What is parental responsibility?
- Parental responsibility means the legal rights and obligations that parents and guardians have for their child.
- When the GMC refers to 'parents', it means those with parental responsibility for a child or young person.
- This responsibility extends until the child reaches the age of 18 in England, Wales and Northern Ireland, and 16 in Scotland.
Who has parental responsibility?
Parental responsibility is not necessarily automatic for all parents.
A child's birth mother will usually have parental responsibility, as will fathers married to the mother at the time of birth of the child.
Unmarried fathers will only have automatic parental responsibility if:
- their child was born after 15 April 2002 (Northern Ireland), 1 December 2003 (England and Wales) or 4 May 2006 (Scotland)
- the father's name is on the birth certificate.
Parental responsibility can also be held by adoptive parents, those appointed as a legal guardian or those given a residence order.
Additionally, when a child is subject to a care order, parental responsibility will be held by the local authority.
- Parental responsibility may be acquired or awarded, and it may also be removed by a court order. Parental responsibility agreements are another way for fathers, step-parents and registered civil partners to acquire parental responsibility.
- Divorce or marital separation does not affect parental responsibility. See our guide to children whose parents are separated for more on this subject.
- If you need to confirm or are in doubt that someone has parental responsibility for a child, seek legal advice before proceeding.
When is parental responsibility relevant?
Parental responsibility can be an important factor in a number of situations involving the care and treatment of children or young people.
Treatment and consent
Parental responsibility may play a part in deciding whether you can treat a young patient, as well as who can give authority for a child to be treated.
You may need someone with parental responsibility to authorise treatment, but the GMC advises that all children should be involved as much as possible in decisions about their care and their views taken into account (0-18 years: guidance for all doctors). Some examples where parental authority may be needed might include:
- infant vaccinations: authority is required from a person with parental responsibility.
- recordings or photographs: if a child lacks the necessary maturity and understanding to consent to recordings as part of their care, authority must come from someone with parental responsibility.
- major or hazardous elective surgery: despite children over the age of 16 being able to consent to treatment on their own behalf, parents should be involved in discussions surrounding major surgery unless the child refuses permission for this.
Access to records
Situations involving parental access to a child's medical records can vary, and may need to be assessed on an individual basis. The child's competence can also be an issue in such situations (see below).
- A person with parental responsibility may access the records of a competent child if the child consents.
- The situation may be different for online requests. The RCGP suggests that full parental access to a child's records should stop at age 11, and that ongoing access should be discussed both with the parents and the child. More detailed guidance can be found in the RCGP's Patient Online toolkit, under the 'record access' section.
- Additionally, the MDU has published a guide to online access to records that may be useful.
- If requested, you may disclose information to the police or social services without consent from the child or from someone with parental authority if it is needed to safeguard a child. You may disclose only that information which is necessary, and only on a need-to-know basis.
Parental responsibility is frequently relevant in cases where a child is not deemed competent.
- Although parental responsibility extends up to the age of 18 (16 in Scotland), children aged 16 or over are assumed to be competent unless shown otherwise.
- Children under 16 may also be assessed as competent. Even if they are not, you should involve them as much as possible in the decision-making process, particularly if it involves sensitive subjects such as contraception.
- Gillick-competent children should be asked to consent on their own behalf, but should also be encouraged to involve their parents as well.
- If a child is not Gillick-competent, someone with parental responsibility should authorise treatment and any disclosure of information on the child's behalf.
What is Gillick competence?
'Gillick competence' is a common term in medico-legal language, and refers to a young person under 16 with capacity to make any relevant decision. Usage stems from the case of Gillick vs West Norfolk and Wisbech, wherein the House of Lords ruled that the child in question could be given contraceptive advice and treatment without her parents' knowledge or consent. As a result, children with capacity are now termed 'Gillick competent'.
Disputes between parents
Many cases involving parental responsibility will only require you to deal with one person, but some types of treatment require the agreement of both parents (such as male circumcision for religious reasons).
Parents may not always agree on decisions involving their children, in which case you may be put in a difficult situation. In these cases:
- It is normally appropriate to ask parents to resolve their disagreement.
- If parents continue to disagree on treatment, you may have to help them resolve their conflict and reach a consensus before starting treatment.
- If the parents cannot agree and the dispute cannot be resolved informally, you should seek legal advice about whether to apply for a court ruling.
- The Department of Health's Reference guide to consent for examination or treatment addresses this sort of conflict.
This guidance was correct at publication 16/11/2018. 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.