what is classed as paeds?
<18
who is deemed competent?
Competence: all people over 16 are assumed to be competent to give consent to medical treatment
are <16 yr old competent?
- Under 16: needs to be assessed on an individual basis
what are the components of competency?
Competency components: understand there is a choice and this choice may have consequences
- Ability to weigh info
- Ability to understand and retain information
- Ability to communicate to decision
what is gillick competency?
children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent
at what age can a child have competency regarding their health info?
Children age of 12 are generally expected to have competence to give/ withhold their consent to the release of information eg not allowing parents to see medical notes
who should assess competency?
Assessment: skilled and experiences in discussions with young patients and eliciting their views
- Good to have other HCP that have built good rapport with child present if needs be
what is parental responsibility (PR)?
Parental Responsibility: they can provide consent on behalf a baby or a child who lacks competence and making choice in best interest
when does mother get PR?
at birth automatically
when does father get PR?
- In UK: father gets PR if married to mother at time of birth, unmarried requires name on birth certificate
- If father not married: need court registration PR agreement married step parents can acquire the same
who gets PR in surrogacy?
- Surrogacy: PR falls to birth mother, if she is married then their partner gets PR then need biological parents to gain court order
what happens if there is disagreement between people with PR?
Disagreements between people with PR: Dr only need consent from one parent can not undermine if one has already expressed their wishes
- Ideally need to mediate between
- Legal team advice clinician can act in best interest
who can give consent of a child/ young person?
Those who can give consent of a child/ young person: competent child/ young person, parent with PR, courts, a person caring for a child eg grandparent/ childminder can do anything to promote child’s welfare
if a child refuses to give consent, can it be overruled?
- A competent refusal in a person under 18 can be overruled by court of person with PR
in an emergency, where no -PR contact, non competent child who makes choices?
- Emergency: clinician can make decision in best interest
what is best interests?
Best interest: if a child lacks competence if is assumed that child’s parents had best interests at heart
- Objective test to find out child’s best interests patient wishes, feeling, values, patient ability to understand and weigh up alternatives
- Clinical judgement
- Parents views on what it is likely to benefit them
ow does confidentiality apply to children?
: a duty of confidentiality is owed to all childrena dn young people and the same as adults
- Disclosure: only minimum relevant info, only to appropriate authorities, document the disclosure in medical records, be prepared to justify the decisions
what happens if HCP suspects abuse/ neglect with regards to confidentiality?
- Abuse/ neglect risk: any suspicions then it must be acted on < disclose to appropriate authorities with minimum info and inform child
what are frazer guidelines?
Frazer guidelines: try to persuade child to talk to parents in respect to contraceptives, should take into account:
- Are they likely to have sex without contraception
- Whether the pt mental/ physical health is likely to suffer is do not get contraception
- Whether this is pt best interest
if a young person, requests an abortion, what can PR do?
Abortion: PR has no rights to overrule the child choice of abortion
what if a child lacks competency regarding contraception?
Competency: if they lack competency about contraception can they consent to sex?
when is sex in young people most concerning?
- Concerning sex in under 13
- Concerning if age difference
- Any reasons for sexual assault/ violence/ prostitution etc
what is FGM?
FGM is collective term for range of practices involving removing/ altering parts of healthy female genitalia – different degrees of mutilation are practiced by different cultural groups
