Consent and the Child

• What is The Children Act 1989?

  • Promotes welfare of child
  • Introduced concept of Parental Responsibility
  • Outlined duties of Local Authorities in protecting welfare of children
• What is The Children Act 2004?

  • All NHS bodies have duty to safeguard
  • Encourages multi-agency co-operation
  • Established databases to facilitate information sharing
  • Introduced: Children's Commissioner and Local Safeguarding Children Boards
• What is The Children, Schools and Families Act 2010?

  • Established clear procedures/protocols for communication between agencies
  • Placed role of Local Safeguarding Children Boards under greater scrutiny
• What is the mental capacity act 2005?

  • Supports decision making
  • Applies to age 16+ years
  • Introduces concept and test of capacity
  • Establishes Lasting Power of Attorney
• What are the human rights acts?

  • European Convention on Human Rights 1953: Established basic human rights.
  • Human Rights Act 1998: Incorporates European Convention on Human Rights into UK law
• What is the UN convention on the Rights of the Child 1990?

  • Act in best interests of child
  • Child has basic rights (including right to life)
  • Parental responsibility
  • Express opinion
  • Adequate standard of living, education, leisure, play and culture
  • Protection from abuse/exploitation
  • Protection of privacy
  • Not subject to excessive interference
  • Capital punishment forbidden
• What is in place to protect privacy?

  Data Protection Act 1998 - Relates to sharing of personal and sensitive data

  NHS Code of Practice Regarding Confidentiality 2003 - Relates to disclosure of confidential information
• When are privacy exemptions?

  • First ask consent for information to be shared
  • Risk of serious harm
  • Public interest
  • Required by law
• What is the Freedom of Information Act 2000?

  Relates to right of access to information, including medical records
• What is consent?

  • a process, not a single event
  • informed
  • involve voluntary decision making
  • Individual must be able to make an informed decision(GDC Standards Principle 3: Obtain valid consent)
• What are the types of consent?

  Non-verbal: Routine examination Verbal: Simple treatment such as restorations Written: Extensive treatment Always for General anesthesia Always for sedation Extractions in some work places
• Who can give consent?

  In England a child is any person under the age of 18
• Can 16/17 year old's give their own consent?

  1) If the have the mental capacity 2) If they are able to make an informed decision
• How can you test if a patient can make an informed decision?

  Test of capacity. Must be able to:

  1. understand relevant information

  2. retain information

  3. weigh up risks/benefits - part of decision making process

  4. communicate decision
• What to do if a 16-17 year old DOES have the mental capacity?

  • Deal with young person directly
  • Although if risk of significant harm, encourage to involve family. Refusal can be overridden by:• parents • court 'in their best interests
• What to do if a 16-17 year old DOESN'T have the mental capacity?

  Treatment must be in best interests of individual

  Consider:• re-gain capacity, Views/opinions of relevant individuals (Local Authority, parents, health professionals). Patient’s past decisions or patterns of behaviour
• What if there is conflict in consent?

  The final decision lies with clinician• If there is a variety of equal options may choose least restrictive
• Who gives consent for children under 16years old?

  Who gives consent depends on child's ability to understand the nature and implications of the proposed treatment(no fixed age at which a child has capacity to consent)
• what are the guidelines for children giving consent?

  The child needs to:

  1) understand that there is a choice

  2) Willing and able to make a choice

  3) understand the nature/purpose of the proposed treatment

  4) understand the associated risks and side effects

  5) understand the alternatives to the procedure, the risks attached to them and consequences of no treatment

  6) Free from pressure
• What is Gillick competency?

  Child (under 16) can consent to medical treatment if deemed competent by medical professional, without need for parental permission or knowledge
• Can a parent challenge a child's decision?

  Yes. Parent or court can override a decision to decline treatment if its in the child's best interest
• What if a child is not Gillick Competent?

  Consent is obtained from someone with Parental Responsibility
• Who has parental responsibility?

  • Mum
  • Adoptive parents
  • Marries fathers if they were married at time of birth If the mother marries biological father after birth
• Do unmarried fathers have parental responsibility?

  Agreement with mother • Court Order • If the biological father marries the biological mother of his child after the birth
• Do same-sex partners have parental responsibility?

  Yes, if they were civil partners at the time of the treatment, e.g. donor insemination or fertility treatment. For same-sex partners who aren't civil partners, the 2nd parent can get parental responsibility by:• Parental Responsibility Agreement• jointly registering the birth
• Who else can have parental responsibility?

  Local Authority: • If child in foster care • If there is a Care Order• If under Emergency Protection Order Court: • If child is a Ward of Court Legal guardian:• If parents have died • Adult with Child Arrangements Order • PR shared Special Guardianship Order • May exercise PR to the exclusion of all others with PR
• Who DOES NOT have parental responsibility?

  Foster parents: May have Delegated Authority

  Step parents: Can apply for Court Order or Parental Responsibility Agreement Grandparents: Can apply for Child Arrangements Order or Special Guardianship Order
• How to prove parental responsability?

  • Adult claiming PR must bring relevant documentation prior to signing consent • Photocopy or scan into patient notes
• What if there is a disagreement?

  Treatment can proceed with consent of one person with parental responsibility, even if opposition from other parent
• What if a child is not Gillick Competent and the mother is 15?

  Assess competence of mother, may need to involve grandparents, etc.
• What if a c hild not Gillick competent and the parent is incompetent?

  Involve child's family, carers, social workers, act in best interests
• What if there is an emergency?

  Child can be treated without consent if immediately necessary and in child's best interests
• Why is it important to know who is with the child for their appointment?

  • Implications for obtaining consent • Accurate medical history • Accurate pain history