Education And Debate

Withholding consent to lifesaving treatment: three cases

BMJ 1995; 310 doi: (Published 11 February 1995) Cite this as: BMJ 1995;310:373
  1. Anne Elton, principal social workera,
  2. Peter Honig, social workera,
  3. Arnon Bentovim, consultant child psychiatrista,
  4. Jean Simons, team managerb
  1. a Department of Psychological Medicine, Hospital for Sick Children, Great Ormond Street, London WC1N 3JH
  2. b Social Work Department, Hospital for Sick Children
  1. Correspondence to: Ms Elton.
  • Accepted 9 August 1994

The refusal of children or their parents to consent to treatment that professionals regard as essential always results in a dilemma. Responding to such refusals demands careful and sensitive clinical and ethicolegal intervention and close cooperation among professionals, in particular doctors and social workers. Since the introduction of the Children Act 1989 the number of cases in which children have withheld consent to lifesaving treatment has risen, and it is now increasingly recognised that children have a right to have their views legally represented if a local authority or health authority seeks a court's leave to carry out treatment. Professionals have to consider which legal route, under either the Children Act or the Mental Health Act, is likely to be best for the individual child.

Since the introduction in October 1991 of the Children Act 19891 several cases have been brought on the issue of a child or young person refusing to consent to medical treatment or assessment.2 3 4 This is perhaps not surprising as the Children Act highlights the need for a young person or child to give such consent if he or she is deemed to be “Gillick competent”—that is, of sufficient understanding to make an informed decision.”5

The ethical and legal issue of whether children can withhold consent to treatment has been discussed previously,6 7 and court decisions have been reported in legal columns. We report the cases of three patients at this hospital during 1993 in which consent was withheld and subsequent application to the courts was made. We discuss various legal issues and consider the complex professional teamwork necessary to try to ensure the best interests of the child patient and the merits and disadvantages of the different means of gaining consent.

The cases


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