BANFF & GAMRIE MEDICAL PRACTICE
CONSENT FOR TREATMENT OF CHILDREN
AND YOUNG PEOPLE
November 2008
Review: November 2010
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BANFF & GAMRIE MEDICAL PRACTICE
Policy
(The term “medical service, examination, procedure or treatment” should be taken to
include any medical, surgical, psychological or psychiatric services, examination, procedure
or treatment)
All patients of Banff & Gamrie Medical Practice have the right to:

The highest attainable standard of health, for the treatment of illness and
rehabilitation of health.

Be treated fairly and equitably in the provision of medical service,
examination, procedure or treatment.

Medical services, examination, procedures and treatments that are in their
best interest.
Patients who have the capacity to understand the nature and possible consequences
of a medical service, examination, procedure or treatment also have the right to:

consent to or refuse either in part or in full to any medical service,
examination, procedure or treatment.

be involved in discussions and decision and have their views respected in
respect of any medical service, examination, procedure or treatment.

confidentiality and that no information supplied by them or about them is
disclosed without their consent, unless it is a legal obligation to do so.
The Practice, medical professionals and support staff have a responsibility to those
young patients who do not have the above capacity to ensure that the young patient
receives no less favourable service, care or treatment.
Young patients also have the right to be consulted and their view sought about any
proposed medical service, examination, procedure or treatment, where they are
capable of understanding (even at a rudimentary level) and have the ability to form
an opinion, and have the right to have their views taken into account in decision
making.
Parental Responsibility
Parents, guardians and persons in official positions of locum parentis hold the
primary responsibility for the welfare of the young patient in their care. GPs and
support staff at the Practice will as normal procedure seek the views and permission
of those responsible for the welfare of the young patient prior to providing medical
service, examination, procedure or treatment.
It is assumed that parental responsibility lies with:

The biological mother (unless removed by court order)
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
The biological father (provided he was married to the young patient’s mother
at the time of conception, or birth, or the father has acquired parental
responsibility via a court order or parental responsibility agreement, or the
parents have subsequently married (unless removed by court order).

The young patients legally appointed guardian.

A person to whom the court has awarded a residence order in relation to the
young patient.

A local authority designated in a care order for the young patient (but not
where the child is being “accommodated” or in “voluntary care”.

Any person or organisation holding an emergency protection order for a
young patient.
In Scotland, the Family Law (Scotland) Act 2006, which came into force on 4 May
2006, confers parental responsibility and parental rights on unmarried fathers where
the father is registered as the child's father. However, it only applies to unmarried
fathers who are registered as the father after 4 May 2006.
It cannot be assumed that foster parents, stepparents or grandparents automatically
have “parental responsibility”. A person with “parental responsibility” may however
arrange for some of their responsibility to be discharged by others either routinely or
on a temporary basis.
The medial professionals and support staff will however only accept consent from
the person with “parental responsibility” for routine care or treatment unless they
have given written confirmation that they have discharged the duty of consent to
another named individual.
In an emergency situation, GPs and support staff will accept consent from a person
who has authorisation to discharge responsibility on behalf of the person with
parental responsibility, as long as they are in possession of all the necessary facts
and that the actions are in the best interest of the young patient, for example child
minders, school staff.
Young Patient Consent
A patient is deemed to have the capacity to make informed consent to a medical
service, examination, procedure or treatment if they can:
 understand the advice provided/proposed treatment
 understand the potential consequences
 make an informed choice
Capacity is task specific, meaning that the medical professionals and support staff
need to assess it at every proposed treatment and/or intervention.
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The medical professionals will always encourage a young patient to involve the
people with parental responsibility or another responsible adult in any discussions
and/or decisions about medical service, examination, procedure or treatment.
If however the young patient does not want to involve others medical professionals
should use the Fraser Guidelines as the basis for assessment of capacity.
The Fraser Guidelines:
1. The young person understands the advice being given.
2. The young person cannot be convinced to involve parents/carers or
allow the medical practitioner to do so on their behalf.
3. It is likely that the young person will begin or continue having
intercourse with or without treatment/contraception.
4. Unless he or she receives treatment/contraception their physical or
mental health (or both) is likely to suffer.
5. The young person’s best interests require contraceptive advice,
treatment or supplies to be given without parental consent.
If the medical service, examination, procedure or treatment is in relation to sexual
health it is the judgement of the Law Lords that although a young person or their
partner may still be committing an offence if having sex under the age of 16, Lord
Fraser also stated that “doctors giving such advice in good faith are not committing a
criminal offence of aiding and abetting unlawful intercourse with girls under 16”.
Conflicts
If there is any dispute between the wishes of the person with parental responsibility
and the wishes of the young patient, the medical practitioner will after further
discussion, and possibly seeking the second opinion of another medical
professional, recommend the medical service, examination, procedure or treatment
that is in the best interest of the patient.
If the person with parental responsibility is unhappy with the recommendations of the
medical professional they can make an appointment to see another medical
professional within the practice or be given details of private services if requested.
Current Legislation:
The United Nations Convention on The Rights of The Child
The UN Convention on the Rights of the Child was passed by the UN in November
1989 and ratified by the UK in December 1991. Key principles include.


Each child has a right to be treated as an individual.
Each child who can form a view on matters affecting him or her has the right
to express those views if he or she so wishes.

Each child has the right to protection from all forms of abuse, neglect or
exploitation.
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

Parents should normally be responsible for the upbringing of their children
and should share that responsibility.
So far as is consistent with safeguarding and promoting the child’s welfare,
public authorities should promote the upbringing of children by their families.
The Age of Legal Capacity (Scotland) Act 1991:
The Age of Legal Capacity (Scotland) Act 1991 provides that a person under the age
of 16 years shall have legal capacity to consent (or withhold consent) on his or her
own behalf to any surgical, medical or dental procedure or treatment, including
psychological or psychiatric examination, where, in the opinion of an attending
qualified medical practitioner, he or she is capable of understanding the nature and
possible consequences of the procedure or treatment. This means that a person of
any age has the right to determine their own health care treatment without recourse
to the views and wishes of their parents.
The Children (Scotland) Act 1995:
The Children (Scotland) Act 1995 is the product of debate and consultation going
back to 1988. A decision was made to bring the two strands of private and public law
together into one Act; it is also the first attempt to frame children's legislation in a
way that meets the standards of the UN Convention on the Rights of the Child.
There are three general principles that are found throughout the Act. These are:

The welfare of the child is the paramount concern.

The child's views should be taken into account.

Courts and children's hearings should not make formal orders relating to
children unless they are convinced that they are necessary for the welfare of
the child.
Themes that runs throughout this Act and is contained within Scottish Office
guidance is that while Police and Social Work Departments continue to have the lead
role in child protection, there is a corporate responsibility for all agencies that deal
with children to participate in protection measures.
Another theme is one of emphasising prevention and viewing children and families
as being in need, of which one need may be to be protected.
More emphasis is placed on working in partnership with parents and on taking a
more measured response unless there is evidence that the child is at immediate risk
of significant harm.
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