Consent_Children_Flashcards
At what age can a young person be treated as an adult and presumed to have capacity to decide according to the General Medical Council?
At 16 years or older, a young person can be treated as an adult and presumed to have capacity to decide.
Can children under 16 years old have the capacity to decide on medical treatment?
Yes, children under 16 years old may have the capacity to decide, depending on their ability to understand what is involved.
What can be done if a competent child refuses treatment?
If a competent child refuses treatment, a person with parental responsibility or the court may authorise investigation or treatment which is in the child’s best interests.
What are the requirements of the Fraser Guidelines for providing contraceptives to patients under 16 years of age?
The Fraser Guidelines state that the following requirements should be fulfilled: the young person understands the professional’s advice, cannot be persuaded to inform their parents, is likely to begin or continue having sexual intercourse with or without contraceptive treatment, their physical or mental health is likely to suffer without contraceptive treatment, and it is in their best interests to receive contraceptive advice or treatment with or without parental consent.
What is the difference between Fraser competency and Gillick competency?
Fraser competency refers specifically to contraception, while Gillick competency refers to general issues of consent in children.
What has been debunked regarding Victoria Gillick’s permission to use her name?
The widespread rumours that Victoria Gillick removed her permission to use her name or applied copyright have recently been debunked.
SUMMARISE CONSENT IN CHILDREN
Consent: children
The General Medical Council have produced guidelines on obtaining consent in children:
at 16 years or older a young person can be treated as an adult and can be presumed to have capacity to decide
under the age of 16 years children may have capacity to decide, depending on their ability to understand what is involved
where a competent child refuses treatment, a person with parental responsibility or the court may authorise investigation or treatment which is in the child’s best interests*
With regards to the provision of contraceptives to patients under 16 years of age the Fraser Guidelines state that all the following requirements should be fulfilled:
the young person understands the professional’s advice
the young person cannot be persuaded to inform their parents
the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent
Gillick or Fraser?
Some doctors use the term Fraser competency when referring to contraception and Gillick competency when referring to general issues of consent in children. The (widespread) rumours that Victoria Gillick removed her permission to use her name or applied copyright have recently been debunked.
More information can be found in the following article:
Wheeler R. Gillick or Fraser? A plea for consistency over competence in children BMJ 2006;332:807
*in Scotland those with parental responsibility cannot authorise procedures a competent child has refused
A 12-year-old high school pupil presents to you in GP with low mood. When you discuss the
background of her mood it emerges that she has been bullied for having had sex with a 17-year-old boy in the same school. This only happened once and no alcohol or drugs were involved. She said that she wasn’t forced to have sex with him and that ‘it was consensual’.
What is the most appropriate immediate course of action?
You should disclose that this girl has been sexually active to the relevant authority
You must keep this consultation confidential because she consented to the sexual activity
You must contact the patient’s mother as she is the legal guardian
You must ask the girl to discuss it with the police because of her age
You must advise the girl to have the bullying dealt with at school
You should disclose that this girl has been sexually active to the relevant authority
The issue of consent and confidentiality for young people around sexual issues can often be difficult, however, there is no doubt in this case.
Option 1 is the correct answer. Legally, children under the age of 13 are unable to consent to sex. As such, you should normally disclose this. Any decision to not disclose should be discussed with a named or designated doctor for child protection and should be properly documented. It is very rare that this should happen.
Option 2 is not correct because as the patient is under 13 she CANNOT consent to sexual activity.
Option 3 is not correct. Although someone will likely have to discuss what has happened with the girl’s mother it is not your first and most pressing duty.
Option 4 is not correct. You have a duty to notify the relevant authority about what has happened yourself and you cannot leave it in the hands of the patient.
Option 5 is not correct. Apart from not necessarily achieving much, this option neglects your duty to report.
See 67. 0-18 years guidance: Sexual activity
http://www.gmc-uk.org/guidance/ethicalguidance/childrenguidance6469sexualactivity.asp
