Guidelines for medical professionals on consent and refusal of treatment
You can provide medical treatment to a child or young person with their consent if they are competent, or with the consent of a parent or the court. You can provide emergency treatment without consent to save the life of, or prevent serious deterioration in the health of, a child or young person. You should involve children and young people as much as possible in decisions about their care, even when they are not able to make decisions on their own.
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. That means you must make sure that all relevant information has been provided and thoroughly discussed before deciding whether or not a child or young person has the capacity to consent.
The capacity to consent depends more on young people's ability to understand and weigh up options than on age. When assessing a young person's capacity to consent, you should bear in mind that:
It is important that you assess maturity and understanding on an individual basis and with regard to the complexity and importance of the decision to be made. You should remember that a young person who has the capacity to consent to straightforward, relatively risk-free treatment may not necessarily have the capacity to consent to complex treatment involving high risks or serious consequences. The capacity to consent can also be affected by their physical and emotional development and by changes in their health and treatment.
If a child lacks the capacity to consent, you should ask for their parent's consent. It is usually sufficient to have consent from one parent. If parents cannot agree and disputes cannot be resolved informally, you should seek legal advice about whether you should apply to the court.
Parents can consent to investigations and treatment that are in the young person's best interests.
Treatment can also be provided in the young person's best interests without parental consent, although the views of parents may be important in assessing the young person's best interests.
Treatment can be provided in the young person's best interests if a parent cannot be contacted, although you should seek legal advice about applying for court approval for significant (other than emergency) interventions.
16 and 17-year-olds who do not have the capacity to consent are treated as adults who lack capacity and treatment may be given to safeguard or promote their health.
You should encourage young people to involve their parents in making important decisions, but you should usually abide by any decision they have the capacity to make themselves. You should also consider involving other members of the multidisciplinary team, an independent advocate or a named or designated doctor for child protection if their involvement would help young people in making decisions.
Respect for young people's views is important in making decisions about their care. If they refuse treatment, particularly treatment that could save their life or prevent serious deterioration in their health, this presents a challenge that you need to consider carefully.
Parents cannot override the competent consent of a young person to treatment that you consider is in their best interests. But you can rely on parental consent when a child lacks the capacity to consent. In Scotland parents cannot authorise treatment a competent young person has refused. In England, Wales and Northern Ireland, the law on parents overriding young people's competent refusal is complex. You should seek legal advice if you think treatment is in the best interests of a competent young person who refuses.
You must carefully weigh up the harm to the rights of children and young people of overriding their refusal against the benefits of treatment, so that decisions can be taken in their best interests. In these circumstances, you should consider involving other members of the multidisciplinary team, an independent advocate, or a named or designated doctor for child protection. Legal advice may be helpful in deciding whether you should apply to the court to resolve disputes about best interests that cannot be resolved informally.
You should also consider involving other members of the multidisciplinary team, an independent advocate, or a named or designated doctor for child protection, before seeking legal advice, if parents refuse treatment that is clearly in the best interests of a child or young person who lacks capacity, or if both a young person with capacity and their parents refuse such treatment.
If treatment is being refused on the grounds of their religious or moral beliefs, you must discuss their concerns and look for treatment options that will accommodate their beliefs. You should involve the child in a way appropriate to their age and maturity. If following a discussion of all the options you cannot reach an agreement, and treatment is essential to preserve life or prevent serious deterioration in health, you should seek advice on approaching the court.
In an emergency, you can provide treatment that is immediately necessary to save life or prevent deterioration in health without consent or, in exceptional circumstances, against the wishes of a person with parental responsibility. Legal permission for treatment in the face of parental refusal should be sought at the earliest available opportunity.
| Situation | Appropriate Action | Considerations |
|---|---|---|
| Competent child consents | Proceed with treatment | Encourage parental involvement but respect child's decision |
| Competent child refuses | Seek legal advice | Balance child's rights against benefits of treatment |
| Child lacks capacity, parents consent | Proceed with treatment | Ensure treatment is in child's best interests |
| Child lacks capacity, parents refuse | Seek legal advice/court order | Especially for life-saving or essential treatment |
| Emergency situation | Provide necessary treatment | Without consent if needed to save life or prevent serious harm |