Intended for healthcare professionals

Clinical Review ABC of adolescence

Consent, competence, and confidentiality

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7487.353 (Published 10 February 2005) Cite this as: BMJ 2005;330:353

Law of consent and refusal of medical treatment

Vic Larcher provides a useful overview of concepts related to issues of consent, competence and confidentiality in adolescents. I briefly want to comment on these complex issues, while concentrating on exploring the refusal of medical treatment by competent children.

The obtaining of consent is important for the patient and doctor involved. Participating in giving valid consent gives the patient the right to self- determination and the doctor the legal authority to proceed with treatment. The law of consent for children is very intricate. The difficulties arise from assessing the competence of the child in these age groups. The 'Gillick ruling' implied a law for all to follow. If a child was judged to have reached a certain level of understanding and could comprehend the nature of the proposed treatment, then that child was to be treated as an autonomous adult without interference from parents.

Following case law contradicted this concept giving more authority to parental rights and the courts, by allowing them to consent to medical treatment on behalf of a competent child that refused medical treatment.

The courts are finding it difficult to extricate the notion of a child leading to harm by refusing medical treatment, even though they might be competent to make that decision. The courts have had to balance concepts of autonomy, welfare and best interests of the child. The law has not provided clear cut authority that would guide us on the rights of a child's refusal. At the moment the courts are relying on the case specific facts to determine the outcome of cases and are abiding with 'doing what is in the child's best interests'.

Competing interests: None declared

Competing interests: No competing interests

20 December 2010
Mohammed Dani
Locum SHO
Littlemore Mental Health Centre. Oxford. OX4 4XN