Page 3 | Gillick competence

putthatdown · 2021-12-28T21:24:46+00:00

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

Original poster

putthatdown · 28/12/2021 22:32

yep and the dangers of going under a general far outweigh the advantage of a local. Recovery time being one of them. Anyway DD ended up having a local - as DH insisted and she was absolutely fine. For those that feel 10 is a good age to take such a decision how low would you go? 2/3yrs of age? The thing I hate is that it completely negates the fact that these are children. DD shouldnt have to make these decisions - theres enough crap when you're an adult without forcing it on a child. And what if it goes badly would DD then have the live with the emotional aftermath of knowing she had chosen a general?? Mad, mad mad!

OP posts:

Hellocatshome · 28/12/2021 22:32

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 it were explained. I dont think my 11 year old knows what a local anaesthetic actually entails having never had one.

Original poster

putthatdown · 28/12/2021 22:33

no explanation

OP posts:

ErrolTheDragon · 28/12/2021 22:33

Local anaesthetic is uncomfortable and the procedure is quite anxiety inducing.

There's a good reason for that - local anaesthetic contains Adrenalin (I think it helps keep the anaesthetic itself local). This was explained to me before a mole removal - I was feeling calm enough in my head but my body wasn't! DH had to have lots of locals for a tooth filling the other week (he's resistant to them) and came out absolutely hyper.

So I'm inclined to think a surgeon wouldn't want to use a local on kid's neck unless the child was really up for it.

Chloemol · 28/12/2021 22:36

It’s not you having the operation is it? It’s your child

She wants a GA because she doesn’t want to be awake, and having to keep still. It’s probably less scary for her

Ionlydomassiveones · 28/12/2021 22:39

This reply has been withdrawn

This has been withdrawn at the poster's request.

Ponoka7 · 28/12/2021 22:44

@putthatdown, I think that you have an exaggerated view of the dangers of GA in healthy children. As for how low in age, my GD has had a say in her pain relief and relaxants at 7. She has opted for sedation. Children are given the minimum possible and generally shake it off quickly.

Hotpinkangel19 · 28/12/2021 22:45

@putthatdown

yep and the dangers of going under a general far outweigh the advantage of a local. Recovery time being one of them. Anyway DD ended up having a local - as DH insisted and she was absolutely fine. For those that feel 10 is a good age to take such a decision how low would you go? 2/3yrs of age? The thing I hate is that it completely negates the fact that these are children. DD shouldnt have to make these decisions - theres enough crap when you're an adult without forcing it on a child. And what if it goes badly would DD then have the live with the emotional aftermath of knowing she had chosen a general?? Mad, mad mad!

Don't be so silly - you can't compare the understanding of a 2-3 year old to a 10 year old. I think 10 is a age that some input is acceptable.

LuaDipa · 28/12/2021 22:45

@putthatdown

yep and the dangers of going under a general far outweigh the advantage of a local. Recovery time being one of them. Anyway DD ended up having a local - as DH insisted and she was absolutely fine. For those that feel 10 is a good age to take such a decision how low would you go? 2/3yrs of age? The thing I hate is that it completely negates the fact that these are children. DD shouldnt have to make these decisions - theres enough crap when you're an adult without forcing it on a child. And what if it goes badly would DD then have the live with the emotional aftermath of knowing she had chosen a general?? Mad, mad mad!

Huge difference between age 10 and age 2/3. Most 10 year olds can have a procedure explained to them and understand what is happening. It’s not mad to involve a child in decisions involving her care, it’s sensible and proper. You may be well meaning, but you and your dh have just shown your dd that her thoughts and opinions don’t matter a jot to you. That will have a far greater emotional aftermath than anything else.

Original poster

putthatdown · 28/12/2021 22:59

DD had a local - she wasn't hysterical, writhing in pain or in any way distressed. She was fine. Because our NHS Drs are able to remove moles in their sleep! The mole was on the back of her neck and was unsightly as it was one that had multiple growths on it. I had expected the Dr to listen and to take my view into account. It was the fact that it was a minor op that made me also so concerned that general would be on the table...I dont feel that there has been any public debate around this and I dont agree that children are in a position to make decisions like this. The Dr ignored my wishes - and this I find strange. I also find it strange that so little infornation was given to my DD - it was impossible for her to make a choice when presented with so little information

OP posts:

Sirzy · 28/12/2021 23:13

So basically you told your daughter her views on her own body where irrelevant and you and your husband over rode her autonomy. Nice message to send her

Ireolu · 28/12/2021 23:23

The doctor made a best interest decision with regards to anaesthesia. For reasons already mentioned relating to operating on a 10 yr olds neck. Several important blood vessels in the neck.

Glugglejug · 29/12/2021 00:16

Mate you do realise that is what Gillick competence is, right? The autonomy to make decisions about yourself and your body REGARDLESS of what anyone else might want to push you into?

It is up to you, as the adult, as to whether you can influence your daughter. Most parents are able to do this. If your relationship is so poor with her that she doesn’t listen to you there must be a reason. have you thought about seeking help to improve your parenting?

XenoBitch · 29/12/2021 00:17

I need an umbrella for the massive drip feed here.
So DD has already had the op...

CuntAmongstThePigeons · 29/12/2021 01:24

You're totally not being unreasonable op. So many people have such a shallow understanding of gillick competency. Its actually more about preserving the ability of a child to carry on their established life than it is about permission over their own body. Gillick competency was established in order to let young girls take the morning after pill essentially because it was accepted a child COULDN'T consent to changing their entire life set up and assuming responsibility for a minor when they themselves where still one. Gillick competency is about preserving children's right to NOT have unprecedented medical procedures not for their right to have it! Hence why we see it referenced so frequently in discussions about children consenting to puberty blockers. They are incapable of consenting to giving up adulthood, eg sexual maturity etc. As they have no understanding of what they're giving up. Only an adult could no what a massive thing it is to compromise their sexual enjoyment/fulfilment. Which is of course what happens when children take puberty blockers. In this instance I think its important you have recognised this issue. Children cannot appropriately comprehend the risks of GA, so how can they possibly consent to it!!!!! Allowing children to choose their own consent is a slippery slope. PIE anyone?

ChrimboGateauxCatto · 29/12/2021 01:56

I'm with everyone else on this. They assessed her as competent and allowed her to express a preference.

TooBigForMyBoots · 29/12/2021 02:03

They offered a GA for that???

I know people who've had proper bits cut out without the offer of GA.

YouCantTourniquetTheTaint · 29/12/2021 02:20

YANBU if the Dr did not explain the difference between a local and general anesthetic, the pros and cons on each, or what the operation entailed, how on earth can a 10yo make an informed decision?

I'm petrified of going to the dentist, so I now need to be completely knocked out for a dentist to do any work. When I went to the hospital to have a consultation, the Dr explained the difference between the local and general anesthetic, so I could make a decision, I'm in my 30's I've never had an operation, so I needed it explained to me, to make the best decision I could. How can a 10yo possibly make that decision without the relevant information.

Kids should have bodily autonomy, absolutely but they need to know the potential ramifications of their decision.

OrangeShark27 · 29/12/2021 06:50

@TooBigForMyBoots they offered a GA for a child. Yes, what is it you don't understand about the difference between a child and an adult?

Its not about the child chosing, it's about the Dr assessing that child's ability to cope with the procedure under LA. A 2/3 Yr old isn't going to be offered LA for that procedure regardless of how much the parents want it because it's cruel amd not safe.

I don't really understand how you only had a 10 minute appointment but suddenly have had the whole procedure, and no where anyone has actually told you it was a GA

Cuck00soup · 29/12/2021 08:06

@Glugglejug

Mate you do realise that is what Gillick competence is, right? The autonomy to make decisions about yourself and your body REGARDLESS of what anyone else might want to push you into?

It is up to you, as the adult, as to whether you can influence your daughter. Most parents are able to do this. If your relationship is so poor with her that she doesn’t listen to you there must be a reason. have you thought about seeking help to improve your parenting?

Gillick competence refers to the ability of a child to consider information and weigh the risks and benefits.

Competence is about far more than bodily autonomy. I remember a hugely distressing situation where an adult patient had to have surgery ordered by a court because her reasons for refusing it didn't demonstrate that she understood the life-limiting consequences of not having the procedure.

The situation in the OP is less drastic and the OPs child absolutely should be involved in the discussion and offered appropriate choices. However, as I said last night few ten year olds would be able to demonstrate Gillick competence to consent to a general anaesthetic.

TinyLittlePandaSneeze · 29/12/2021 08:13

I find it a bit odd that they didn't explain to you why they were going with the option you said you'd prefer.

LowlyTheWorm · 29/12/2021 08:22

How is it possible that in the OP it sounds like this just happened but then it transpires that actually the child HAD the procedure and it wasn’t even a GA after all as her dad “insisted” she get a local?
So the Drs DID listen to an adult- just not to you @putthatdown? Did you even try to say at the appt that you would prefer the local for your dd and why? Did YOU explain to your child which was which in order for her to make an informed choice? Was there any point in you child having an opinion as you and her father were going to override it anyway? Great lesson she has learnt about her rights to her own body eh? And about women and girls versus men as well.
👏🏻

TinyLittlePandaSneeze · 29/12/2021 08:24

@XenoBitch

I need an umbrella for the massive drip feed here. So DD has already had the op...

Yeah so she's already had the OP? And had a local?

Wtf

sashh · 29/12/2021 08:24

Glad she has had the procedure OP and that all is well.

I was about to say (before your update) that the form might have been so that there is an anesthetist present as the final decision is made on the day.

EarthStoodHardAsPrion · 29/12/2021 08:36

Was the doctor young?

I find it bizarre that she or he would ask you and your daughter separately, receive different answers, and then randomly go with one, against the wishes of the other (obviously more competent) party. Then it’s even odder to subsequently to change the decision, based on what the other (male) person argued.

I’d expect a competent and mature doctor to instigate further discussion and give more explanation in these circumstances, allowing you as a family to reach a consensus. I would also expect a competent doctor to recommend the much safer option of local anaesthesia, where it is a suitable option (as it obviously was) and only offer general as an option if the family consensus was that the child would be too distressed by being awake through the procedure.

So, OP, you are not unreasonable. The doctor did not handle your daughter’s consultation in a competent way. Had they gone ahead with the GA and there had been adverse consequences, the doctor would have been in a lot of trouble for overruling your perfectly reasonable request for the safer option without very good reason. The uninformed feelings of a ten year old are not good enough grounds for taking the unnecessary risk.