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Law and Paediatrics

Gillick competency - "the parental right to determine whether or not a child below the age of 16yrs will or will not have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to enable him to understand fully what is proposed"

"The adolescent must possess qualities associated with self-determination and self-identity, appropriate cognitive abilities, and the ability to rationalize and reason hypothetically. Understanding, intelligence, and experience are also important qualities that may determine competence"

Consent can be given by

  • The child if aged > 16 years (presumed to have capacity)
    • Encourage young people to involve their parents in decision making, but abide by decisions they have capacity to make themselves
  • The child if aged < 16 years and judged to be competent (i.e. Gillick) on a decision-by-decision basis
    • Understand the nature, purpose and necessity of the proposed therapy
    • Demonstrate an understanding of the benefits, risks, and potential consequences of not having the treatment
    • Understand that this information applies to them
    • Retain and use the information to make a decision
    • Ensure their decision is made without being pressurised
  • Parents (if parents can't agree seek legal advice)
  • Individuals or local authority with parental responsibility
  • The Courts
  • 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.
    • When consent cannot be obtained, you may provide medical treatment, provided it is limited to what is immediately necessary to save life or avoid significant deterioration in the patient’s health

All patients under 18 years cannot refuse treatment that is otherwise intended to prevent their serious harm or death - if time allows you should seek legal advice

Mental Health Act​

Patient suffering from "mental illness, mental impairment, or psychopathy" (not including drug or alcohol abuse) which requires treatment or poses a risk to themselves or others

  • Section 2: Admission for Assessment - approved by two doctors, one of whom is a psychiatrist, to detain for assessment and treatment for up to 28 days
  • Section 3: Admission for treatment - approved by two doctors, one of whom is a psychiatrist, to detain for treatment for up to 6 months
  • Section 4: Emergency admission - under recommendation of a doctor (usually GP) to detain for up to 72h
  • Section 5(2): Detention of a patient already in hospital - patient's doctor in charge (or deputy) for up to 72h - no treatment without consent (except emergency)
  • Section 7: Guardianship

Note that the MHA regulates treatment of physical health problems only to the extent that such treatment is part of, or ancillary to, treatment for mental disorder. ie treating drug over-dose is permitted, but not an unrelated condition

A patient on section 17 leave can be recalled at any time by the responsible clinician. The patient may also be given 'leave to reside in other hospitals' and can be kept in custody at that hospital

Treatment requires a second opinion, except for urgent treatment to prevent serious deterioration or alleviate serious suffering, or to prevent the patient from becoming violent and endangering themselves or others

Sources​

  • Oxford Handbook of Paediatrics, 2nd edition
  • Oxford Handbook of Clinical Specialties
  • GMC "0–18 years: guidance for all doctors"
  • Mental Health Act