Consent_in_Children_Flashcards
What is the general guideline for consent in patients less than 16 years old?
Patients less than 16 years old may consent to treatment if they are deemed to be competent (an example is the Fraser guidelines, previously termed Gillick competence), but cannot refuse treatment which may be deemed in their best interest.
What is the general guideline for consent in patients between 16-18 years old?
It is presumed patients are competent to give consent to treatment.
What is the general guideline for consent in patients 18 years or older?
Patients 18 years or older may consent to treatment or refuse treatment.
What are the Fraser Guidelines for providing contraceptives to patients under 16 years of age?
- The young person understands the professional’s advice. 2. The young person cannot be persuaded to inform their parents. 3. The young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment. 4. Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer. 5. The young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.
summarise consent in children
Consent in children
The law around consent in children is complicated. However, as a rough guide:
patients less than 16 years old may consent to treatment if they are deemed to be competent (an example is the Fraser guidelines, previously termed Gillick competence), but cannot refuse treatment which may be deemed in their best interest
between the ages of 16-18 years it is presumed patients are competent to give consent to treatment
patients 18 years or older may consent to treatment or refuse treatment
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
A 15-year-old known type 1 diabetic comes in with vomiting, abdominal pain, and drowsiness. On examination, you notice her breath smells of pear drops. She tells you that she can’t be admitted right now as she is missing a friend’s birthday party. After explaining the risks of leaving she seems to understand, can repeat what you have said, and explain her decision. Her parents say that she should stay for treatment. What should you do?
Call security to restrain the patient
Accept the patient’s decision to leave
Make the patient sign a self-discharge form
Admit the patient for treatment, seeking legal advice if she continues to refuse treatment
Tell the patient that she cannot leave as she doesn’t have capacity
Admit the patient for treatment, seeking legal advice if she continues to refuse treatment
This individual is under the age of 16 and is deemed to have capacity. Therefore, they have the right to agree to a treatment without a parent’s consent, but if they choose to refuse it, you must weigh up their best interests. As the patient has diabetic ketoacidosis, the decision to leave would most likely be fatal and so it would be fair to make the decision that it is in her best interests.
The General medical council’s ethical guidance states: ‘Parents cannot override the competent consent of a young person to treatment that you consider is in their best interests. But you can rely on parental consent when a child lacks the capacity to consent. In Scotland, parents cannot authorise treatment a competent young person has refused. In England,Wales and Northern Ireland, the law on parents overriding young peoples competent refusal is complex.’
‘You must carefully weigh up the harm to the rights of children and young people of overriding their refusal against the benefits of treatment so that decisions can be taken in their best interests’
GMC ethical guidance: 0-18 years guidance: If a young person refuses treatment. Paragraphs 30-33.
You are the FY1 on a paediatric ward, one of your patients is a 14-year-old female with anorexia. She is currently refusing to be tube fed. You assess her capacity and deem that she has the capacity to refuse. However, neither of her parents agree with her decision. What do you do?
As she has capacity she can refuse treatment
Section her under section 2 of the Mental Health Act
Discharge her for non-compliance
As the patient and her parents cannot agree, seek advice from the courts
Inform her that as she is under 16 she cannot refuse treatment
Inform her that as she is under 16 she cannot refuse treatment
The family law reform act of 1969 states that ‘those over 16 can consent to treatment, but cannot refuse treatment under 18 unless there is one consenting parent, even if the other disagrees’.
Seeking advice from the courts would be inappropriate at this stage.
