Medical/dental treatment and child's consent

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Before I reveal my hand, please can I ask what you feel the legal and ethical implications are where a child point blank , clearly states they refuse important treatment for serioius but non-lifethreatening ailment.Sorry it's vague but I don't want to influence replies. Age say 11-13

I think in that situation you’d be hard pressed to find a doctor willing to perform the treatment. They would hopefully be able to give your child enough information and confidence to change their mind and also refer to other services for phobia therapy etc ( ie if child had needle phobia).

Out of interest is the child terrified or stubborn? Or possibly have a point of view that needs to be considered? Also is the treatment time specific? Could it be delayed or modified in a way acceptable to the child?

It depends very much on what it is. You say it isn't life threatening but would not having it have an irreversible impact on their life in the future. I think I would go for bribery rather than forcing them to do something though.

I think as the parent you have the responsibility to make the decision for them.

Like all matters of discipline with children as they get older they have to agree to do what you tell them to do, whether that is cooperating with dentists and doctors, doing their homework, being grounded as punishment, etc.

How invasive and important is the treatment, and is there a viable alternative? Are we talking about wearing glasses or surgery? What's the impact of not getting it done now, can it be done later?

Earlier today I was in such a situation with my 15 year old. She was due a procedure and had been anxious about it since knowing. She has said a number of times that she didn't trust the person who had instructed for it to be done. We have tried to talk through the reasons why it should be done and how some anxiety is understandable.

Today she questioned the practitioner about whether it really needed to be done (not the person who had referred her). They would not advise but said that we could discuss further the reasons with the original referer, get a second opinion or they could refer her for sedation if it was undergoing the actual procedure that was the issue.

I did feel that this wasn't my decision to make and that my daughter needed to consent. The practitioner remained very neutral and kept on saying that they didn't mind, it was our choice. I don't believe they would have gone ahead without daughter consenting.
Had a tense moment, not really knowing what to do, before explaining that all other options would mean that there was a lot more time to build up the anxiety and make the procedure a much bigger thing that it actually was, and may well still result in the same outcome.

Daughter agreed to go ahead and afterwards said that she was glad that she had.

It's a tricky one. My DS was told age 9 he needed braces and was hysterical, wouldn't even consider it. Thankfully the orthodontist said he'd need to wait a year, we have an appointment next month and he seems to have come round to the idea. It's not something I could have forced as like others have said it requires patient compliance. However I wouldn't consider that 'serious' as it's something that can be done at any point in the future. I think as long as the child has all the facts and an understanding of the consequences of refusal then you can't really force them and I doubt medical professionals would be happy to either.
I work in veterinary medicine where I carry out procedures against the patients will every day, however even then I don't believe in forceful restraint and would use sedatives in tricky patients rather than causing distress by pinning them down, unless it was a dire emergency.

It really does depend on circumstances. My DS has had previous operations in the past, when he was too young to really have any input. They were operations that improved his eyesight but may have seemed purely cosmetic to those who did not understand.

Last year he was offered another op, age nearly 11. He said point blank he did not want to surgery. I told the surgeon we would review it in a year, as with him saying no I was not prepared to go against his wishes at this age.

Another op would not improve his eyesight at this age, would purely be cosmetic, so really has no impact on his health.

Today we had his annual review and he has said he wants to have the operation. If he hadn't, we would not have pushed it.

I suspect your circumstances are different though.

Depends what it is. Most dentists take the “gillick competence” approach which was a legal case years ago with regards to an under 16. It basically suggests that if the child is able to understand the consequences of their action or inaction then they are deemed competent to say yes or no to treatment themselves. Each child is different; you could have a mature 13 year old who understands the consequences of their inaction or an immature 13 year old who doesn’t understand what would happen; they just know they don’t want it done. Each child would be treated differently in this scenario.

Hard to say wihout more info, but Gillick compentency can be a grey area, especially where mental health is concerned.

If they do not receive treatment and their wellbeing is compromised to the extent that professionals become worried, it can turn into a child protection issue. I have known this happen.

My advice would be to really listen to the child’s concerns and also help them see the benefit of treatment, but ultimately it’s best tackled from a ‘this is what is happenig next, let’s discuss how to get through it’ angle. Some choices are too scary / overwhelming for children to make. Parents are responsible for their child’s wellbeing and need to make these decisions for them.

At 13 I had issues with my jaw (the ligament had gone and it kept popping out on one side) which I was offered an operation to fix. It was explained to me that the procedure would leave me with a small scar under my cheek bone, but would massively improve my situation.

At the time the problem was irritating but manageable, so I chose to wait on the understanding that if the situation worsened I could go ahead. I had it done at 16 when I started getting some pain with it.

I'm so glad that my parents and the medical professionals allowed me to make that choice myself. The scar doesn't bother me now, but I think if I'd been forced to undergo the op when I didn't want it I would have a very different view of it!

Assuming this situation is something similar in that it can be done later/won't be made worse by not having the procedure, then I would definitely allow the child the final choice.

At 11-13 they would be deemed competent unless there were underlying SN

en.wikipedia.org/wiki/Gillick_competence

It really depends on context the their own ability to understand the consequences of their action (or inaction). A child not wanting a painful operation that will greatly improve their quality of life is very different to a child who has been through extensive cancer treatments and doesn't want to try "one last thing" because they know at best it extends life by a few months.

A child who refuses treatment to face death is incredibly brave, but with support from appropriate medical personnel their wishes should be supported. (Stroppy teenagers however may need to be overridden if it's in their best interest)

My understanding of "Gillick competence" is that it is actually only about minors being competent to consent TO treatment, not competence to refuse treatment. Which actually makes a moderate amount of sense.

So in practice I don't think a child of this age saying no would suffice on its own; but in most non emergency situations the child would continue to be involved in discussion with parents and doctors over whether the procedure should go ahead. And a decision to refuse would ultimately be the parents and/or doctors decision having weighed up the importance of the procedure against the child's refusal.

So I think in most "non life threatening" circumstances, postponement would be the most likely outcome. If it was something where delay would increase problems or lead to a worse outcome, then it might sometimes be appropriate to say, actually, sorry, I know you don't want it but you need to have it done and that's that.

Serious can become life threatening if left untreated. If the child refused, was untreated, became seriously ill and died I'm pretty sure the authorities wouldn't shrug their shoulders and say oh well, it was their choice and they showed they were competent to make that choice. It would be the parents that would be accused of neglect. Like pp said, Gillick and Fraser are usually for people to give consent rather than refuse consent but there may be case law that says otherwise.

My ds1 refused to have sutures aged 13 to a wound on his chin after falling of his bike. The hospital had even got an on call plastic surgeon in to try to persuade him. He also refused a tetanus booster at the same time. I was furious with ds1 at the time. I work as a mental health nurse in the same hospital he was seen at and knew the staff, I also knew he had capacity to make this decision even though I tried to persuade him. He was left with a bigger scar than if he had been sutured but went home and read up on tetanus and had the booster the next day.

D's 13 has ASD and a needle phobia. He has needed quite extensive dental work for several years now and has not consented. The dentist referred him to clinical psychology for help with the phobia, attempted GA sedation several times (he got got very anxious bot h times and the nurse insisted it didn't go ahead) and numerous other relaxation/CBT techniques in order to treat the now quite serious decay. They absolutely will not force a non life saving procedure, at every point ds has been told that he is in charge.