Consent to Treatment

Where you are concerned or unsure about the law, you can discuss with a senior or your medical defence organisation. This section is to give an overview for exams and not legal advice.

A person is recognised as an adult with full autonomy to make decisions about their health when they turn 18. 16 and 17 year olds can also make independent decisions about their health, but if they refuse treatment this can be overruled in certain situations by parents, people with parental responsibility or the court. Children under 16 can make decisions about treatment, but only if they are deemed to have Gillick competence. There is no lower limit to the age where children can make decisions about their health, however it is unusual for consent to be taken from someone under 13.

The way this is usually tested in exams relates to girls under 16 years seeking contraception from their GP. This is the scenario that established “Gillick competence” and “Frazer guidelines” in the first place.

 

Gillick Competence

Gillick competence refers to a judgement about the whether the understanding and intelligence of the child is sufficient to consent to treatment. Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. Consent needs to be given voluntarily. When prescribing contraception to children under 16 it is important to assess for coercion or pressure, for example coercion by an older partner. This might raise safeguarding concerns.

 

Frazer Guidelines

Frazer guidelines are specific guidelines for providing contraception to patients under 16 years without having parental input and consent. The guidelines were set down by the House of Lords in 1985. To follow the guidelines, they need to meet the following criteria:

  1. They are mature and intelligent enough to understand the treatment
  2. They can’t be persuaded to discuss it with their parents or let the health professional discuss it
  3. They are likely to have intercourse regardless of treatment
  4. Their physical or mental health is likely to suffer without treatment
  5. Treatment is in their best interest

Children should be encouraged to inform their parents, but if they decline and meet the criteria for Gillick competence and the Frazer guidelines confidentiality can be kept.

 

Safeguarding

It is important to explore whether there is any possibility of abuse or exploitation and if this is present confidentiality may need to be broken. Where the child is not deemed to be Gillick competent and the child is at risk of harm, this should be escalated as a safeguarding concern.

Children under 13 cannot give consent for sexual activity. All intercourse in children under 13 years should be escalated as a safeguarding concern to a senior or designated child protection doctor.

 

Last updated January 2020
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