2. WHAT IS “INFORMED CONSENT?”
“Consent
is
the
autonomous
authorization of a medical intervention
by individual patients”.
Patients are entitled to make decisions
about their medical care and have the
right to be
given all available
information relevant to the refusal.
3. SCENARIO
A 10-year-old boy was playing near an underconstruction building of his school when he
accidentally runs through a glass window and
lacerates the radial artery. His teacher brings
him to the emergency department. The boy is
bleeding and needs both a blood transfusion
and surgery to correct the defect.
4. QUESTIONES
I.
What should the doctor do in this emergency
situation if the person eligible to give consent is
not reachable?
II.
Who can consent to medical treatment on behalf of
this young child?
III. Is the patient competent to make such a decision?
5. Solution-1
The management in an emergency is different. In an
emergency situation, when a person with parental
responsibility is not available to consent, the doctor
has to consider what the child’s best interests are
and then act appropriately. The treatment should be
limited to what is reasonably required to deal with
the particular emergency. Wherever possible, it is
advisable to discuss the case with a senior
colleague, if available. In all cases, it is important to
document fully what decisions were made and why.
6. Solution-2
Only a parent or a guardian can give consent on
behalf of the minor. However the guardian must be
legally assigned by the court to give the consent.
The teacher, the principal, the school nurse, the
grandparents cannot give consent. Seeking a court
order at that moment is also wrong, because it might
take a lot of time and delay the treatment.
7. Solution-3
It is up to the doctor to decide whether the child has the
maturity and intelligence to fully understand the nature of
the treatment, the options, the risks involved and the
benefits. A child who has such understanding is
considered Gillick competent (or Fraser competent). The
parents cannot overrule the child’s consent when the
child is judged to be Gillick competent. Children under 16
who are not Gillick competent and very young children
cannot either give or withhold consent. Those with
parental responsibility need to make the decision on their
behalf.
8. Conclusion
1. Situations where life saving intervention is
required the doctor has to intervene under
common law.
2. Child’s consent must be respected if he
has fully understood the procedure.
3. Guardian can only give consent if legally
assigned by the court.
9. References
•
Children's Rights and the Developing Law By Jane
Fortin 3rd edition- Chapter-1 (Children’s autonomy
and parental role)
•
Kaplan medical ethics by Conrad Fischer, Caterina
Oneto. Chapter-2 ( Competence and the capacity to
make decisions).
•
Lecture Informed consent by Dr. Ishaaq Sarhandi
