines?

Answer 17

A doctor can proceed to give advise and treatment specific to contraception, abortion and STI provided he is satisfied that:

1. The girl (although under 16 years) can understand his advice)
2. He cannot persuade her to inform her parents
3. She is likely to continue have sex anyway
4. Her physical or mental health are both likely to suffer otherwise
5. Her best interests require him to give it

Question 18

What does The Queen On The Application Of Sue Axon v The Secretary Of State For Health state?

Answer 18

That a medical professional can provide advice and treatment on sexual matters w/o parental knowledge or consent provided he or she follows Fraser guidelines

Question 19

What does the Sexual Offences Act state?

Answer 19

A person is not guilty of aiding, abetting or counselling the commission against a child of an offence to which this section applies if he acts for the purpose of:

1. Protecting child from STI
2. Protecting physical safety of child
3. Preventing child from becoming pregnant
4. Promoting child’s emotional well-being by the giving of advice

Question 20

What does the United Nations Convention of the Rights of the Child (UNCRC) state about children’s interests?

Answer 20

Best interests of children must be primary concern in making decisions that may affect them

Question 21

What does the Children act state about children’s interests?

Answer 21

The welfare of the child should be the paramount concern in any decision made by the court and all children’s services/organisations in relation to that child

Question 22

As stated by the GMC guidance, what should an assessment of best interest of a child include?

Answer 22

• Views of child
• Views of parents
• Views of others close to the child
• Culture, religious or other beliefs/values child or parents
• Views of other healthcare professionals involved in childs care or welfare
• Which choice, if there is > 1, will least restrict child or young persons future options