Ethics and Adolescents

Question 1

What is the GMC guidance on treating adolescents and children?

Answer 1

Doctors must safeguard and protect the health and well-being of children & young people.

Well-being includes treating young people as individuals & respecting their views, as well as considering physical and emotional welfare

Question 2

What are the legal considerations for minors aged 16-18?

Answer 2

Family Law Reform Act (1969)
Mental Capacity Act (2005)

consent to be treated as if given by adult

note: that minors 16-18yo CANNOT refuse Rx

Question 3

What is the Gillick case?

Answer 3

mother challenged that should be contraception prescribed to adolescent at doctor’s discretion (w/o parental consent)

Question 4

What is ‘Gillick competence’?

Answer 4

• consent dependent on MATURITY and UNDERSTANDING
• nature of consent
• individual should have sufficient maturity to understand what is involved

consider the FUNCTIONAL CAPACITY of individual

Question 5

What did Lord Scarman (in Gillick) comment re: parental vs. paediatric rights?

Answer 5

parental right yields to the child’s right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision

Question 6

What are the Fraser guidelines?

Answer 6

criteria to be met if Dr proceeds to give advice and Rx:

• patient understands advice
• Dr can’t persuade patient to inform patients or allow Dr to do so
• Patient v. likely to have sexual intercourse with or w/o contraception/advice
• Patient’s mental/physical health likely to suffer
• advice/Rx is in best interest

Question 7

What do the Fraser guidelines generally refer to?

Answer 7

for use in context of sexual health and contraception

Question 8

How does the law distinguish consent for minors?

Answer 8

sex: legal consenting age is 16

distinguish between <13 (‘statutory rape’) and minors between 13-16

Gillick: allows minors with sufficient understanding to consent to confidential advice/Rx

be aware of child protection but don’t make assumptions

Question 9

What considerations should be used to assess Gillick competence in practice?

Answer 9

Approach on a case-by-case basis
Competence is a dynamic concept
A minor may consent to one type of treatment but not another
Unwise decisions do NOT necessarily mean a minor is incompetent
The more urgent/serious the treatment, the more willing are the courts to intervene

Question 10

What are the guidelines surrounding ‘refusal of care’ in minors?

Answer 10

distinction between consent to and refusal of Rx

parents/courts/Dr can override refusal of Rx even if child IS Gillick competent

controversial, should always be referred to senior clinician

Question 11

Who determines treatment if child is NOT Gillick competent?

Answer 11

Parents or proxy acting in best interests

Question 12

How is consent considered for a minor >16yo?

Answer 12

= presumed capacity

can give consent

Question 13

What was the Axon case?

Answer 13

Mrs Axon did not want to prevent daughters having a termination but wanted to be informed on it

matter of confidentiality

Question 14

What did Gilber J say in response to the Axon claim?

Answer 14

once a child is Gillick competent, the parent loses any right under the Human Rights Act 1998 to respect for family life and to make decisions for the child.

Question 15

How is ‘privacy’ considered for minors aged 16-17?

Answer 15

to be treated as adults for the purposes of consent to treatment and are therefore entitled to the same duty of confidence as adults

relatively well established as legal, ethical and professional notion

Question 16

How is ‘privacy’ considered for minors aged <16?

Answer 16

Children who are Gillick competent

= have the maturity and understanding/intelligence to consent

also (generally) entitled to have their confidentiality protected and respected.

Question 17

How is ‘privacy’ considered for NON-COMPETENT minors aged <16?

Answer 17

Lots of uncertainty!

Should a minor whom a doctor judges not to be Gillick competent expect confidentiality?

Do doctors have a duty to contact parents of an incompetent minor?

Does Gillick encourage minors to approach doctors understanding discussions to be confidential?

Can we say that just because a child is not competent to consent to treatment they cannot be competent to decide not to share information

Question 18

What are the key points to consider when treating adolescents?

Answer 18

Use Gillick criteria to evaluate COMPETENCE

Distinction: ‘consent to’ vs ‘refusal of’

place of confidentiality and duty of care for a minor (for those NOT Gillick competent)