I would like to see the age limits completely scrapped, and maturity brought in. As you grow up, your age has a stereotype. I'm trying to escape from that stereotype.” - Robin, aged 13 - quoted in “Children's Consent to Surgery”1if competent to understand the consequences should a child be able to consent and, more importantly, refuse to consent to medical treatment? Some recent rulings in the English law courts have apparently disenfranchised children, and the debate has resurfaced on their rights to self determination. The issue has a tremendous impact on paediatric practice, and all those who care for children should have a clear understanding of the legal and ethical consensus.

From the late 1960s to the early 1990s changes in the law on consent progressively increased the rights of those under 18 to self determination - always dependent on their capacity to understand the implications of their decisions. The case of Gillick v West Norfolk and Wisbech Area Health Authority established that children under 16 years could give legally effective consent to medical treatment, independent of their parents' wishes, provided they had sufficient understanding and intelligence.2

The position was reversed in 1992 in the case Re …