Intended for healthcare professionals

Clinical Review ABC of adolescence

Consent, competence, and confidentiality

BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:353
  1. Vic Larcher


Adolescence represents the final phase in the transition from the dependence of infancy to the autonomy of adulthood. It can be difficult for young people, parents, and health professionals alike, because of the nature and speed of change. Uncertainty over ethical and legal rights and responsibilities may lead professionals to refuse to see adolescents aged under 16 years on their own for fear of incurring parental wrath or even legal action. Disputes may arise in relation to an adolescent's competence to seek, consent to, or refuse medical treatment, and his or her right to confidentiality. In most cases these disputes can be resolved by discussion, compromise, and partnership, but in extreme circumstances the courts may be involved.

Balancing rights and responsibilities in adolescent care

Ethical and legal principles

All professionals have a duty to act in the best interests of their patients. Adults have the right to decide what their best interests are and to have their choices respected. Legally, adolescents' rights to make decisions for themselves depend on their ability to do so (called competence). Ethically, however, professionals have a duty to respect the rights of adolescents, irrespective of their ability to make decisions for themselves, provided that to respect these rights does not result in harm to the adolescent or to others (as laid down in the UN Convention on the Rights of the Child).

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The legal principle underpinning provision of health care for children (under 18s) in the United Kingdom is that their best interests (welfare) are paramount. Legal duties are defined both by statute—for example, the Children Act 1989 and the UK Human Rights Act 1998—and by common law, which derives general principles from specific cases. UK law respects the rights of families to privacy, autonomy, and minimal outside intervention but acknowledges that parental rights decline during adolescence. In deciding …

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