01 March 2011
The presumption of competence to make decisions regarding medical and dental interventions occurs at the age of 16 years in the UK. However, case and statute law in England and Wales supports the broad principle that a child under 16 years can give consent if able to demonstrate sufficient understanding and intelligence to comprehend what is proposed and the attendant risks. Statute law in Scotland makes similar provision for children under age 16. It is for the doctor or dentist to use clinical judgment to decide whether the child possesses such a level of understanding and intelligence.
Younger and ‘non-competent’ children under age 16 normally require consent from any one person with parental responsibility (e.g. natural mother, court-appointed guardian or a carer) prior to any intervention. The courts can also grant consent. In an emergency situation, treatment can proceed without consent provided this is deemed in the best interest of the child. Caution is still advised when considering certain forms of treatment, e.g. general anaesthesia or sedation, and extraction of teeth in those less than 16 years.
In England and Wales refusal of treatment by ‘competent’ children under age 16 or by the parents of ‘non-competent’ children can be overridden by a person with parental responsibility or the courts if that treatment is again deemed in the child’s best interests. In Scotland the situation is different: a parent or guardian cannot authorise an intervention that a 'competent' child has refused.