Who can consent for children?

WHEN is it appropriate for people like grandparents or childminders to consent to treatment in children?

WHEN a child needs to consult a doctor or dentist, it is likely that a parent will be the one present to discuss and consent to any necessary treatment.

But what if a grandparent is the one who turns up in your consulting room seeking help for a child’s health problem? Or perhaps a childminder?

The issue of who can consent for treatment in children can, in certain situations, be a difficult one to judge and MDDUS advisers have dealt with a number of calls from members seeking advice on this topic.

It is important to remember the basic principle that, generally, only a person with what is known as "parental responsibility" can consent to a child’s medical or dental treatment (assuming the child does not have the capacity to give consent themselves).

Once it has been established that the child is not legally competent (see the General Medical Council’s 0-18 years: guidance for all doctors), the next step is to determine whether the person consenting to their treatment has parental responsibility.

By law, a mother always has parental responsibility for her child but not all fathers do. In relation to children born after December 1, 2003 (England and Wales), April 15, 2002 (Northern Ireland) and May 4, 2006 (Scotland), both biological parents have parental responsibility if they are registered on a child’s birth certificate.

For children born before these dates, the biological father will only automatically acquire parental responsibility if the parents were married at the time of the child’s birth or at some time thereafter. If the parents have never been married, only the mother automatically has parental responsibility, but the father may acquire that status by order or agreement.

Parents do not lose parental responsibility if they divorce or separate, but they do in cases where the child is given up for adoption. A person also holds parental responsibility if they are the child’s legally appointed guardian or have been granted this right by a court.

In cases of marital separation, extra caution is advised when the parent who no longer resides with the child becomes involved in decision-making about their healthcare. Problems can arise if the resident parent is not kept fully informed and it is recommended to seek advice from MDDUS before proceeding. 

Exceptions to the rule of parental responsibility include carers authorised by a parent and emergency situations where essential treatment can be provided to preserve life or prevent serious deterioration. The GMC offers more detail in its guidance 0-18 years, which states:

“People without parental responsibility, but who have care of a child, may do what is reasonable in all the circumstances of the case to safeguard or promote the child’s welfare. This may include step-parents, grandparents and childminders.

“You can rely on their consent if they are authorised by the parents. But you should make sure that their decisions are in line with those of the parents, particularly in relation to contentious or important decisions.”

As this guidance states, consent from people who are caring for a child – but do not have parental responsibility – can be accepted “if they are authorised by the parents”.

Such consent does not need to be in writing and the healthcare professional does not need to consult the parents unless there is cause to believe the parents’ view would differ significantly. So while there is no specific agreement between parents and a third party in any given situation, the third party can give consent providing it is in the child’s best interests. An example of this would be a teacher accompanying a pupil to A&E for urgent treatment following an accident at school.

For more detailed advice on specific cases, consult an MDDUS adviser.

ACTION: Only someone with parental responsibility – or authorisation from a parent – can consent to treatment in children who lack capacity, except in an emergency.