Consent might come up in your Med School interview, because it’s an important issue in the world of Medicine. Make sure you cover this hot topic when you’re doing interview prep and understand its place in medical ethics.


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Consent In Mental Health Patients

For someone to consent for mental health treatment, they must:

  • Have capacity to make this decision.
  • Be over 16 years old, as a general rule.
  • Have enough information to make the decision.
  • Be giving consent voluntarily, without pressure from others.

If there is a lack of capacity to consent for treatment, the medical professional must make a decision in the person’s best interests and take a variety of factors into account. This could involve talking to the person’s family or close friends.

In addition to instances of lacking capacity, mental health patients may also receive treatment without consent if it’s an emergency life-saving treatment, or if they are detained/sectioned under certain sections of the Mental Health Act.

Children And Consent

The Children Act 2004 (a reinforcement of TCA, 1989) states that adulthood is reached after the 18th birthday. This means that 18-year olds are to be treated like all other adults who are able to consent for themselves, unless there are exceptional circumstances.

16- and 17-year-olds are presumed to be able to make decisions about their health independently from their parents and are usually able to consent for themselves.

It is typically under 16s who must be assessed for competency to consent before being able to agree to an intervention. This is known as Gillick competence.

If a child is unable to demonstrate this competence, then the following people can consent on their behalf:

  • The child’s mother or father
  • A legally appointed guardian
  • Local authority designated to care for the child
  • A person with a residence order concerning the child
  • A local authority/person with an emergency protection order for the child

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The Four Pillars of Ethics And Consent

Consent is a difficult concept, particularly when it comes to children and young people. You should apply the four pillars of ethics to any dilemmas about consent.

When it comes to autonomy, you should think about:

  • If a child can make a decision about their health, their decision should be respected.
  • Only those able to make informed decisions that promote health and avoid harm should have the privilege of autonomy.

This means that a child should not be able to consent to a test or treatment if they cannot understand the intervention and its accompanying risks and benefits.

For beneficence, think about:

  • If a child is able to understand the treatment and decide that it is in their best interests, they should be deemed competent to consent.
  • Children under 16 may lack the cognition to understand the implications of certain tests or treatments, so their decision may not be rational and in their true best interests.

This is particularly important when children refuse treatment. If refusing treatment may result in serious mental or physical harm, the decision may be overruled by a parent or a court of law, to ensure the best interests of the child are prioritised over autonomy.

When it comes to non-maleficence, consider:

  • If preventing a child from receiving a treatment that they are willing to consent for causes them harm, accepting their consent and giving them treatment will avoid this harm.
  • If a child is engaging in potentially dangerous or illegal behaviour, it could be argued that their parents should be informed.

It is important to consider whether the child is put at risk from treatment or a lack of treatment.

For justice, be sure to think about:

  • The Gillick test was created to ascertain if a child under 16 was capable of making their own decisions.
  • With legal guidelines promoting the autonomy of children if they are deemed competent, there are no specific legal arguments against the autonomy of children – it is down to clinical judgements and avoidance of harm.

The Gillick test states that if a child can understand and comprehend a treatment, its implications (including the risks and benefits) and alternative options, they have the ability to consent.

To get a better understanding of applying the key pillars of ethics to consent and young children, it is worth looking into the Keira Bell case.

Medical Consent Scenario

A 15-year-old girl comes in alone and tells her GP that she is sexually active. She also states that she would like to start taking contraception.

When it comes to capacity and consent, you should consider:

  • If you refuse to supply contraception without parental consent, the child may suffer emotional harm from revealing her sexual activity to her parents.
  • On the other hand, she may decide not to tell her parents and continue the sexual activity without contraception. This would put her at risk of unwanted pregnancy and sexually transmitted infections.

However, if the girl was engaging in sexual activity with an inappropriate adult, the situation would change. By providing treatment, you may be allowing the behaviour to continue and remain a secret from the parents, both of which would put the child at risk of harm. In this instance, Gillick competence is very important and will help the GP to understand whether sexual abuse is taking place, whether the child’s safety is at risk and whether the child is able to consent to sexual activity.

For the specific case of contraception in under 16s, it may be valuable to familiarise yourself with the Fraser guidelines.

Medical Consent Questions

It is possible that you will encounter questions about medical consent in your interview. Some topics that could arise are:

  • Are there any scenarios in which consent is not required? If so, can you give an example?
  • A patient admits they are using illegal substances. Can you disclose this to the local authorities without patient consent?

To find out the answer to these questions, check out our ethics questions guide.


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