Consent in children and young people

Question 1

What two key issues was the gillick case related to?

Answer 1

1) CONFIDENTIALITY
2) CONSENT

Question 2

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

Answer 2

Doctors have a duty of confidentiality no matter what the age of the patient.

Parents or those with parental responsibility are legally responsible for their chidren incl. for matters related to their health

they are not able to exercise this responsibility properly if drs are unable to share info with them

specifically they are not able to make descisions if a) they do not know there is a decision to be made and b) they not given relevant infor upon which to base decision

in order to permit parents to exercise resp. dr must share revelant info with them.

Question 3

In order to be held responsible for their children, parents must have some authority over them, so the question is:

When does parental authority over their children give way to their child’s (developing) autonomy, such that the child is entitled to the same privacy and respect for their abilities to make their own decisions as an adult?

Answer 3

Basically as the age of the child increases the capacity and autonomy of the child increases and the parental responsibility and authority decreases.

Question 4

What three components are of consent

Answer 4

Information

voluntariness/ freedom from coercion

capacity

Resulting decision –> patient needs to be able to communicate

Question 5

What are the key components of capacity?

Answer 5

Voluntariness and the ablility to understand information

Question 6

Childrens rights and interests: What are the three stages of development of capacity that a child will progress through as they get older?

Answer 6

Protection (from parents or care giver)

participication

self determination and autonomous decision making –> as child progresses to adult has increasing capacity.

Question 7

What are the legal definitions of a child?

Answer 7

UNCRC (united nations convention on the rights of a child) –> every human being below the age of 18 yrs unless under the law applicable to the child, majority is attained earlier.

UK age of majority 18 -> parental responsibility holds until 18.

UN thinks politically everyone under 25 deservees special protections, as younger adults have less economic power in society.

Question 8

What are the key rights of a child?

Answer 8

• Right to life, survival and development
• Protection rights
• Most important is article 12:•(respect for the views of the child): when adults are making decisions that affect children, children have the right to say what they think should happen and have their opinions taken into account.

Question 9

How do we translate article 12 into clinical practise?

Answer 9

children should as far as reasonably and practically possible participate in decisions about them

But participation fall short of giving them the power to decide matter for themsevles - e.g. to conset ( or refuse consent) to tx.

They obtain the power to consent if and only they have capacity

but might not apply equally to refusal

Question 10

What are three key acts to know w consent and children?

Answer 10

Mental Capacity Act

Children Act

Sexual Offences Act

Question 11

What is the mental capacity act?

who does it apply to?

how does this affect dr?

how are parents involved?

Answer 11

Applies to aged 16 and over

if 16 plus assumed to have capacity and can therefore decide matters for themselves

onus on others to demonstrate a LACK of capacity, not on the person to demonstrate capacity (dr must prove no capacity)

however parental responsibily remains in place until the age of majority therefore a parent can consent/ make decisions for the child

Question 12

What was the gillick vs West norfolk case ruling?

Answer 12

outcomes of the gillick case:

Parental right to determine whether or not minor child receives medical tx terminates when child achieves sufficient understanding and intelligence to understand fully what is proposed.

Must be able to express his/ her own wishes.

i.e competent child can consent to own tx. w/out parental involvement

Question 13

What does a childs ability to give consent depend on?

Answer 13

depends on the child’s maturity and understanding and the nature of consent required.

child must be able to ax. adv/ disadv. of the tx proposed.

Question 14

What are the 3 key points of gillick competence?

How does this differ to adult consent?

Answer 14

• no fixed age, it depends on the degree of maturity and understanding, and the nature of the decision to be made –> IT IS DECISION SPECIFIC.
• Fully understand the nature, purpose and implications
• applies to all medical tx. and not just contraception

Differs to adult consent in that the threshold to “fully understand” is greater than adult capacity

And tx. if offered is because the dr has already determined what is in the px. best interests, but this is difficult if the child refuses consent.

Question 15

What does GMC guidance say on child compentence and capacity?

Answer 15

• capacity to consent depends more on young persons ability to UNDERSTAND and WEIGH UP options than on age
• Must be able to understand the nature/ purpose and possible consequences of investigation or tx. proposed, and consequences of not having tx.
• Ax maturity on individual basis, giving regard to complexity and importance of the decision to be made.
• Remember may have capacity for straight forward risk free tx but more complex tx w risk needs greater level
• capacity to consent also affected by physical and emotional development and by changes in health and tx.

Question 16

What are the fraser guidelines?

Answer 16

Fraser guidelines are specific to contraception, abortion and STI

A dr can proceed to give advice and tx. provided they are satisfied in following criteria:

1. that the px. will understand the advice
2. that they cannot persuade them to inform parents or consent to allow dr to inform parents that they are seeking contraceptive advice
3. that they are very likely to continue having sexual intercourse w or w/out contraceptive tx
4. the unless they receive contraceptive advice or tx. physical or mental health are both likely to suffer
5. that best interests require dr to give contraceptive advice, tx or both w/out parental consent.

Question 17

Describe the framework of the sexual offences act (2003)

Answer 17

Medical professional entitled to provide advice and tx. on sexual mattera without parental knowledge or consent provided they follow Fraser Guidelines. You are not guilty of encouraging underage sex if the reasons for the consultation are protections from:

1) STI
2) physical harm
3) pregnancy

or promotion of emotional well being

Question 18

Children’s interests:

UN convention of the rights of the child

article 3 says what?

Children act: what does this say?

Answer 18

UNCRC article 3 –> best intersets of children must be primary concern in making decisions that may affect them

Children act –> welfare of child should be paramount concern in any decision made by the court (2004 modification extends this to all children services/ organisations) in relation to that child.

Question 19

What is the GMC guidance on children’s interests?

Answer 19

Ax of best interests should include:

1) views of child or young person as long as they can express them (and previously exp.)
2) views of parents
3) views of others close to child or young person
4) cultural, religious or other beliefs/ values of child or parents
5) views of other HCP involved in providing care
6) least restrictive option

Question 20

When are children presumed to have capacity?

What are gillick competent under 16s entitled to?

Answer 20

16- 17 yrs old

Gillick competent under 16s are entitled to confidentiality wrt decision but should be encouraged to include parents

parents can also authorise tx.