CSP & Global health Flashcards
The law around abortions
1967 abortion act (amended in 1990)
2 registered medical professionals must sign a legal document (HSA1 form)
TOP legal before 24 weeks gestation
- if it reduces the risk to a woman life
- if it reduces risk to her physical/mental health
- if it reduces the risk of physical/mental health of her existing children
- if baby has substantial risk of being seriously mentally/physically handicapped
No limit to gestational age if
- risk to mother’s life
- risk of grave/permanent injury to mothers physical/mental health
- substantial risk that child born would have such physical mental abnormalities as to be seriously handicapped
Parental Responsibility
If <13 = presumption of no capacity cannot be rebuked. In such circumstances those who have parental responsibility have the duty to make choices on their behalf in their best interest
More than one person may have parental responsibility for a child (typically both parents)
Consent to medical examination and treatment can be carried out by just one person with parental responsibility, with no duty to consult anyone else.
Once acquired it remains even if parent were to diverse
Who can have parental responsibility
Mother always have parental responsibility
Father can have responsibility only under certain circumstances. Only if:
- If father is married to mother in terms of insemination, conception or birth.
- If father is named on the birth certificate
- Doesn’t need to be the biological father necessarily
- If the mother writes a letter to the father giving parental responsibility
- If the court gives father parental responsibility.
Adopting parents or Legal guardian
Person obtaining residence order (e.g., grandparent)
Local authority named in a care order or in the form of social services
NB Just being the biological father does not give you the responsibility to make decisions on the behalf of the child.
Can a Jehovah’s Witness Minor Refuse Life-Saving Blood Transfusion?
Officially, even if they are Fraser/Gillick competent they cannot refuse!
Children cannot refuse life-saving treatment based on religious grounds even if they have capacity.
NB They can however refuse if it is on rational grounds.
Minors and Clinical Trials
> 16 / capacity = It is good practice to also seek consent from the guardians, particularly when enrolling children in clinical trials. You don’t need their consent legally speaking but it is a good idea to follow the guardian’s wishes (i.e., if they don’t agree, withdraw request to enroll patient if the patient agrees but the parents don’t). It will allow you to distance yourself from conflict (what the good practice clause recommends).
NB: you do not want to avoid conflict at all costs. E.g., if it is life-saving treatment you give it to the child if the child has capacity and wants it / it’s in their best interest.
The children act 1989
The child’s welfare is paramount.
The child is a person, not an object of concern. Children of sufficient maturity should be listened to, although not
necessarily be given full power of autonomy.
Children should be brought up by parents or wider family without the interference of the State, unless placed at risk.
Family links should be maintained if a child is placed out of the home.
The Act addresses issues of potential conflict such as care arrangements if parents split up; decisions about schooling and medical treatment; arrangements to protect the child from harm.
Court orders relating to children
A specific issue order:
gives directions from the court, such as whether treatment should be given. This order is rarely used if the child is over 16 years.
An emergency protection order:
enables a child at urgent risk to be taken to a safe place.
A care order:
enables a local authority to take over the care of a child, giving that authority parental responsibility.
A child assessment order:
is used when there is suspicion of harm but lack of evidence.
Minors & consent
minors over 16 years can give consent or refuse treatment as if they were adults. It is, however, unclear, whether or not refusal may be overridden by parents or the court to prevent harm.
Gillick competency
A Gillick competent child (less than 16 years but over 13) may give consent, although refusal may be overridden by parents or the court to prevent harm.
NB If the child is not Gillick competent then at least one person with parental responsibility (PR) should give consent; persons with PR are legally obliged to act in the child’s best interests; if all persons with PR refuse consent for a procedure that the doctor thinks is in the child’s best interests, then the doctor should involve the court. In an emergency, the doctor should act so even without consent and without involving the court.
Abortion & contraception in <18s
Girls >16 years or who are Gillick competent may give consent to abortion under the law or be given contraceptive advice or treatment without informing the parents, if they cannot be persuaded to tell their parents and if it is deemed to be in their best interests.
Confidentiality in <18s
Children who are >16 years or are Gillick competent have the same rights of confidentiality as adults, unless disclosure is deemed to be necessary according to the known provisions of disclosure.
Rules around Child Abuse
When abuse is suspected the prime responsibility is to the child.
The doctor should write down as much detail as possible; advise the person reporting the case to report directly to the social services at a local authority, or do that himself or herself. Normally, the relevant adult should be informed, but not in the case of suspected sexual abuse.
The doctor has a right to examine the child even against the parent’s consent. The doctor must be able to justify doing so.
Grounds for intervention under mental health act
Compulsory treatment and detention are legally justified when: danger to self or danger to others.
The mentally handicapped under the mental health act
Are not considered psychiatric adult patients.
Cannot be detained involuntarily.
Can be treated without informed consent if cannot give consent.
Argument: ‘best interests’. The doctor decides.
Deprivation of liberties (DoLS)
applied when MCA is used in such a way to deprive a person of their liberties i.e. their not free to leave / subject to continuous supervision & control
authorisation lasts up to 1 year & cannot be extended
