see also: [[Capacity and consent]] see: [EMA 2025 - The Problem With ‘Gillick’](bookends://sonnysoftware.com/ref/DL/214301) #paeds #tables > - Depending on specific circumstances, consent to medical treatment of a patient < 18 years old may be provided by either: > - the parent or legal guardian > - patient who is Gillick competent and age >14 > - court > - no consent (doctor) in an emergency | phrase | definition | | -------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Mature minor | age >14 with cognitive and emotional capacity | | Gillick competent | persons >14 who may have the capacity to provide consent in certain circumstances, in keeping with the mature minor doctrine <br>- ==A minor is NOT able to **refuse** treatment using this principle== | | age of majority | 18 years | | Emancipated minor | usually after court order, lives away from parents independently | | medical emancipation | a concept, not law or legal principle. eg age >15, minor has a child (can consent for child +/- themselves) | | Marion's case | aussie case. patents <16 with high risk sexual activities can receive treatment and sexual advice without telling their parents | - consent in Australia generally based on principles that are applicable nationally irrespective of state law minor differences. However, specific mental health and consent laws may apply in each state - the **age of majority** is 18 years - for minors < 18, a principle proxy decision maker (parent, guardian, appointed person, or board) may provide consent for the child - ==in the case of an emergency, the **principle of necessity** justifies treatment without consent== if it is in the best interest of the patient # Emancipated minor - can make decisions including health and financial decisions -- entering a lease, employment, sale/purchase of assets, etc - emancipation happens generally after a *court order* - a ==medically emancipated minor== is one who is considered fit to make medical/health care decisions - ==*medical emancipation is a concept, not a legal principle or law*== that can be applied in certain circumstances , eg: - minors who have a child (may consent for the child and sometimes self) - minors who are married - minors who are aged 15 or older - high school graduates - living away from home without parents (eg emancipated minors) # Gillick competence and Mature Minor doctrine - a 15 year old patient can NOT refuse life saving treatment based on Gillick competence principle or the Mature Minor doctrine - *these are principles and NOT laws* within the australian context - **Gillick competence** is a British based principle based on an UK case that persons >14 may have capacity to provide consent in certain circumstances, in keeping with the mature minor doctrine - ==A minor is NOT able to **refuse** treatment using this principle== where the clinician deems it in the best interest of the patient to proceed with an intervention. - Court sanctioned permission is required to adjudicate cases where conflict exists btwn clinician, parents, and patient > [!pearl] Important > A Gillick competent child's decision to refuse recommended treatment may be overridden by a court exercising its *parens patriae* jurisdiction ## Marion's case - similar to the Gillick case, even though it arose specific to the issue of sterilisation in Australia - states that for ==All patients <16 years who understand all aspects of the advice and possible adverse consequences== where the doctor cannot persuade the young person to inform his or her parents, that in respect of contraception and sexually transmissible illnesses the young person: - is very likely to begin or to continue having sexual intercourse with or without contraceptive treatment - treatment for a sexually transmissible illness - unless they receive advice and treatment on the relevant sexual matters, his or her physical or mental health is likely to suffer - then 'in best interests of the young person' require him or her to receive advice and treatment from the clinician - certain laws from different states within Australia provide further direction in the area of conset to minors ## Role of the courts - in Marion's case, it ws held that courts may exercise general supervisory role ot act to protect the best interests of the child. - this guardianship jurisdiction permits courts to overrule parents (and their Gillick competent children) who have refused treatment, and to authorise treatment based on the concept of 'best interests.' - courts are capable of adjudicating disputes that relate to a child's proposed medical treatment in the event of a conflict btwn parents and children, or involving parents, children, and medical practitioners # special situations - [[Anorexia]] is complex. - the principle of starvation-induced cognitive deficit should be considered - adolescent psychiatrists will invoke the *mental health act* in order to admit pts who do not have capacity as a result of their substrate deficiency. ## Parents who won't give consent / overriding parental consent for life-saving treatment see also: [[Non-accidental injury|NAI]] > [!references]- not-so-helpful references about overriding parent decisions > - [Overriding parents' medical decisions for their children: a systematic review of normative literature.](bookends://sonnysoftware.com/ref/DL/228333) - [online PDF link](https://jme.bmj.com/content/medethics/40/7/448.full.pdf) > - [when doctors and parents disagree 2016](https://www.ncbi.nlm.nih.gov/books/NBK436918/) - some ethics about “the zone of parental discretion” > - [treating minors](https://www.health.nsw.gov.au/policies/manuals/Documents/consent-section-8.pdf) - [devonthink link](x-devonthink-item://93B3FD72-C3B6-40BE-B6F5-C50B8B647DE1) > - [RCH - consent parent fact sheet](https://www.rch.org.au/info/guide-to-rch/Consent/) > In general, this is a very difficult situation. Attempt to reason with the parents, consider culturally-sensitive communication, involve legal and social work and hospital executive / ED executive - The Supreme Court in each state and territory has the power to override parental decisions using their *parens patriae* jurisdiction when it's in the child's ***best interests*** - Can apply for an urgent court order - This jurisdiction can apply to a parent or child's refusal to consent to recommended medical treatment, and to a parent or child's request for treatments which are not considered to be in the child's best interests - In Victoria, notify the **Public Advocate** if parents refuse significant treatment > It is important to be aware that an assignation of [[#Gillick competence and Mature Minor doctrine|Gillick competence]] to an adolescent in a particular situation provides no guidance on how to *resolve* a situation where a Gillick competent adolescent refuses to consent for treatment that others (parents or clinicians) perceive to be in their best interests. See: - [treating children when their parent's wont give consent](https://australianemergencylaw.com/2024/10/07/treating-children-when-their-parents-wont-give-consent/) - [overriding a parents objections to life-saving treatemnt for their child](https://australianemergencylaw.com/2019/09/25/overriding-a-parents-objections-to-life-saving-treatment-for-their-child-wa/) - [A parent's right to refuse medical care](https://www.mdanational.com.au/advice-and-support/library/articles-and-case-studies/2016/03/a-parents-right-to-refuse-medical-care) - [Child protection legislation](https://aifs.gov.au/resources/resource-sheets/australian-child-protection-legislation)