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Young people and consent – should competence be applied more consistently? - contraception-esc.com

Young people and consent – should competence be applied more consistently?

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.

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