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Original poster

Gillick competence

85 replies

putthatdown · 28/12/2021 21:24

My DD had a large mole on her neck and we were able to get an appt to have it removed. At the pre-op meeting the dr asked my DD who is 10 what she preferred a general or local pain relief? She then asked me. DD said general as she wanted to go to sleep. I said local and the Dr wrote down General. Has the world gone completely mad. Since when did medics expect a 10yr old to know what pain relief they should have? Since when did my say as a parent become irrelevant. I feel like my role as a parent is being undermined and that the state is now taking responsibility for every area of my childs thinking! Scary times

OP posts:
Antsgomarching · 28/12/2021 21:50

If the doctor explained in detail to your DD about what those options would entail I would expect a ten year old to understand. I would let my DD at ten choose as long as I was confident she understood what her options were. At that age I probably would have chose general just to see what it was like but I’m sure your DD has more sensible reasons.

snapsieplopp · 28/12/2021 21:52

Would you want to be awake whilst having a large mole removed from your neck?

It's a fairly routine procedure & everyone I know has had it under local.

countbackfromten · 28/12/2021 21:53

We have very clear guidance from the GMC about looking after children www.gmc-uk.org/-/media/documents/gmc-guidance-for-doctors---0-18-years---english-20200211_pdf-48903188.pdf

This line is key - “When treating children and young people, doctors must also consider parents and others close to them; but their patient must be the doctor’s first concern.“

It sounds as if the doctor was involving your daughter in the consultation exactly as they should. And I agree with @Oinkypig, it about ensuring the child’s voice is heard!

snapsieplopp · 28/12/2021 21:54

I had a few stitches & wasn't offered any anaesthetic as a child, now that was painful!

countbackfromten · 28/12/2021 21:55

And I can imagine it was a surgeon you were seeing and not an anaesthetist. We do some procedures under GA that we would do for adults under local anaesthesia, we use sedation for some procedures and ultimately the final decision and discussion is with us on the mode of anaesthesia. We are the specialists in that.

Do I involve children in my discussions tailored to their age and other factors? Of course!

Porfre · 28/12/2021 21:56

Having an LA really hurts.

I've had operations under LA and it took a lot not to freak out.

The needle is sharp and it really stings when the LA goes in. And they put it in and out around the area being operated on. And it really hurts every time they do this for the first few minutes until the LA starts working. It's really painful and in the neck area youd have to be really still.

Then they'd cut the area and you'd feel them cutting it. It doesnt hurt once the LA works but feels dull. But you can still feel the sensation of the scalpel. It's horrible and really difficult to stay calm I would have thought especially in the neck area.

The surgeon probably thought she wouldn't cope with an LA so made the decision themselves.

ShinyHappyPoster · 28/12/2021 21:57

A lot of 10-yr-olds wouldn't understand the possible implications or potential complications of a GA. It would need quite an extensive conversation for a doctor to explain them in an age-appropriate way that wouldn't potentially terrify the DC.
And that's part of the problem because sometimes medical risks are frightening and if a doctor tries to soft-soap them, how can the DC possibly be deemed Gillick competent?
Then there's the issue that we now have DCs being deemed Gillick competent regarding procedure that can and do have lifelong implications. Whilst, in the justice system (around sentencing) it's been accepted that the brain isn't fully developed in under-25-yr-olds which impacts their risk-taking and decision-making.

XenoBitch · 28/12/2021 21:57

@snapsieplopp

Would you want to be awake whilst having a large mole removed from your neck?

It's a fairly routine procedure & everyone I know has had it under local.

Would you expect a child to remain calm and still when having a mole removed? The doctor will be holding a scalpel to this girl's neck. A GA is probably safer all round.
snapsieplopp · 28/12/2021 21:58

My brother did but I guess it was different when we were kids as I doubt a choice was given.

shouldistop · 28/12/2021 21:59

@snapsieplopp

Would you want to be awake whilst having a large mole removed from your neck?

It's a fairly routine procedure & everyone I know has had it under local.

You know more than one person who's had a large mole removed from their neck? Were any of them children who would rather be asleep for it?
snapsieplopp · 28/12/2021 22:00

My brother & my mum actually

megletthesecond · 28/12/2021 22:00

I had a mole on my chest removed under local. It was horrible smelling the burning.
GA all the way, for everything here. I want the medical team to crack on without me stressing.

snapsieplopp · 28/12/2021 22:01

& other relatives, we are a very moley family & a big one!

LadyMonicaBaddingham · 28/12/2021 22:02

I suspect that the GA was offered because the procedure involves the neck - jugular vein/risk if patient panics/ability to see exactly what is going on.

Your daughter should be able to feel supported in her decision, not questioned.

BewareTheRedNosedDragon · 28/12/2021 22:02

@ShaneTheThird

This is a very weird thread.

One the one hand yes even children are able to have a say in their own medical treatment.

On the other why on earth would they even offer GA for a quick routine procedure when GA has such serious complications?!

My ds had an ingrowing toenail minor procedure recently and was offered GA if he wanted it. They appear to be offered to children where they wouldn't be to adults because children find surgery much more difficult presumably. I'm amazed that anyone is surprised that it was offered.
olympicsrock · 28/12/2021 22:05

Why on earth would you put your 10 year old through an operation that is for cosmetic reasons . When you believe she is competent to make up her own mind about her body , then take her back to talk about getting it removed. You can’t have it both ways.

Sirzy · 28/12/2021 22:05

A calmly sleeping child is much safer to operate on than an awake panicking child.

I get your concerns but have you stopped and asked her why she prefers that option? I had a mole removal she 10, in the long run it was done with another operation I had to have a GA for but no way would have managed it wihj a local

Sirzy · 28/12/2021 22:06

@olympicsrock

Why on earth would you put your 10 year old through an operation that is for cosmetic reasons . When you believe she is competent to make up her own mind about her body , then take her back to talk about getting it removed. You can’t have it both ways.
Mole removal isn’t always for cosmetic reasons. Mine wasn’t.
snapsieplopp · 28/12/2021 22:07

Why on earth would you put your 10 year old through an operation that is for cosmetic reasons

It may not be cosmetic, they can be cancerous or uncomfortable eg catching on things

Cuck00soup · 28/12/2021 22:11

This isn't quite right. Gillick competence would require the child to weigh up the risks and benefits of having the procedure under general anaesthetic, something most 10 year olds would not have the maturity to do.

On the other hand the 10 year old can express a preference.

Consent for GA would require someone with parental responsibility or a court order unless it was a medical emergency.

OrangeShark27 · 28/12/2021 22:19

How many times have you tried to cut a large mole out from a hysterical child's neck? If a child isn't able to cope with the procedure it's simply not safe.

That's quite a big procedure for a 10 year old. Some may manage it, but many won't. Local anaesthetic is uncomfortable and the procedure is quite anxiety inducing. At 10 your Dd is old enough to know if she can manage a local.

The question is does a parent have the right to force a child through local anaesthetic they don't want? Sometimes you have to be firm with parents, I have been in situations where parents refuse general while their child is becoming increasingly more distressed, and you have to say no, this child isn't able to cope with a local, you don't want to traumatise them.

I highly doubt the surgeon went GA or LA and then just wrote down Ga. There must have been discussions and some form of consent. They must have actually informed you it was under GA

Original poster
putthatdown · 28/12/2021 22:27

No explanation was given. Unfortunately NHS is very busy and the Dr had 10mins to check the mole, explain that it would be removed and then asked about pain relief.

OP posts:
OrangeShark27 · 28/12/2021 22:28

Also 10 is an age where the child is old enough to know what a local anaesthetic entails. It will be multiple injections to the area and will be uncomfortable

If they go into the procedure confident they can do it, they be fine. If they go in scared thinking they can't they probably won't get through the procedure. The best way at 10 to gauge if a child is capable of local is to ask them.

10 is probably the lower limit of a child where you even consider local for this, and only if the child is capable and complaint.

OrangeShark27 · 28/12/2021 22:29

But they must have told you it was general not just written it down otherwise your going to turn up for your general having eaten breakfast thinking it was a 10 minute LA job

Ponoka7 · 28/12/2021 22:31

"On the other why on earth would they even offer GA for a quick routine procedure when GA has such serious complications?!"

Because without the child's cooperation, consent etc, it won't go ahead at all. The child will be traumatised, possibly put off for good and an appointment will be wasted. My GD has had to have procedures done. At 7 she wanted sedation. They tried without it and there was no way that they could go ahead with it. They will only restrain to an extent. Serious complications in healthy children is very rare.

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