The ABC of Children's Medical Ethics Flashcards
What is gillick competence?
A measure of whether a young person under 16 with capacity is able to measure relevant healthcare decisions
What are the Fraser guidelines?
- Patient, can understand advice
- Dr can’t persuade patient to inform parents or allow Dr to inform her parents
- Patient v. likely to have sexual intercourse with or without adequate contraception/advice
- Patient’s mental/physical health are likely to suffer
- Advice/treatment is in patient’s best interests
How is gillick competence assessed in practice?
- 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 the courts are to intervene
How is confidentiality of adolescents (16-17) treated?
- Treated as adults for purposes of consent to treatment, so are entitled to same duty of confidence as adults
How is confidentiality of adolescents (<16) treated competent and not competent?
Competent - Generally entitled to have their confidentiality protected and respected
Who can give consent for a young child?
An individual with ‘parental’ responsibility, such as a parent, legal guardian. But the scope of parental consent is limited by best interests of child.
Parents may not be able to consent to certain treatments or. refuse life saving treatment without court approval.
Temporary carer - A person who has care of the child, but not parental responsibility may do:
- “What is reasonable in all circumstances of the case for the purpose of safeguarding or promoting the child’s welfare”
Courts - Can authorise and/or refuse medical treatment for a child (and over-rule both the child, people with parental responsibility and temporary carers).
- Children Act 1989 (2004), section 8
- “Specific issue orders”
- “Prohibited steps orders”
- “Inherent jurisdiction of the court”
- “Warship” powers
- “Ward of court”
Describe parental responsibility
- In England, birth mother always has PR
- In England, biological father:
- Has PR if married to biological mother at time of conception, birth, or currently
- If not married then can get written PR via written agreement with mother, court order, or jointly registering the birth of of the child (with the mother) - i.e being named on the birth certificate as the father
- Other people may have PR:
- Step parents and civil partners can have PR (provided everyone else with PR agrees)
- Anyone with a residence order which is still in force (an order saying that the child should live with them)
- Local authority (if care order has bee made)
- Adoption agency (temporarily)
- Legal guardian (e.g. if both parents die)
- Parental responsibility once acquired continues even when the parents divorce
- The law presumes that a child born to a married woman is the child of her husband (unless father denies or someone else asserts paternity)
- Step parents do not automatically have parental responsibility but may acquire it
In what circumstances would consent not be required?
- Emergencies - can provide emergency treatment without consent to save the life of, or prevent serious deterioration in the health of a child or young person - GMC
- If you have time to get a court order (may be otrained within hours)(ex parte)
- Abandonment by parents
- Abuse by the parent
- Child protection procedures must be followed
What are some disagreements that could occur when treating a young child, and how can these be resolved?
- Doctors and parents disagree with child
- If doctors want to treat (or not treat) but child/parnets does not want treatment, and disagreement cannot be resolved, apply to courts for decision of ‘best interest’- Doctors disagree with parents and/or child
- Child and parents disagree
- Gillick competent children can consent without agreement from parents
- However, children cannot refuse consent, this parents can consent for a child and overrule a child’s regusal
- If serious disagreement, apply to court for judgement about ‘best interests’
- Parents disagree with each other
- Disagreement within the management team
- Communication
- Shared decision making is best model is best for ethical paediatric care (Pearce)
Describe the welfare section of The Children act 1989
- Ascertainable wishes and feeling of child
- Child’s physical and emotional needs
- Likely effect of any changes in family circumstances
- Capability of parents (or no other person) to meet the child’s needs
- Any harm suffered or likely to be suffered
- The age, gender or cultural background of the child
- Other factors in the child’s background
What is GMC guidance for treating young children?
- Doctors must safeguard and protect the health and well-being of children + young people. Well-being includes treating young people as individuals and respecting their views, as well as considering physical and emotional welfare - Page 4
- Doctors should always act in the best interests of children - Page 5
What should be assessed in the case of best interests?
- Views of minor
- Views of parents
- Views of others close to minor
- Cultural, religious or other beliefs/ values of minor & parents
- Views of other healthcare professionals involved in providing care
- Which choice will least restrict future options
When can confidentiality be breached?
- Overriding public interest
- Best interest of incompetent child
- Disclosure required by law
