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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'.
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