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[James Cox]

On 29 Jan 2008, at 22:41, Ian Batten wrote:

>
> On 29 Jan 2008, at 21:51, James Cox wrote:
>
>> Parents typically get carte blanche to decide what treatments their  
>> kid has
>
> From http://cks.library.nhs.uk/knowledgeplus/medico_legal/child_protection_consent
>
>> When a child requests medical treatment, the Clinician must address  
>> wider issues of confidentiality and the competence of the child to  
>> request such treatment. A child is described as "Gillick competent"  
>> if he or she has "sufficient understanding and intelligence to be  
>> capable of making up his own mind". The child would then be able to  
>> consent to medical treatment, and parental rights will yield to the  
>> child's right to make his/her own decision. The issue of  
>> confidentiality is addressed in Confidentiality and record keeping  
>> in the context of child protection.
>> Whereas a child may be Gillick competent and have a right to  
>> request medical treatment, he or she would not, however, be  
>> entitled to refuse treatment.
>>
>
> I think, however, that a doctor who conspired with a parent to force  
> treatment onto a clearly unwilling fifteen year old would risk  
> finding their name entering into the literature.    That the name  
> Gillick is invoked shows this is doctrine from within the past  
> twenty years; the inverse case of a competent child refusing  
> treatment may simply not yet have arisen.  I can imagine, say, a  
> competent terminally ill 15 year old wanting ``no 222'' on his/her  
> notes against her parents' wishes being a good starting point for a  
> row.

 From my part-time student lawyer/observer stance, whilst this is all  
true in principle, it gets hazier when it is practice. For instance,  
in the sad case of Terri Schiavo, it was deemed that even someone who  
was technically an adult was deemed unable to make her own personal  
medical choices.  (yes, I know that the US system differs from ours,  
but these are basic moral ethics that tend to transgress legal  
borders). The point is that, if a terminally ill child wants a DNR and  
the parents disagree, then i think it would still take a fairly  
liberal judge to find in favour of the kid; especially if depression  
is listed as a diagnosis somewhere.

Still, gillick competence does comes into play for our electives;  
however against hospitals err on the side of caution: transgender  
teens go through long periods of what's known as 'paused puberty'  
where they take high-dose hormone suppressors until they have shown a  
consistent state of mind as to their preferred gender, as well as  
undergoing several psychiatric profiles. Sure, changing gender is a  
fairly irreversible experience, but still there is a significant  
period of assessment (with parental involvement too) before any  
positive action is taken.

I was going to use the example of a rhinoplasty or breast enlargement  
- fairly typical electives for the modern day human, where i believe  
has been applied to children in their teens with severe self-image  
problems, however any doctor worth their salt would refuse treatment  
unless absolutely necessary, given the risks to growth involved. The  
other possible electives that really fit in with teens (within the  
discipline of plastics, the most controversial) may be removal of  
abnormal body parts, skin grafts for burn victims, etc - but i'd be  
hard pushed to imagine a parent refusing such treatment. When it comes  
to more traditional electives- fixing minor heart defects, dealing  
with sports injuries, etc - again i'd be hard pushed to imagine a  
parent choosing to refuse such a course of action, where a doctor  
believes it is safe to go ahead.

Interestingly the one other elective treatment that may cause  
contention is where we started: abortion. If i remember correctly, a  
doctor may not be permitted to involve a parent in an abortion without  
the patient's consent, however prescription of birth control pills  
still seems to involve parental notification for minors. If i squint,  
i can see the legal argument in that, but it seems to smack of a lack  
of consistency.

Best,

james

PS: btw, 'no 222' is an interesting reference- i had to check it out  
to confirm what you meant.. :)