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Consent and capacity in children and young people
  1. Roger Palmer1,
  2. Gareth Gillespie2
  1. 1Department of Medical Services, Medical Protection Society, London, UK
  2. 2Department of Communications, Medical Protection Society, Leeds, UK
  1. Correspondence to Dr Roger Palmer, Medical Protection Society, 33 Cavendish Square, London W1G 0PS, UK; roger.palmer{at}mps.org.uk

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Introduction

The issues surrounding consent and capacity in children and young people can be complex and are usually delicate. This is largely down to the number of considerations one has to make in each case, when assessing a minor's competence to give consent. The process of making such an assessment depends on the age and maturity of the minor, the minor's best interests—weighed against the minor's views and those of the parents (those with parental responsibility)—and the nature of the treatment itself. This article will look at the issues around the assessment of capacity in children and young people, and the role it plays in obtaining valid consent.

The age of consent

Autonomy permits that any competent adult can decide on their medical treatment. This includes the absolute right to decline any treatment whatever the potential outcome and for whatever reason he or she wishes, so long as it is an individual choice (ie, without undue influence) and does not adversely impact society (ie, the public health balance). Moreover, that this consent can, and should, be permitted to be withdrawn at any time up until the treatment is provided without a deadline after which refusal is ‘inadmissible’. These freedoms of choice are enshrined in law and protected by the profession who advise their patients on the options, the potential benefits and their consequences.

The age at which a person is considered a competent adult, capable of making their own decisions regarding their medical treatment, regardless of its wisdom (assuming there are no other factors affecting their mental capacity to do so), is inconsistent across the UK jurisdictions. In England, Wales and Northern Ireland, this age is 18, while in Scotland it is 16. In England, Wales and Northern Ireland, however, those aged 16 and 17 are presumed to have the capacity to consent and can …

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