# data[].attributes.headline
1. Welcome to this learning package about consent in minors within a healthcare setting

# data[].attributes.subject
1. Welcome to this learning package about consent in minors within a healthcare setting

# data[].attributes.body
This package provides a range of documents, videos, weblinks and further reading.  Each section is numbered so you can be sure to work through them in the correct order N.b. you will need to scroll across using the bar at the foot of the screen to see all parts of the package. You will also need to scroll down (using the side bar) to see all content in each tab. Sections which are not numbered can be viewed in any order.
Aim of the session:
To develop knowledge of the existing legal frameworks on consent in minors

# data[].attributes.body
The concepts of consent and assent.

Consent is a legally defined decision given by someone who is competent, who has been adequately informed (and has adequate understanding), and who is free from undue influence enabling them to make a voluntary decision. The person can provide consent themselves (provided they are competent). Otherwise someone else who is empowered by law can provide it (e.g. a parent in the case of children). A child who is not capable of giving consent alone can still be involved in the decision-making process with others who are able in law, to provide consent.

Assent is difficult to define and is used in diverse ways, e.g. compliance by a child as young as three, through to the active agreement of a young teenager etc. Assent is agreement given by a child / young person, or others who are not legally empowered to give consent. It is important to provide children / young people with information that matches their capacity when seeking assent.
(NHS Health Research Authority, undated)

# data[].attributes.headline
2b. The dual purpose of consent : 1. Legal. 2.Clinical 

# data[].attributes.subject
2b. The dual purpose of consent : 1. Legal. 2.Clinical 

# data[].attributes.body
Legal:

The tort of battery is committed where any non consensual contact take place.

A person who intentionally touches another against that other’s will commits a trespass to that person

Clinical:

Enlisting the patients faith and confidence in the efficacy of treatment

Establishing  a trusting therapeutic relationship

Enabling a more efficient recovery

# data[].attributes.headline
2c. Consent and refusal: Two sides of the same coin

# data[].attributes.subject
2c. Consent and refusal: Two sides of the same coin

# data[].attributes.body
The competent adult can consent to and refuse medical treatment

The right to say yes should mean the right to say no?

However if a child under 18 refuses medical treatment there are others who can make a decision on their behalf including the courts

Factors involved in the debate on consent:

Competence

The measurement of competence

The principle of autonomy

Confidentiality

Respect for young people

Meeting the needs of children and young people in the 21st century

Policy drivers

Sexual Offences Act 2003

# data[].attributes.headline
3. Video about Children: Consent, Capacity and Competence.

# data[].attributes.subject
3. Video about Children: Consent, Capacity and Competence.

# data[].attributes.body
These are key concepts in consent in minors. This is the first in a series of 4 videos contained within this learning package.

# data[].attributes.attachment_link.title
Children: Consent, Capacity, and Competence (Part 1 of 4)

# data[].attributes.headline
4. Gillick Competence and Fraser Guidelines

# data[].attributes.subject
4. Gillick Competence and Fraser Guidelines

# data[].attributes.attachment_link.title
Children: Gillick Competence and Fraser Guidelines (Part 2 of 4)

# data[].attributes.attachment_link.title
Mental Capacity Act mini-lecture (Part 3 of 4)

# data[].attributes.headline
6. Scenarios on Gillick Competency and Capacity

# data[].attributes.subject
6. Scenarios on Gillick Competency and Capacity

# data[].attributes.attachment_link.title
Scenarios on Gillick Competency and Capacity (Part 4 of 4)

# data[].attributes.headline
7. Legal Frameworks for Capacity and Consent for Young People.

# data[].attributes.subject
7. Legal Frameworks for Capacity and Consent for Young People.

# data[].attributes.body
Read this excellent guide to capacity and consent for young people developed by lancashire safeguarding adults board.

# data[].attributes.body
I am kind of torn between the two because I think that someone of my age would understand the decision they were going to make, why though would someone want to die so young? (girl aged 16)

I think I am old enough to make my own decisions at 15. I think you should able to refuse treatment if you want to. (boy aged 15)

# data[].attributes.headline
8a. Case Law involving refusal of treatment. Click on these weblinks to learn more 

# data[].attributes.subject
8a. Case Law involving refusal of treatment. Click on these weblinks to learn more 

# data[].attributes.body
https://www.cascaidr.org.uk/2017/03/23/re-m-a-child-refusal-of-medical-treatment-1999-2-flr-1097/

https://www.theguardian.com/uk/1999/jul/16/claredyer.sarahboseley

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119017/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116313/

https://www.medicalandlegal.co.uk/wp-content/uploads/2012/05/The-legal-framework-empowering-children-under-18-to-make-decisions-in-relation-to-their-medical-treatment-examined-through-the-prism-of-international-human-rights-obligations..pdf

# data[].attributes.headline
8c.  Hannah Jones aged 13 refuses life saving heart transplant

# data[].attributes.subject
8c.  Hannah Jones aged 13 refuses life saving heart transplant

# data[].attributes.body
This is a case from 2008.  It is an American report on a British case.  You will see that her father mentions that legal action was being considered by the local NHS trust.  Ultimately this never came to court as in 2009 Hannah changed her mind and had surgery.
Follow this link to the news report in the Guardian https://www.theguardian.com/uk/2009/jul/21/hannah-jones-heart-transplant

Almost 10 years later she met the surgeon who cancelled his holiday to operate on her:
https://www.bbc.co.uk/news/av/uk-43110989

# data[].attributes.body
Children Act. 1989. Updated 2004.
Cornock, M. 2010.

Hannah Jones, consent and the child in action: a legal commentary. Paediatric Nursing 22(2), pp. 14-20.

Cornock, M. and McAlinden. 2018. Law and Policy for Children and Young People's Nursing. In: Essentials of Nursing Children and Young People. London: Sage.

Gilmore, S. and Herring, J. 2011. "No" is the hardest word: consent and children's autonomy'. Child and Family Law Quarterly 23(1), pp. 3-25.
Hendrick, J. 2010. Law and Ethics in Children's Nursing. Chichester, West Sussex: Wiley Blackwell.

Human Rights Act. 1998.
McFarlane, A. 2011. Mental capacity: one standard for all ages. Family Law 41(5), pp. 479-485.
Mental Capacity Act. 2005.
Mental Health Act. 2007.
NHS Health Research Authority (undated) http://www.hra-decisiontools.org.uk/consent/principles-children.html [Accessed 2 September 2021].
Nursing and Midwifery Council. 2018. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. NMC: London.
UNICEF. 1989. UN Convention on the Rights of the Child. Available at : https://www.unicef.org.uk/what-we-do/un-convention-child-rights/ [Accessed 2 September 2021].

Image sources:
Welcome (Group of children) https://previews.123rf.com/images/lenanichizhenova/lenanichizhenova1703/lenanichizhenova170300648/75052100-kids-thumbs-up.jpg
The voice of young people : https://media.istockphoto.com/photos/close-up-of-preteen-friends-in-a-park-smiling-to-camera-picture-id839295912?k=20&m=839295912&s=612x612&w=0&h=wKqW995vF1K5Z22jO-j-mxQnOO0-bukCQa6L1Y_KWP4=
Unicef (Rights) https://www.unicef.org.uk/what-we-do/un-convention-child-rights/

# data[].attributes.attachment_link.readable_text
What is the UN Convention?

The UN Convention on the Rights of the Child (UNCRC) is the basis of all of our work. It is the most complete statement of children's rights ever produced and is the most widely-ratified international human rights treaty in history.

What makes the UN Convention so special?

The Convention has 54 articles that cover all aspects of a child's life and set out the civil, political, economic, social and cultural rights that all children everywhere are entitled to. It also explains how adults and governments must work together to make sure all children can enjoy all their rights.

Every child has rights "without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status" (Article 2).

The Convention must be seen as a whole: all the rights are linked and no right is more important than another. The right to relax and play (Article 31) and the right to freedom of expression (Article 13) have equal importance as the right to be safe from violence (Article 19) and the right to education (Article 28).

We are the only organisation working for children recognised by the Convention.

The Convention is also the most widely ratified human rights treaty in the world. All UN member states except for the United States have ratified the Convention. The Convention came into force in the UK in 1992.

# data[].attributes.attachment_link.title
UN Convention on the Rights of the Child - UNICEF UK

# data[].attributes.attachment_link.description
The United Nations Convention on the Rights of the Child (UNCRC) is the basis for all of UNICEF's work and upholds children's rights all over the world.

# data[].attributes.body
Daily Express (5.8.2021)

Can parents make their 16 or 17-year-olds get the vaccine? Law explained.

https://www.express.co.uk/news/uk/1472814/can-parents-make-16-17-year-old-get-covid-vaccine-law-explained-evg

Department of Health (2009)  Reference guide to consent for examination or treatment Second edition https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf

Care Quality Commission : https://www.cqc.org.uk/sites/default/files/Brief_guide_Capacity_and_consent_in_under_18s%20v3.pdf

British Medical Association: https://www.bma.org.uk/advice-and-support/ethics/children-and-young-people/children-and-young-people-ethics-toolkit

NHS: https://www.nhs.uk/conditions/consent-to-treatment/children/

# data[].attributes.attachment_link.readable_text
Experts have advised all 16 and 17-year-olds in the UK should be offered a coronavirus vaccine. Previously, only under 18s who had certain health conditions, lived with someone with a low immune system, or were approaching their 18th birthday, were eligible for vaccination.

The Joint Committee on Vaccination and Immunisation (JCVI) made the recommendation, but it is not clear when these jabs will be offered.

About 1.4 million teenagers will become eligible for a vaccine when the rollout opens up.

Some countries, including the US, Canada and France, are routinely vaccinating children aged 12 and over.

The UK Government said ministers would be following the advice from the JCVI.
READ MORE: JCVI deputy insists children as young as 12 to get first dose
Can parents make their children get the jab?

Generally, parents cannot force their 16 or 17-year-olds to get vaccinated, though they can provide consent for vaccination.

The legal principles of consent states: "At 16 years of age a young person is presumed in law to have the capacity to consent, so young people aged 16 or 17 years should consent to their own medical treatment."

On consent says, the law says: "For consent to immunisation to be valid, it must be given freely, voluntarily and without coercion by an appropriately informed person who has the mental capacity to consent to the administration of the vaccines in question."

The law goes further, saying that a 16 or 17-year-old who fully understands what is involved in a procedure can refuse treatment (in this case, vaccination) if they desire.

The law states: "Where someone aged 16 or 17 years consents to vaccination, a parent cannot override that
consent.

"Young people who understand fully what is involved in the proposed procedure (referred to as 'Gillick competent') can also give consent, although ideally their parents will be involved.

"If a Gillick-competent child consents to treatment, a parent cannot override that consent.

"If the health professional giving the immunisation felt a child was not Gillick competent then the consent of someone with parental responsibility would be sought.

"If a person aged 16 or 17 years or a Gillick-competent child refuses treatment that refusal should be accepted."

For under-18s without the "capacity to provide consent", the law is slightly different.

The guidance says: "The Mental Capacity Act (2005) applies to those aged 16 years and over and is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment.

"If an adult has been assessed as lacking capacity, that is they cannot make this decision or act for themselves, it may be possible to proceed with immunisation under the principle of acting in their 'best interests'."

Across England, 223,755 under-18s have received a first vaccine dose, according to NHS data to 25 July.

They are only offered now to those over-12s who have underlying conditions or live with others at high risk.

But there was criticism after it emerged GPs were advised to hold off inviting clinically vulnerable 12 to 15-year-olds to take a vaccine due to uncertainty over insurance.

# data[].attributes.attachment_link.title
Can parents make their 16 or 17-year-olds get the vaccine? Law explained

# data[].attributes.attachment_link.description
Experts have advised all 16 and 17-year-olds in the UK should be offered a coronavirus vaccine. Previously, only under 18s who had certain health conditions, lived with someone with a low immune system, or were approaching their 18th birthday, were eligible for vaccination.

# data[].attributes.headline
I hope you have enjoyed working through this learning package.  If you have any questions about the content or anything related to it please don't hesitate to contact me on: brimblemj@cardiff.ac.uk

# data[].attributes.subject
I hope you have enjoyed working through this learning package.  If you have any questions about the content or anything related to it please don't hesitate to contact me on: brimblemj@cardiff.ac.uk