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Priscilla Alderson
1. Changing up a gear young people’s sexual health and well-being Young people’s rights 10 th September 2008 Priscilla Alderson Professor of Childhood Studies Social Science Research Unit Institute of Education University of London www.ioe.ac.uk/ssru/
2. Which are the most important rights for young people’s well-being? Who uses UNCRC?
3. At the end of your life, what do you think you might look back on as the most important aspect of your life?
4. Young people – Adults with full adult rights 18+ Young people 16-18 (Family Law Reform Act 1969; marriage; army; school leaving) Children 0-10/12 and young people 10/12-17 HR Act 1998, Children’s Rights UNCRC 1989; Gillick.
5. UNCRC ‘3 Ps’ Provision rights – health care, education, adequate standard of living Protection rights – from harm, abuse, neglect, discrimination, violence, torture, inhuman or degrading treatment, exploitation, and arbitrary punishment, arrest, detention or interference (Articles 1- 3, 5-11, 18-19, 22-23, 30, 32-40).
6. UNCRC ‘3 Ps’ Participation rights - Freedoms of information and expression, thought, conscience and religion, association and peaceful assembly (Articles 12-17); Rights to life and survival, to privacy and family life, to a legal identity, to cultural life and the arts, and due legal process (Articles 6-8, 12-17, 31, 37, 40); The whole UNCRC is imbued with respect for the child’s person, worth and dignity, and with the social, economic and political means of promoting these within a ‘free society’ (Article 29).
7. To express views To the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child: the views of the child being given due weight in accordance with the age and maturity of the child UNCRCR:12)
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9. Four levels of decision making 1. To be informed 2. To form and express views. 3. To influence a decision. 4. To be the main decider about proposed research/treatment/care. 1-3 Children Act 1989, Children Act Scotland 1995.; DH 1990 UN Convention of the Rights of the Child (1989) 4 Gillick v Wisbech and W Norfolk HA 1995 PA+JM 1996
10. The Gillick Guidelines ’ As a matter of law the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when they child achieves a sufficient understanding and intelligence to understand what is proposed’ and ‘ sufficient discretion to enable him or her to make a wise choice in his or her own interests.’ Gillick v Wisbech & West Norfolk AHA (1985) 3 All ER 423
11. The Fraser Guidelines 1. That the girl (although under 16 years) will understand his (the practitioner’s) advice; 2. That he cannot persuade her to inform her parents or allow him to inform her parents that she is seeking contraceptive advice; 3. That she is very likely to begin or to continue having sexual intercourse with or without contraceptive treatment; 4. That unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer. 5. That her best interests require him to give her contraceptive advice, treatment or both without the parental consent.
12. ‘ No. 2. That he cannot persuade her to inform her parents’ is not a test of competence. It denies that most decisions are made by competent children/young people with their parents. Lord Fraser speaks about contraception but Lord Scarman stated that ‘Gillick’ applies much more broadly and he makes no mention of Fraser’s guidance. Fraser and Sexual Offences Act 2003 protect professionals who advise minors ‘in good faith [they are not committing a criminal offence of aiding and abetting unlawful intercourse with girls under 16’.
13. Reproductive and sexual decisions may cover medical and surgical treatment (termination) and merge into social, personal, life-course, relationship, and privacy (ContactPoint) decisions. What is competence to make decisions? How is it assessed? Status – age/ mental state Outcome – practitioner agrees with decision Function – practitioner agrees with person’s methods and reasoning in decision making.
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15. Informed consent/refusal ( Helsinki ) Involves knowing about the intervention’s: * purpose, nature and duration * methods and means * hoped for benefits * harms, costs and risks * alternatives * effects on health and person
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18. Consent and negotiation A test of child’s fixed competence? Or of adults’ ability to nurture competence? One way information giving and assessing? Or two way exchange of information and decision making? An event? Or a process of sharing knowledge and control and choices?
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20. Some key research conclusions * Child development age/stage theory (now often <25+), slow steps from zero at birth to mature adulthood, can be misleading and un helpful * Understanding and maturity relate far more to experience than to age or ability * Disadvantaged young people may know far more than sheltered privileged ones (international studies) * Normative assessments( that measure and judge people against a norm) are less useful than ones that listen to each person’s reasoning and values.
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