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Consent – whatyou have a right toexpect
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Giving consent for medical examination or treatment of your child
Before a doctor, nurse or therapist can examine or treat your child, they need consent or agreement. Sometimes children can give consent for themselves, depending on their age and how well they understand. Sometimes you will be asked to give consent for them as their parent.
This leaflet will help make it clear to you who can give consent andwhen and how. How will your child or you be asked?
The way people providing health care (doctors, nurses or therapists) askfor consent partly depends on what they plan to do. It may be simple. For example, your GP might ask to have a look at your child’s throat. You would then encourage a young child to open his or her mouth forthe doctor. Older children will do so of their own accord. That showsyou and they have given consent. For something more complicated,like an operation, you or they will be asked to sign a form agreeing tothe treatment. 2 Consent – what you have a right to expect: A guide for parents
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Who is responsible for giving consent? You are entitled to agree to treatment on behalf of a child up to age 18 for whom you have what is called “parental responsibility”.
However, children also gain rights to agree for themselves as they get older – as you’ll see over the page. Who has parental responsibility? Mothers automatically have parental responsibility for their children. Fathers also have parental responsibility if they were married to the mother when the child was conceived or born, or if they got married to her later. Unmarried fathers do not automatically have parental responsibility for their child, but a court order or a “parental responsibility agreement” can give it to them.* People looking after your child like childminders or grandparents do not have parental responsibility, but you can authorise them to take medical decisions for your child, if you wish.
* The National Family and Parenting Institute produce a leaflet Is it legal? a parents’ guide to thelaw which gives more information about parental responsibility and how to acquire it (www.e-
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How do you decide what’s best?
Parents are expected to make health care decisions for their children,based on what they feel is in a child’s “welfare” or “best interests”. Butit’s still a good idea to involve children as much as possible. Even whenthey’re not old enough to make decisions completely on their own,children can still play a part in decisions about their health care. Themore they’re involved, the more likely they are to feel positive abouttreatment. What if you and people providing health care don’t agree?
Sometimes health care professionals and parents may not agree on whatis in the child’s best interests. Usually the professionals cannot then goahead and provide treatment.
It’s always important to keep discussing things, so that eventuallyagreement can be reached. For example, it may help to ask for a secondmedical opinion, or talk to other people involved in caring for yourchild. But sometimes health care professionals may believe a particulartreatment is crucial for the child, perhaps life saving. Then they can aska court to decide. Equally, after seeking legal advice, it may be possiblefor you to go to court to request or prevent treatment, if you think it’sin your child’s best interests.
On the rare occasion things go this far without agreement, the court hasthe power to grant or refuse the request of you or the practitioner if itthinks this is the right thing to do. 4 Consent – what you have a right to expect: A guide for parents
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When can children give consent for themselves? 16-18 year olds
Once children reach the age of 16, they can agree to examination ortreatment just like adults. People providing health care do not thenhave to ask you for consent as well. Under 16s
The rules say that children under 16 may still be able to give consentfor themselves, provided they are mature enough to understand fullywhat is involved. So who gives consent – your child or you?
There is no hard and fast rule. A lot depends on the seriousness ordifficulty of the proposed treatment. Although your child might begrown-up enough to consent to a meningitis vaccination, for instance,it might be too much to expect him or her to grasp all they need toknow for consenting to a heart operation.
Even if your child is grown-up enough to give consent independently,people providing treatment will still encourage them to involve you intheir decision. However, if children refuse to share information withparents, health care professionals must normally respect their wishes.
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What do you and your child need to know?
In order to make a decision, you and your child need to be provided with information about the treatment being offered. If you feel you haven’t understood or don’t have enough information, you should always ask questions. For example:
What sort of things will the treatment involve?
How good are the chances of getting such benefits?
If there are risks, are they minor or serious?
What may happen if your child doesn’t have treatment?
If the person who is asking you to agree to the treatment isn’t able toanswer your questions, ask them to find out or arrange for someone elseto talk to you about your concerns. How much time can we take to decide?
If your child or you want more time to think about the decision, say so. In emergencies, decisions may have to be taken quickly, but at othertimes it will usually be possible for you and your child to take as muchtime as you need. It is up to the two of you to decide whether or not togo ahead. 6 Consent – what you have a right to expect: A guide for parents
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What if my child refuses treatment?
Sometimes children who are able to take their own decisions refusetreatment which their parents wish them to accept. In spite of that,health care professionals can legally overrule them and go ahead withthe treatment if a parent has given consent.
But young people may resent treatment given to them against their will. So it’s better for everyone to avoid this happening.
If your child is refusing treatment, try to find out what’s worrying thembefore considering going against their wishes. So long as the child’scondition is not life-threatening, it may be possible to delay treatmentuntil the child is willing for it to go ahead. Suppose I don’t want my child to have treatment?
You may not want your child to have a particular treatment or intervention – contraception, for example. But if your child has the maturity to understand what’s involved and asks for it, the law does allow health care professionals to provide treatment or care they believe is appropriate. Although they will always try to persuade children to keep parents informed, they must respect the wishes of a child who refuses to share information with you.
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What if children are asked to take part in research?
This may be as part of their treatment, for example to compare twodifferent kinds of treatment; or it may be quite separate, for examplebeing asked to provide extra blood samples for a research project. Inany case, a research project will always be approved by a Research EthicsCommittee before your child is asked to take part in it.
You and your child should usually be given an information sheet aboutthe research project, and you should both ask as many questions as youwant before coming to a decision, for instance about:
(and if the research is a new or different treatment)•
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Only you and your child can decide whether any risks are worth takingfor possible benefits to them or future patients.
The older children are, the more you should involve them in decisionsabout whether to take part. If children are mature enough (see page 5),they can decide for themselves.
If you or your child decide they do not wish to take part, this ought notto affect the rest of their care. Having agreed to take part, if either ofyou change your mind, your child is free to withdraw at any time. Is there any advantage or disadvantage to taking part in research?
Sometimes your child may only be able to get a certain treatment aspart of a research trial. This is because it is new or experimental andcannot be made generally available until properly tested.
There is a type of research in which neither you, your child or doctorknows whether the proposed treatment is new, standard or even notreatment. (You and your child will always be told what options arebeing used in the research project, even though you will not knowwhich option your child will receive.) If you or your child is not happyabout being involved in this kind of trial, either of you should feel freeto say no. Your child will always be able to have the available standardtreatment. All treatments, even established ones, have risks and thesehave to be weighed up when making your decision.
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Suppose we’re not happy about how we’ve been approached about consent?
You can tell the health care professionals concerned that you’re worried. But if you’re still not satisfied, you are entitled to complain. You canfind out how to go about it from Your Guide to the NHS or from NHSDirect on 0845 4647. NHS Direct can also give you details of a newservice called PALS (Patient Advocacy and Liaison Service) designed tohelp sort out problems simply and quickly. 10 Consent – what you have a right to expect: A guide for parents
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Would you like more help with giving consent?
Here’s a list of useful organisations you can ask for more help andsupport about giving consent to treatment and taking part in research. The Patients Association Action for Sick Children Patient Concern
Produces leaflets, Medical researchand you and Genetic research and
specialising in consent-relatedissues; campaigns for patientchoice and empowerment.
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If you require further FREE copies of this publicationplease contact:
Department of Health PublicationsPO Box 777London SE1 6XHFax: 01623 724524E-mail [email protected]
Or you could call the NHS Response Line on 08701 555 455
Please quote reference 24474 when ordering.
It is also available on our website at: www.doh.gov.uk/consent.
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