Consent to treatment

Question 1

What are the 4 key factors to consider when gaining consent?

Answer 1

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

Question 2

What are the two groups of people by law that may fail to provide consent?

Answer 2

These groups may fail the competency/capacity requirement of consent
= adults who lack capacity and children

Question 3

What is classified as a minor?

Answer 3

under 18 years

Question 4

What are the 2 laws for those under 18 years of age?

Answer 4

1) law of consent for those aged 16 and 17 years of age

2) law of consent for those under 16 years of age

Question 5

Who are the parents?/ Who has parental responsibility?

Answer 5

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

Question 6

Does parent responsibility remain if the parents divorce?

Answer 6

remains even if the parents divorce

Question 7

What does the law assume in terms of a child born to a married women?

Answer 7

assumes the child is a child of her husband

Question 8

How do people other than parents acquire responsibility?

Answer 8

• 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

Question 9

How does a step parents acquire parental responsibility?

Answer 9

They do not automatically acquire PR, they have to either do it by residence order, appointed guardian or adopt the child

Question 10

Does an unmarried father have parental responsibility?

Answer 10

An unmarried father may not have parental responsibility but they do have to pay child support

Question 11

What is the Family Law Reform act of 1969?

Answer 11

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

Question 12

How can the family law reform act of 1969 be overridden?

Answer 12

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

Question 13

Are 16/17 year olds able to refuse treatment?

Answer 13

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)

Question 14

How did the Gillick law come about?

Answer 14

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

Question 15

What did the house of Lords say about the case of Gillick?

Answer 15

Stated that girls under 16 could consent to contraception without parental consent providing that they were sufficiently mature to understand its nature and implications

Question 16

What does Gillick competence mean?

Answer 16

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”

Question 17

What are the Lord Fraser’s guidelines?

Answer 17

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

Question 18

What are the DOH guidance 2004?

Answer 18

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

Question 19

When is the Gillick/Fraser competence applied?

Answer 19

the competency test has been applied to all other types of medical care involving children under 16

Question 20

How do you assess Gillick/Fraser competence?

Answer 20

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

Question 21

Which bodies/people can overrule a child’s (Gillick/Fraser or 16-17yrs olds) consent to treatment?

Answer 21

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

Question 22

Which bodies/people can overrule a child’s (Gillick/Fraser or 16-17yrs olds) refusal to treatment?

Answer 22

Can REFUSE treatment BUT refusal can be overridden by both the court and by a person with parental responsibility

Question 23

Who provides consent when a child is not Gillick/Fraser competent?

Answer 23

Consent may be given by anyone with parental responsibility

Question 24

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?

Answer 24

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

Question 25

What are outlined in the “protecting children and young people: the responsibilities of all doctors (2012)”?

Answer 25

• 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