Consent and Competence in Children

OVERVIEW

A child or minor is a person who is younger than the age of majority

  • In Australia the age of majority is 18 years, this is the age at which citizens can exercise all the civil rights available to Australians
  • A child of (or over) 16 years of age may give consent for medical treatment
  • In certain situations, a child less than 16 years of age may give consent

CONSENT WHEN <16 YEARS OF AGE

  • A minor is considered to be competent to consent to treatment when the person ‘achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed’
  • This test is known as the Gillick competence test
  • A patient under the age of 16 years can consent to medical treatment without the knowledge or required acceptance of a parent or guardian in situations such as:
  • Under common law principles or as set out in local legislation, when the patient is deemed competent
  • Dependent on the patient’s maturity, marital status, economic independence and the ability to understand benefits and risks of what is proposed
  • An emancipated minor (i.e. a child who is married or living independently) who is usually legally able to provide consent
  • For major or complex treatment, it is appropriate to seek consent from a parent or guardian on the assumption that the younger patient will not fully comprehend the circumstances and cannot therefore give truly informed consent
  • Always try to persuade a child to notify the parent

References and Links

LITFL

Textbooks

  • Stewart C, et al. The Australian Medico-Legal Handbook (1st edition), Elsevier,2007 [Google Books Preview]

FOAM and web resources

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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