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• Practice points
CONSENT AGE OF
How old is old enough when it comes to making personal choices regarding sexual health?
A 14-year-old girl named Mary has made an emergency appointment at the GP surgery for a “bad cough”. She turns up for the consultation with her 17-year-old sister but does not appear unwell when her name is called in the waiting room.
Inside the consulting room you ask her what seems to be the problem and Mary bursts into tears. “She’s pregnant,”
her sister blurts out. In a few minutes Mary calms down enough to explain that the father is a 15-year-old boy at her school with whom she had consensual sex. He does not know she is pregnant and Mary has no plans to tell him or her parents. Her sister adds: “Our Dad would go mental if he found out.” Mary is adamant she wants you to arrange for an abortion. The family has been with the practice for many years
and you suggest that she makes an appointment to discuss the matter with her regular GP in the practice but Mary insists that you deal with the issue. “I just couldn’t face Dr Jones,” she says.
S
UCH scenarios occur more often than you might imagine as our advice call records at MDDUS will attest. Making decisions on issues of consent in children and adolescents can be complicated – especially when the patient is at an age where their maturity and competence to make decisions
about serious medical interventions could possibly be in question.
Old enough to choose Young people are presumed to be competent to make decisions regarding their own medical care at the age of 16 years in the UK. In children under 16 both case and statute law in England and Wales support the broad principle that a child can give consent if able to demonstrate sufficient understanding and intelligence to comprehend what is proposed and the attendant risks. In Scotland, statute law makes similar provision for children under age 16. It is for the doctor to use clinical judgment to decide whether the child possesses a sufficient level of understanding and intelligence. Younger and ‘non-competent’ children under age 16
normally require consent from any one person with parental responsibility (e.g. natural mother or father, court-appointed guardian or a carer) prior to any intervention. The courts can also grant consent. In an emergency situation, treatment can proceed without consent provided this is deemed in the best interest of the child.
The GMC offers very specific advice on issues of consent
in children in its document 0-18 years: guidance for all doctors, which is available on the GMC website. Among ‘first principles’ expressed in the guidance is the recognition that children and young people are “individuals with rights that should be respected”. It also states: “When treating children and young people, doctors must also consider parents and others close to them; but their patient must be the doctor’s first concern.” In dealing with a patient in Mary’s situation the advice
from the GMC and MDDUS is to encourage the young person to involve her parents or others in the decision-making process unless there is some reason to suspect this might not be in the patient’s best interests. In judging the competence to consent in a child under 16 the GMC states: “You must decide whether a young person is able to understand the nature, purpose and possible consequences of investigations or treatments you propose, as well as the consequences of not having treatment. Only if they are able to understand, retain, use and weigh this information, and communicate their decision to others can they consent to that investigation or treatment.” In the guidance the GMC also makes specific reference to
the provision of contraceptive, abortion and STI advice and treatment to under-16s without parental knowledge or consent. This is permitted provided that the young patient:
• understands all aspects of the advice and its implications
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