In an emergency, you can provide medical treatment without the consent of a child or young person to save their life or prevent serious deterioration. In all other situations you will need valid authority, which might come from the patient, their parent(s) or the court.

Even when children cannot consent and you're relying on the authority of the parents or the court, you should always involve children as much as possible in decisions about their care.

When can a child or young person consent?

At 16, a person is assumed to have sufficient maturity and understanding to provide consent for treatment.

Under the age of 16, a child might have Gillick competence for a decision. Each case (and decision) needs to be assessed on an individual basis.

Parents cannot override the competent consent of a young person for treatment if you consider it in their best interests. But you can rely on parental authority if the young person lacks capacity to consent.

Refusing treatment is different from consent (more below).

Who has parental responsibility?

For children who lack Gillick competence, you should ask for their parent’s consent to treatment. It's usually enough to have the consent of one parent.

Read our guide on parental responsibility, including what to do if the parents disagree.

What about 16-year olds who lack capacity to consent?

In Scotland, adulthood begins at 16, so 16- and 17-year olds who lack capacity to consent are treated as adults who lack capacity.

Elsewhere in the UK, 16- and 17-year olds are not yet adults. You can rely on parental authority to provide treatment in the young person’s best interests.

What if a young person refuses treatment?

Respect for young people’s views is important. If a young person refuses treatment, you must carefully weigh up the harm it would cause to their rights by overriding their refusal, against the benefits of treatment.

All decisions must be made in the best interests of the child or young person.

These are often complex situations requiring a multi-disciplinary approach - including involving child protection services in some cases.

The law on parents overriding young people’s competent refusal is complex and varies around the UK. Contact us for advice on these matters and to discuss on a case-by-case basis.

Withdrawing and withholding life-sustaining treatment

Section 4 of the Department of Health's guidance emphasises that decisions must be made in the child’s best interests, which is broader than medical interests and should include emotional and other factors. The guidance recommends a court ruling should be sought as early as possible where there is a disagreement over withdrawing life-sustaining treatment.

The GMC has also issued guidance on withdrawing life-sustaining treatment in neonates, children and young people and the resolving disputes. When it comes to disputes between adults with parental responsibility for a sick child, it recommends considering the following to help resolve the dispute:

involving an independent advocate
seeking advice from a more experienced colleague
obtaining a second opinion
holding a case conference or ethics consultation
using local mediation services

If, after taking these steps, there is still disagreement, seek legal advice on applying to the court for an independent judgment.

Emergencies

In an emergency where there is no time to obtain authority or resolve conflicts, you should act quickly to provide appropriate, immediate treatment to safeguard the child's life and prevent serious deterioration of their condition.

If the parents are available, you should get their authority. In situations where they can't be contacted immediately, the doctors should proceed in the best interests of the child.

Consent and young patients

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