Who can consent?
- In most cases, you will need to make a valid assessment of the child's ability to consent to the proposed treatment themselves.
- Even when children are too young to consent, they should be involved in the decision making and informed of the proposals for treatment wherever possible.
- When a child lacks capacity to make a particular decision, authority will be required from someone with parental responsibility.
Who has parental responsibility?
A child's birth mother will usually hold parental responsibility. If the child's father is not married to the mother, his role may be more complicated to determine.
Read our guide for further detail, or see appendix 2 of the GMC's 0-18 years: guidance for all doctors.
The details of consent and refusal for medical treatment vary in different UK jurisdictions for older children, but for young children the approach is uniform. In most clinical scenarios, the authority of just one parent with parental responsibility will be sufficient.
When a child attends a medical appointment they are usually accompanied by one parent, and in most situations it will be reasonable to assume the other parent would be in agreement about the proposed course of action.
What if the parents disagree?
There may be situations where the child's parents are known to disagree, or where you believe they are likely to disagree - for example, if one parent opposes a particular treatment on religious grounds, or objects to specific immunisations.
You may need to do your best to help the parents resolve their conflict and reach a consensus before starting treatment.
If the dispute cannot be resolved informally, and you think treatment is in the child's best interests, seek legal advice about whether to apply a court ruling as to whether treatment is lawful.
The Department of Health has stated: 'Consent given by one person with parental responsibility is valid, even if another person with parental responsibility withholds consent. However, the courts have stated that a 'small group of important decisions' should not be taken by one person with parental responsibility against the wishes of another, citing in particular non-therapeutic male circumcision and immunisation. Where persons with parental responsibility disagree as to whether these procedures are in the child's best interests, it is advisable to refer the decision to the courts'.
Withdrawal of life-sustaining treatment
Section 24:10 of the Department of Health's 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 resolution of disputes. Regarding 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.
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.
This guidance was correct at publication 10/08/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.