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4 Pillars of Medical Ethics: Consent and Young People

Medical Ethics: Consent and Young People

Consent from a patient is vital before any examination or test is performed on a patient or any treatment is given, and as such the issue of consent is a crucial one to consider when observing medical ethics. 

For young children, parents can give consent on behalf of the child.

In adults, the patient is able to consent unless they are thought to lack capacity, which meaning considered to have an impaired ability to make decisions about their own care.

However, when it comes to young adults the issue of consent is a little more complicated. Understanding how this process is vital to ensuring young adults are treated appropriately and safely.

What Does the Law Say? 

The Children’s Act (1989, 2004) states that adulthood is reached after the 18th birthday, which means that 18 year olds are to be treated like all other adults able to consent for themselves.

16-17 year olds are presumed able to make decisions about their health independent of their parents, so are usually able to consent for themselves.

Crucially, it’s under 16s that must be assessed for competency to consent before being able to consent to an intervention.

In order to think through this ethical scenario we should consider the four principles of medical ethics. In a nutshell they are:

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Autonomy

For Being Able to Consent Aged Under 16:

If a child can make a decision about their health, their decision should be respected.

Against Being Able to Consent Aged Under 16:

Only those able to make informed decisions that promote health and avoid harm should have the privilege of autonomy.

In children, 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.

Read our guide to medical ethics>>

Beneficence

For Being Able to Consent Aged Under 16:

If a child is able to understand a treatment and decide that it is in their best interests, they should be deemed competent to consent.

Against Being Able to Consent Aged Under 16:

Children under 16 may lack the cognition to understand the implications of certain tests or treatments and their decision may not be rational and in their true best interests.

This is particularly important when children refuse a treatment.

If refusing a 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. 

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Non-Maleficence

For Being Able to Consent Aged Under 16:

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.

Take the example of a 15-year-old girl asking her GP for contraception.

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 sexual activity without contraception.

This would put her at risk of unwanted pregnancy and sexually transmitted infections.

Therefore, by accepting the girl’s consent for contraception, you will be avoiding harm.

Against Being Able to Consent Aged Under 16:

Using the above example, if a child is engaging in a potentially dangerous or illegal behaviour, it could be argued that their parents should be informed.

For example, consider if the girl was engaging in sexual activity with 40-year-man.

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.

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Justice

For Being Able to Consent Aged Under 16:

In 1985, after the Gillick vs West Norfolk and Wisbech Area Health Authority case, the Gillick test was devised to ascertain if a child under 16 was capable of making their own decisions.

The 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.

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

Against Being Able to Consent Aged Under 16:

With legal guidelines promoting the autonomy of children if they are deemed competent, there are no specific legal arguments against the autonomy of children, this is down to clinical judgements and avoidance of harm.

Read NHS Hot Topics 2018-19>>

To Summarise… 

Consent in the case of under 16s is a complex issue and must be tackled case-by-case. Clinical judgement and thorough exploration of the situation is vital to protecting and respecting the child.

Words: Gemma White

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