Module 2 - Consenting, Competence and Confidentiality in PAG Flashcards
What are the 4 ethical principles that apply to gaining consent for the consent to be valid?
- Beneficence
- Non-Maledicence
- Autonomy
- Justice
What is the difference between consent and assent?
Consent is gained from a legally empowered person.
Assent is agreement from a child/adolescent who does not have legal empowerment.
Which legislations are considered by courts when deciding a patient’s best interest?
Children’s Act 1989 and 2004.
Human Rights Act 1998.
In which 2 situations should information be withheld from children or adolescents?
- Information that could cause them serious harm.
- If the child or adolescent specifically asks for the information to be withheld.
What is Gilick Competance?
For <16 year olds.
To consent without parental consent or knowledge.
The child has to demonstrate sufficient understanding and knowledge of treatment, process, benefits and risks as well as the alternatives.
There should not be undue influence or fluctuations in capacity.
What are the set questions for Gilick competence?
There are no set questions.
For children and adolescents who lack capacity, who can give consent?
A parent, or person with parental responsibility.
Usually, one parent is enough, but any conflict needs MDT and possibly legal input.
Can children and adolescents consent and refuse treatment?
They can consent if Gilick competent but they cannot refuse treatment.
When must confidentiality be broken in the context of children and adolescents?
If it’s in the public interest.
If it’s in the best interest of the child (or if they lack maturity to decide).
If required by law (Eg FGM or SA).
If a competent adolescent Jehovah’s witness refuses blood, what should be done?
In emergencies, blood can be given as this is in the patient’s best interest.
If the adolescent refuses, blood can still be given in life threatening situations because the child doesn’t have enough life experience to make this decision.
In non emergencies, take into account adolescent’s and parents wishes. Possibly take legal advice or MDT advice if needed.
Who do Fraser Guidelines apply to?
<16 year olds.
What are the Fraser Guidelines?
To assess if GUM advice or treatment can be given to children under 16 years old.
What questions should be asked when using Fraser guidelines?
Can they be persuaded to tell their parents or allow HCP to tell the parents?
Can they understand the advice?
Physical or mental health will suffer without the advice or treatment.
In the patient’s best interest to receive the information or treatment without parents involvement.
The child will continue to have sex regardless.
Under what age can girls not consent (therefore sex under this age is considered rape regardless).
<13 years.
