5


When assessing if a young person is mature enough to give consent, you have to decide if the patient understands the nature, purpose and consequences of the treatment


Recently, I saw a 13-year- old patient who had an ectopic pregnancy. She had been on the pill for the last few months. One of the other GPs in the practice said that her parents are patients at the surgery too. Should I tell them about this? How can I determine if she is mature enough to give consent? MPS member


This is a complex case raising issues including confidentiality, consent and child protection. When assessing if a


young person is mature enough to give consent, you have to decide if the patient understands the nature, purpose and consequences of the treatment you are proposing. If you conclude that they


can understand, retain and weigh up the information


Useful information


■ ■ Sexual Offences Act (2003) – www.legislation.gov.uk/ukpga/2003/42/contents ■■ GMC, 0-18 Years: Guidance for all Doctors – www.gmc-uk.org/guidance/ethical_guidance/children_guidance_index.asp


If you would like to ask one of our medicolegal panel a question please contact sara.williams@mps.org.uk.


and then communicate their decision, then they would appear to have capacity to consent. Always remember that capacity is decision specific. Even if the child does have capacity, it is always good practice to encourage them to involve their parents or a trusted adult to help them in a difficult situation. If the patient does not want


her parents involved, there are only a few circumstances where you can disclose information without her consent. The GMC, in 0-18 Years: Guidance for all Doctors, advises that these situations include: when there is an overriding public interest; if the disclosure is in the best interests of the child who does not have the understanding to make a decision about disclosure; or when it is required by law.


If you consider the child to


be at risk of sexual abuse or at risk of serious harm, then it would be reasonable to disclose such information. However, you should


advise the child what you plan to disclose and explain why before disclosure, unless that would put the child at increased risk of harm. If you are unsure whether disclosure is appropriate you should seek advice from a senior colleague, the local doctor for child protection or your medical defence organisation. If they do advise disclosure then you would have to justify a decision not to disclose. In order to make this assessment it is important that you gain further information from the child. Worrying features in


the history would include


big differences in age between sexual partners, the sexual partner holding a position of trust, the use of force, drugs or alcohol, or involvement of any person known to the police or child protection agencies. It is worth noting that


sexual activity with a child under the age of 13 amounts to an offence of rape under section 5 (1) of the Sexual Offences Act (2003), hence consideration should always be given as to whether or not such cases should be brought to the attention of the relevant agencies.


These cases are fictional, but loosely based on cases in which MPS has been involved.


MEDICOLEGAL FEATURE


SESSIONAL GP | VOLUME 3 | ISSUE 2 | 2011 | UNITED KINGDOM www.mps.org.uk


MICHAELJAY/ISTOCKPHOTO.COM


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