Consent to treatment Flashcards
What are the 4 key factors to consider when gaining consent?
1) Patient must be given adequate INFORMATION
2) Consent must be given VOLUNTARILY
3) Patients must have CAPACITY to give the consent
4) Patients must make a DECISION
What are the two groups of people by law that may fail to provide consent?
These groups may fail the competency/capacity requirement of consent
= adults who lack capacity and children
What is classified as a minor?
under 18 years
What are the 2 laws for those under 18 years of age?
1) law of consent for those aged 16 and 17 years of age
2) law of consent for those under 16 years of age
Who are the parents?/ Who has parental responsibility?
1) Mother of the child
2) Father of the child if married to the mother (either at the time of insemination or birth)
3) Unmarried father of child - no automatic parental responsibility but he may acquire it:
- marrying mother
- written agreement with mother
- court order
- appointment as guardian following mother’s death
- present to register as the child’s father at registry office and their name is put on the birth certificate
Does parent responsibility remain if the parents divorce?
remains even if the parents divorce
What does the law assume in terms of a child born to a married women?
assumes the child is a child of her husband
How do people other than parents acquire responsibility?
- adoption
- guardian - parents by will upon their death
- residence order e.g. grandparents, but co-exists alongside parents parental responsibility
- LA named in a care order (parents still retain parental responsibility
- emergency protection order
How does a step parents acquire parental responsibility?
They do not automatically acquire PR, they have to either do it by residence order, appointed guardian or adopt the child
Does an unmarried father have parental responsibility?
An unmarried father may not have parental responsibility but they do have to pay child support
What is the Family Law Reform act of 1969?
16 and 17 year olds can consent to surgical, medical and dental treatment - this does NOT include treatment unless can be called a treatment also
How can the family law reform act of 1969 be overridden?
The 16/17 year old doesn’t have complete autonomy
Consent can be overridden by a court
But NOT by a person with parental responsibility
There are different rules when it come to refusing treatment
Are 16/17 year olds able to refuse treatment?
This is a limit to their autonomy
They are not able to refuse treatment = both the court and anyone with parental responsibility can override a young person’s refusal (irrespective of the minor’s competence)
How did the Gillick law come about?
Comes about from a famous case called:
Gillick v. West Norfolk and Wisbech AHA 1985
- Mrs Gillick claimed that a DHSS circular advising doctors that they could give contraceptive treatment to girls under 16 without their parents knowledge or consent was unlawful
What did the house of Lords say about the case of Gillick?
Stated that girls under 16 could consent to contraception without parental consent providing that they were sufficiently mature to understand its nature and implications
What does Gillick competence mean?
If a child has sufficient understanding and maturity to understand the nature of the medical treatment and its consequences they are deemed to be “Gillick Competent”
What are the Lord Fraser’s guidelines?
The young person understands the health professionals advice
The HCP cannot persuade the young person to inform his or her parents and will not allow the doctor to inform them that he or she is seeking contraceptive advice
The young person is very likely to begin or continue having intercourse with or without contraceptive treatment
Unless he or she receives contraceptive advice or treatment, the young person’s mental or physical health or both are likely to suffer
The young person’s best interests require the health professional to give contraceptive treatment or both without parental consent
What are the DOH guidance 2004?
Pregnant teenager- they are encouraged to talk to their parents however if they still refuse, every effort is made to involve another adult to provide support = youth worker/other family member
Confirms duty of confidentiality to all patients include those under 16
When is the Gillick/Fraser competence applied?
the competency test has been applied to all other types of medical care involving children under 16
How do you assess Gillick/Fraser competence?
Capacity is not automatically acquired at a fixed age
It has to be assessed on an individual basis
Degree of understanding and intelligence needs to be taken into account - this increases with greater complexity of the treatment
- e.g. it is possible that this child is competent to consent to an examination of his tonsils but not a tonsillectomy
Which bodies/people can overrule a child’s (Gillick/Fraser or 16-17yrs olds) consent to treatment?
They can give consent as if a competent adults (as long as it is the right decision) BUT consent can be overruled by a court but not by a parent/someone with parental responsibility
Which bodies/people can overrule a child’s (Gillick/Fraser or 16-17yrs olds) refusal to treatment?
Can REFUSE treatment BUT refusal can be overridden by both the court and by a person with parental responsibility
Who provides consent when a child is not Gillick/Fraser competent?
Consent may be given by anyone with parental responsibility
What happens if nobody with parental responsibility is willing to give consent for a child that is not Gillick/Fraser competent, can anyone overrule it?
Parents are able to CONSENT or REFUSE treatment
BUT
consent and refusal can be overridden by the court if its in the best interest of the child
Parents also cannot demand treatment that is not in the best interests of the child
What are outlined in the “protecting children and young people: the responsibilities of all doctors (2012)”?
- Identifying children and young people at risk of, or suffering, abuse, or neglect
- Meeting the communication needs of children, young people and parents
- Confidentiality and sharing information
- Child protection examinations
- Giving evidence in court
= guidance come into effect on 3rd September 2012
