From Gillick competence to vaccines: the parental consent conundrum
Partners:
‘Who decides?’ is an important question that underpins the medical treatment of children, regardless of what that treatment is. In most cases, it is not a question that requires much scrutiny – both patient and parent usually want a healthcare professional to use their expertise and knowledge to treat and cure the problem.
However, sometimes making this decision can become complicated. What if the patient doesn’t want what their doctor thinks is best? What if the parents disagree, or object in principle, to what is proposed? No clinician can treat a patient without their consent and by law consent must be ‘informed’, which means the patient must understand what the treatment entails (including its risks and benefits). If the patient is not able to consent, then someone needs to consent on their behalf – with children this often means parents or guardians.
There has always been a grey area with adolescents. While the legal age at which someone crosses the line to adulthood is clear and bright at 18, there are many important areas of life requiring mature judgement that happen earlier and young people’s capacity to make decisions can vary enormously. This makes the issue of consent to medical treatment especially difficult when it becomes complicated by values and politics. An adolescent may have strong views about what is right and wrong that differs from their parents’ views. This has come to the fore in the discussion about the roll out of Covid-19 vaccines for school children and teenagers.
UK vaccines minister Nadhim Zahawi has assured parents that they will be asked to give consent before their children are jabbed. But he has also suggested that if parents refuse their consent, children may be able to consent in their own right under the precedent known as ‘Gillick competence’. Established in the 1980s, the Gillick competence ruling allows the confidential treatment of under-18s without parental consent if the clinician considers they are sufficiently capable of understanding the treatment – and would further be at risk of harm if they didn’t receive it. The 1985 court judgement that established the precedent related to contraception, but it is now applied in other areas. Thanks to a move towards a ‘no decision about me, without me’ form of patient-doctor relationship, clinicians are now more likely to be concerned with what children think, rather than simply what their parents want.
The suggestion that kids could consent to the vaccine without, or in spite of, their parents’ wishes has led some parents to vow to keep their children off school for the duration of any vaccination programme. It has also raised concerns about other ways in which assumptions about Gillick Competency might undermine parents’ authority. A fundamental part of a child’s safety is the love and trust of their parents or guardians – could encouraging children to second guess their parents’ judgement about vaccines lead to a suspicion in other areas of life
What happens when we question parental consent? What about other examples – is it right that a 14-year-old could have an abortion without their parents’ knowledge or consent? And if she can consent to hormonal contraception, why – as the courts are currently discussing in relation to trans children – can’t she consent to hormone blockers to delay puberty? Is there a reason why we’ve seen such an outcry about consent for the Covid-19 vaccination, and not for other school vaccination programmes? And what is the right balance between respecting the decisions that young people want to make for themselves, and respecting the rights of their parents?
