Intended for healthcare professionals

Personal Views

Children have rights too

BMJ 1997; 314 doi: (Published 10 May 1997) Cite this as: BMJ 1997;314:1421
  1. Rachel Bulford
  1. works for Article 12, an organisation run by children and young people–8 Wakley Street, London EC1V 7QE (tel 0171 843 6026) 0171 843 6026)

    I recently had the misfortune to be a hospital outpatient after breaking my leg. My experience made me think about the powers that I have over my own treatment.

    There are three main issues in the debate surrounding the young person's right to a say in health care. The first of these is the actual right to a say. This was covered in the Gillick ruling. When they are considered mature enough by their doctor young people can decide on treatment with or without the consent of their parents. The problem is that the maturity of the child has to be decided by the doctors. Some young people would be deemed mature enough to take a decision about their own bodies, whereas others, seen by different doctors, would not.

    The process of taking your own decision and being treated like a decent human being relies not only on the permission of the doctors but also on the giving of information necessary to make an informed choice. This is the second main issue. There is a traditional view that if you tell a patient about a potentially fatal or serious condition it will do more harm than good. In the case of young people it is important that they do not have to undergo the uncertainty and anxiety of knowing that there is something wrong with their body but not knowing what it is and which treatment may or may not make them better.

    Often parents do not want their children told if they have the HIV virus. Yet how can the child or young person deal with their condition if they do not know about it? How can they come to terms with something inside themselves? When somebody else decides that they may be mature enough to deal with the knowledge they may be suddenly told or, even worse, they may find out by chance.

    A third issue is that of children taking part in medical research which may not benefit the individual, but may benefit sufferers in general. It is unclear how easy it is for a child to request exclusion from research. Again, it is left to medical professionals to make a judgment on the child's maturity to take a decision about themselves. But even very young children should be able to decide if they are to be included in research.

    At what age can children be considered old enough to know what may be worrying information and take a decision which could affect the rest of their lives? Many young people believe that they should be the ones to decide if they are mature enough, not simply a professional who does not know them well. Maturity is a gradual thing which varies from child to child and young person to young person. A 13 or 14 year old who is in full possession of his or her faculties should not be prevented from knowing about his or her condition. Seven year olds have different needs and levels of understanding. This does not mean, however, that a 7 year old should be rejected as being too young to make a decision.

    Not only does the issue of maturity need to be considered, but also the problem of the conflict between parents and children. There are inevitably cases when young people come into dispute with their parents. According to the Gillick ruling, if the young person is “mature” enough their parents' views are overridden. This does not mean that young people who are not considered mature enough should be ignored, as all young people have feelings and views on issues, especially those which effect them and their bodies.

    The taking of decisions is also difficult. Should a 15 year old decide to refuse life saving treatment so that his or her quality of life can be improved for several weeks? If that is what they wish then they should be able to do so. It will be his or her body that does not function properly, not the doctors' or the parents' bodies.

    The main document written on the rights of the child is the United Nations Convention on the Rights of the Child. It deals with all aspects of rights and what we, as children and young people, should be entitled to. As Britain has ratified this convention, the relevant articles should apply to the NHS and to young people's health care. Article 12 states that all children and young people have the right to a say in anything which affects them and for their views to be taken seriously. The convention also says that children and young people should have the right to collect and be given all the information needed to understand any issues.

    So there is provision in the convention for our inclusion in decision making about ourselves in hospitals. There needs to be legislation to require this to happen every time. Young people who spend time in hospital should have the same right to take decisions about their future as anyone else has.

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