DGD12-044
Standard Operating Procedure
Consent and Treatment: Children or Young People
Purpose
This Standard Operating Procedure (SOP) outlines the process for Health Directorate staff to
gain informed consent for children or young people prior to all clinical activities, treatments
or procedures, with the exception of medical treatment given in an emergency to save the
child or young person’s life or prevent serious harm.
The Age of Majority Act 1974 identifies that a person attains full age for all purposes of the
law of the Territory when the person attains the age of 18 years. Children and young people
are under the age of 18 years.
Legally a person can only consent to medical treatment if they are an adult (aged 18 years)
or if they are mature enough to clearly understand the nature of treatment and any risks
involved. Otherwise, a parent or guardian should be asked to consent to treatment on behalf
of the child or young person.
Scope
This SOP provides all Health Directorate staff with information and support to assist with
promoting children and young people’s rights in healthcare, gaining informed consent
through child and youth friendly practices, and in meeting legal obligations to gain valid
informed consent for children or young people. It should be read in conjunction with the
Health Directorate Consent and Treatment Policy and associated SOPs:
 Consent and Treatment SOP
 Consent and Treatment: Capacity and Substitute Decision Makers SOP.
Principles:
 The best interest of the child and young person is paramount
 Informed decision-making is essential for consumer-centred care
 Children and young people have the right to participate in decision-making and,
as appropriate to their capabilities, to make decisions about their care
 Engaging with children and young people in a respectful, participatory way can
assist with reducing any negative impacts of treatment and assist with their
recovery
 Healthcare providers have an obligation to provide care that takes into
consideration children and young people’s rights, their evolving capabilities, and
the rights and responsibilities of parents and carers to provide direction and
guidance to children.
Doc Number
DGD12-044
Version
2.0
Issued
October 2012
Review Date
October 2015
Area Responsible
QSU
Page
1 of 7
DGD12-044
Procedure
1. Consent in a medical emergency
1.1 In the event of a medical emergency relating to a child or young person, parental
consent is not required if the treating medical officer believes that immediate action is
necessary to resolve the medical emergency.
2. Consent by the child or young person – Mature young person consent
2.1 It is not necessary to seek a parent or guardian’s consent if a medical officer assesses the
child or young person has the sufficient intelligence, maturity and understanding to
comprehend the nature of the treatment and the implications of the treatment or
procedure. Tools such as the Gillett principles should be used. In this situation, a child or
young person may give consent for their own medical care.
2.2 The obligation of the medical officer when obtaining mature young person consent is to:
 Document all action taken to establish decision-making capacity for consent, all questions
asked and answers given, and
 Ask another medical officer to assess the mature young person and provide and document
their opinion regarding decision-making capacity for consent. Refer to Health Directorate
Consent: Capacity and Substitute Decision Makers.
3. Consent by people with parental responsibility
3.1 Generally, parents have the primary responsibility for providing consent for the child or
young person.
3.2 If two or more people have parental responsibility for the child or young person, each of
them may act alone in discharging their responsibility.
3.3 An informal carer (acting in place of a parent, e.g. a family friend) may not legally
consent to medical treatment on behalf of a child or young person.
3.4 The Director-General of Community Services Directorate, Office for Children, Youth and
Family Support may provide consent to medical, dental and similar treatment for a child
or young person for whom the Director-General has parental responsibility.
4. Consent for children without parents in attendance
4.1 Where urgent medical treatment is required to save a child or young person’s life or
prevent serious harm and the parents are not in attendance to provide consent, medical
treatment can be given.
4.2 Where a child or young person requires treatment, that is not a medical emergency,
telephone consent may be obtained from the parent or legal guardian. Another health
professional must listen to the consent conversation to corroborate the information
given to the parent or legal guardian and co‐sign that valid informed consent has been
obtained.
Doc Number
DGD12-044
Version
2.0
Issued
October 2012
Review Date
October 2015
Area Responsible
QSU
Page
2 of 7
DGD12-044
4.3 If no parent or legal guardian can be contacted the matter should be escalated to the
following officers before contact is made with an external agency (Refer to Item 7.3):
 Clinical Director of Medicine or Surgery, or Senior Health Professional
 Executive Director of the Division.
5. Consent by persons authorised with daily care responsibilities for children and young
people
5.1 The Director-General of Community Services Directorate, Office for Children, Youth and
Family Support can authorise others to exercise parental responsibilities for a particular
child or young person, where the Director-General holds parental responsibility for that
child or young person. The authorised person may be a carer or a family member and the
authorisation may be given orally or in writing.
5.2 For any child or young person identified as placed in ‘out of home care’, Health
Directorate staff must contact the Office for Children, Youth and Family Support to
confirm the scope of authority of the authorised person.
5.3 For most ‘out of home care’ children or young people, the authorised person will only
have daily care responsibility. In accordance with the Children & Young People Act 2008,
a person with daily care responsibility for a child or young person may only consent to
the following for the child or young person:
a. A health care assessment of physical or mental wellbeing and have access to the
assessment report
b. Health care treatment (on the advice of a health professional), not including
surgery (other than surgery mentioned in dot point c), and
c. Dental treatment (on the advice of a dentist), including minor dental surgery.
E.g. they can take a child or young person to a doctor but cannot consent to surgery.
6. Voluntary care agreements
6.1 Voluntary care agreements enable care of the child or young person to be shared
between the Director-General of the Community Services Directorate and the parents.
These are usually short term agreements of six months or less. In these circumstances,
the Director-General may delegate daily care responsibility to an authorised carer. The
authorised carer may consent to health treatment as set out in Items 5.2 and 5.3.
7. When there is disagreement or refusal in relation to a child or young person
7.1 Where there is conflict or confusion between parents, or parents and a child or young
person, and/or a medical officer about the validity of the consent, the medical officer has
the right to refuse to treat a child or young person.
7.2 Where the medical officer is confident that the child or young person understands the
nature and consequences of the medical treatment or procedure and consents, they can
proceed with the treatment or procedure after gaining consent from the child or young
person and another medical officer confirms the child or young person’s decision-making
capacity for consent. See Item 2: Consent by the child or young person – Mature young
person consent.
Doc Number
DGD12-044
Version
2.0
Issued
October 2012
Review Date
October 2015
Area Responsible
QSU
Page
3 of 7
DGD12-044
7.3 In the event that consent cannot be gained from the parents, guardian or through
mature young person consent, the child or young person and parents, (or adult with
authority to consent) should be informed that the treatment will be withheld pending
discussions with in order of priority the:
 Office of Children Youth and Family Support, and
 The courts, as a last resort.
The Office of the Chief Justice of the Supreme Court ACT contact is: 02 6207 1786.
When this situation arises the medical officer should ensure the following staff are made
aware:
 Clinical Director of Medicine or Surgery
 Senior treating medical officer, and
 Executive Director of the Division.
Evaluation
Outcome Measures
 Valid informed consent is provided for children or young people wherever it is
required.
 All forms used to document written consent are endorsed for use by the Health
Directorate and comply with this policy and associated SOPs.
Method
 Documentation of consent audits overseen by the Governance Health Service
Standard Group.
Related Legislation, Policies and Standards
Legislation
Age of Majority Act 1974
Children and Young People Act 2008
Civil Law (Wrongs) Act 2002
Guardianship and Management of Property Act 1991
Health Practitioner Regulation National Law (ACT) Act 2010
Health Records (Privacy and Access) Act 1997
Health Regulation (Maternal Health Information) Act 1998
Medical Treatment (Health Directions) Act 2006
Medicare Australia Act 2005
Mental Health (Treatment and Care) Act 1994
Powers of Attorney Act 2006
Public Advocate Act 2005
Road Transport (Alcohol and Drugs) Act 1977
Transplantation and Anatomy Act 1978 (2.2, 2.3, 2.5)
Policy
Doc Number
DGD12-044
Version
2.0
Issued
October 2012
Review Date
October 2015
Area Responsible
QSU
Page
4 of 7
DGD12-044
Clinical Record Management Policy
Clinical Record Documentation SOP
Release or Sharing of Clinical Records or Personal Health Information SOP
Consent and Treatment Policy
Consent and Treatment SOP
Consent and Treatment: Capacity and Substitute Decision Makers SOP
Consumer and Carer Participation Framework
Consumer Feedback Standards: Listening and Learning
Patient Identification: Correct Patient, Correct Site, Correct Procedure Policy
Patient Identification: Correct Patient, Correct Site, Correct Procedure Standard Operating
Procedure
General Practitioner – Hospital Access and sharing of Clinical Information within CHHS –
policy
General Practitioner – Hospital Access and sharing of Clinical Information within CHHS - SOP
Standards
ACHS EQuIP 5:
1.1 Consumers/patients are provided with high quality care throughout the care delivery
process.
1.1.3 Consumers/patients are informed of the consent process, and they understand and
provide consent for their health care.
1.6 The governing body is committed to consumer participation.
1.6.2 Consumers/patients are informed of their rights and responsibilities.
3.1.5 Documented corporate and clinical policies and procedures assist the organisation to
provide quality, safe health care.
National Safety and Quality Health Service (NSQHS) Standards:
Governance for Safety and Quality in Health Service Organisations
Partnering with Consumers
Patient Identification and Procedure Matching
Definition of Terms
Capacity
The term capacity is used in this document to mean a person is capable of:
 Understanding the nature and effect of decisions about consent and
communicating the understanding verbally or non-verbally
 Freely and voluntarily making decisions about consent
 Communicating the decisions verbally or non-verbally, and
 Retaining the information, their decision and their consent.
The type of assessment required to determine someone’s capacity will vary depending on
the type of decision being made.
Doc Number
DGD12-044
Version
2.0
Issued
October 2012
Review Date
October 2015
Area Responsible
QSU
Page
5 of 7
DGD12-044
Clinical Activity
Clinical activities improve, maintain or assess the health of a person in a clinical situation and
may include invasive and non-invasive procedures (including those performed in settings
other than the operating room). Some examples are:
• Invasive - taking a specimen of blood
- giving medication via an intravenous, intramuscular or subcutaneous route
- inserting intravenous access, or
- performing a surgical procedure, including a procedure performed in
medical imaging.
• Non-invasive - interventions such as evaluating, advising, planning
(E.g. dietary education, physiotherapy assessment, crisis intervention,
bereavement counselling, a procedure in medical imaging) and giving
medication.
Consumer
In this document the term ‘consumer’ refers to patients, consumers and clients under the
care of the Health Directorate.
Health Professional
There are two Acts which define ‘health professionals’: the Medical Treatment (Health
Directions) Act 2006 (ACT) and the Health Practitioner Regulation National Law (ACT) Act
2010. For the purpose of this document a ‘health professional’ includes all doctors, dentists,
nurses and allied health professionals engaged the Health Directorate to care for consumers.
Informed consent
A person gives consent based upon an appreciation and understanding of the facts and
implications of an action. The person must be given the relevant information and have the
capacity to understand it.
Valid consent is based on the fundamental legal principle that the law protects the integrity
and autonomy of the person. Consent for a procedure or treatment is valid if:
 The consumer has the capacity to give consent
 Full information on risks, benefits and alternatives has been provided and
understood, with understanding demonstrated
 The consent is given freely, and
 The consent is specific to the procedure.
Medical officer
A conditionally registered or unconditionally registered medical practitioner employed by, or
contracted to, the Health Directorate.
Treatment
Medical or surgical management of a consumer (including any medical or surgical procedure,
operation, examination and any prophylactic, palliative or rehabilitative care) normally
carried out by, or under the supervision of a Health Professional.
Doc Number
DGD12-044
Version
2.0
Issued
October 2012
Review Date
October 2015
Area Responsible
QSU
Page
6 of 7
DGD12-044
Treating medical officer
Medical officer who is delegated responsibility for all or part of the care of a consumer. The
treating medical officer may be a junior medical officer or senior medical officer and may not
be the admitting senior medical officer.
Young person
An individual under the age of 18 years who may or may not have sufficient maturity and
understanding to have capacity to make important decisions about healthcare.
References
Charter on the Rights of Children and Young People in Healthcare Services in Australia, 2011,
Children’s Hospitals Australasia
When can I? A Legal Information Handbook for Young People, 2009, Legal Aid Office ACT
Informed Consent for Health Care Treatment, (1999), Office of the Public Advocate of the
ACT, Australian Capital Territory Government
Guidelines for Health Care Professionals Including Medical Practitioners and Dentists. (1999)
Office of the Public Advocate of the ACT Australian Capital Territory Government
Informed Consent for Health Care Treatment. (1999). Office of the Public Advocate of the
ACT. Australian Capital Territory Government
Guide to Informed Decision-making in Healthcare. (2011) Queensland Health. Queensland
Government
Guidelines for Medical Practitioners on Providing Information to Patients. (2004) National
Health and Medical Research Council (NHMRC) (www. nhmrc.gov.au)
Associated SOPs
Consent and Treatment SOP
Consent and Treatment: Capacity and Substitute Decision Makers SOP
Disclaimer: This document has been developed by Health Directorate, specifically for its own use. Use of this
document and any reliance on the information contained therein by any third party is at his or her own risk and
Health Directorate assumes no responsibility whatsoever.
Doc Number
DGD12-044
Version
2.0
Issued
October 2012
Review Date
October 2015
Area Responsible
QSU
Page
7 of 7