CONSENT IN PAEDATRIC PATIENT

CONSENT Consent is the granting to someone the permission to do something they would not have the right to do without such permission. (Malaysian Dental Council) For consent to be valid, the patient must have received enough information to make the decision.

CONSENT A consent is not valid if the patient:  does not know what is planned, or  knows what is planned but has not agreed Valid consent to treatment can only be given by an individual who has the legal capacity (above 18 years of age) to give consent.

TYPES OF CONSENT TYPES OF CONSENT the patient indicates a willingness by his or her behaviour. only limited to Clinical examination, Consultation & Diagnosis IMPLIED Verbal consent is acceptable when the procedures are limited to treatment of the problem presented by the patient. It is necessary for a witness to be present during the explanation and the giving of the consent VERBAL Written consent is consent for treatment signed by the patient or the legal guardian, and duly countersigned by a witness WRITTEN

VALID CONSENT (MDC) VALID CONSENT (MDC) The practitioner should explain to the patient:  the treatment proposed;  the risks involved in the treatment;  advantages and limitations of that treatment  Alternative treatments and costs. The practitioner should not:  give guarantees  make unreasonable promises about outcomes of treatment For minors (below 18 years), written consent must be obtained from parents or legal guardian If general anaesthetic or sedation is to be given, all procedures must be explained to the patient.

Definition of Parental Responsibility All the rights, duties, powers, responsibilities and authority which by law a parent of a child has in relation to the child and his property (The Children Act UK) “A person that has entitled to agree to treatment on behalf of a child up to age 18” (NICE)

Who has parental responsibility? NICE guidelinesAAPD Refered from Children Act 1989, UK Mothers Automatically have parental responsibility for their children. Fathers also have parental responsibility if they were married to the mother when the child was conceived or born, or if they got married to her later. Who need consent from guardian? – patient under age or adult with diminished mental capacity. Who can give consent? – parent or legal guardian. Information needed for informed consent. – Proposed therapy, risks, benefits and alternative therapy

NICE guidelinesAAPD Unmarried fathers do not automatically have parental responsibility for their child, but a court order or a “parental responsibility agreement” can give it to them. People looking after your child e.g: childminders or grandparents do not have parental responsibility, but parent can authorise them to take medical decisions for your child, if you wish.

ISSUES

NICEAAPDMOH Same-sex parents a)Civil partners  Same-sex partners who were civil partners at the time of the treatment will both have parental responsibility. b)Non-civil partners  For same-sex partners who aren’t civil partners, the second parent can get parental responsibility by either: i.applying for parental responsibility if a parental agreement was made ii.becoming a civil partner of the other parent and making a parental responsibility agreement or jointly registering the birth Need to obtain a copy of court orders appointing a guardian to verify who is authorized to give consent. Need to be updated in case of any alteration of treatment

Who can give consent to children for treatment? Person who has parental responsibility are entitled to agree to treatment on behalf of a child up to age 18 Parents are expected to make health care decisions for their children based on what they feel is in a child’s “welfare” or “best interests”. But it’s still a good idea to involve children as much as possible even when they’re not old enough to make decisions completely on their own children can still play a part in decisions about their health care. The more they’re involved, the more likely they are to feel positive about treatment.

When can children give consent for themselves? year olds Once children reach the age of 16, they can agree to examination or treatment just like adults. People providing health care do not then have to ask you for consent as well. Under 16s The rules say that children under 16 may still be able to give consent for themselves, provided they are mature enough to understand fully what is involved.

So who gives consent – child or parents? A lot depends on the seriousness or difficulty of the proposed treatment. Although the child might be grown-up enough to consent to a meningitis vaccination, for instance, it might be too much to expect him or her to grasp all they need to know for consenting to a heart operation. Even if the child is grown-up enough to give consent independently, people providing treatment will still encourage them to involve the parents in their decision. However, if children refuse to share information with parents, health care professionals must normally respect their wishes.

Reference Guideline on informed consent; American Academy of Pediatric dentistry; 2009 NICE