Young people and consent – should competence be applied more
consistently?
C. Hazledine
Abacus Clinics for Contraception and Reproductive Health, Liverpool, UK
Introduction: The issue of young people and consent is an area of
particular concern to all who work in sexual health, as young people are having
sex and wish to avoid the unwanted consequences, but do not always wish to
involve or agree with their parent’s views. There appear to be inconsistencies
in UK law as it stands regarding the provision of consent by young people to
medical procedures. These inconsistencies are particularly apparent in those
young people who are just below the age of legal capacity. Young people below
the age of 16 years who are deemed competent to consent to medical procedures
and treatment are allowed to provide that consent, however, their choice may be
overruled if they refuse a procedure. In other words, the level of competence
required to refuse a procedure is higher than that required to consent.
Objectives: To look at the relevant case law from Gillick and beyond,
through to more recent legislation and look at the impact this may have on
future cases. To look at the guidelines set down by The British Medical
Association and the General Medical Council. To evaluate the general conditions
set down for the assessment of competence, with particular reference to the
young person. To explore the ethical issues relevant to applying the level of
competence more consistently. To offer a possible alternative to the current
legal framework.
Methods: Literature review and critical evaluation of the legal cases
commonly used as a benchmark in these situations.
Results: There is an inequality in the way competence to consent is
applied in young people under the current legal framework. Previous case law
lays down no precise guidance, and Mental Health legislation is a commonly used
tool used to override a young person’s decision. There are many problems
associated with the assumption of competence based on age, as this ignores the
fact that individuals develop at different rates. There are no standardised
guidelines to follow when assessing competence in young people. It is ethically
more acceptable that when conflict occurs, the views of the individual to whom
the decision relates should take preference if they are competent.
Conclusion: Professionals working in sexual health have had some areas
clarified, but will still encounter situations where they need to exercise
judgement without clear guidance.
