Ethics & law
Consent in children and adolescents—who decides?
A practical guide
Arguably, one of the most important aspects of the doctor-patient relationship is patient consent. Consent is only valid if the patient making the decision shows competence to do so, a legal principle that is defined as having the “capacity to undertake the relevant task.”1 Whereas people over the age of 18 are presumed competent both to consent to and refuse medical treatment, the situation in younger people is more complex.1
It can be helpful to separate childhood into three stages: young people, who are presumed to lack decision making capacity; adolescents (≥16 years), who are presumed competent to consent; and “Gillick” competent young people (those who are deemed to have reached “sufficient understanding and intelligence”) under the age of 16.1 Determining young patients’ ability to consent is challenging at every stage, often because the family and medical staff may have different views, and as a result disputes may arise. If