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Consent in minors: the differential treatment of acceptance and refusal. Part 1 Autonomy and children's rights

Published online by Cambridge University Press:  05 June 2023

Tim Hawkins Open the ORCID record for Tim Hawkins [Opens in a new window] ,
Martin Curtice Open the ORCID record for Martin Curtice [Opens in a new window]  and
Tom Adams
Tim Hawkins*
Affiliation:
Consultant in child and adolescent psychiatry with Cornwall Partnership NHS Trust, working in an out-patient child and adolescent mental health service (CAMHS) in St Austell, Cornwall, UK. He obtained a Masters of Laws with Distinction in Mental Health Law in 2021 and has an interest in the treatment of depressive disorder in adolescence and the legal basis for treatment.
Martin Curtice
Affiliation:
Consultant in old age psychiatry with Coventry and Warwickshire Partnership NHS Trust at St Michael's Hospital, Warwick, UK. He obtained a Master of Laws with Distinction in Mental Health Law in 2003 and has an interest in mental health law and the Human Rights Act 1998 and has been widely published in these areas.
Tom Adams
Affiliation:
Clinical associate psychologist with Cornwall Partnership NHS Trust, working in an out-patient CAMHS in Bodmin, Cornwall, UK. He holds a Masters in Clinical Associate Psychology and has an interest in autism spectrum conditions and working with adolescents with trauma-based presentations.
*
Correspondence Dr Tim Hawkins. Email: timothyhawkins@nhs.net
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Summary

This is the first of two articles reviewing consent in those under the age of 18 (also referred to as ‘minors’ in UK law). This can be a complex issue in clinical practice because the law endows competent/capacitated minors with the absolute right to accept treatment, but a limited right to refuse. This first article summarises recent cases of refusal of treatment in minors. It uses them to ask two central questions: how do we, as clinicians, think about autonomous self-determination in minors and to what extent does the rights agenda support minors’ autonomous self-determination? Autonomy as one of the principles of biomedical ethics is explored. How the minors’ rights agenda supports the development of autonomy is considered. The amount of weight given in the domestic courts to the rights of minors with reference to the Human Rights Act 1998 and the United Nations Convention on the Rights of the Child is described. These considerations demonstrate the way that the courts are giving the views of the minor greater weight in decision-making in keeping with age and maturity. This article introduces the second article, which comprehensively reviews decision-making in minors, explores competence and capacity in minors and examines the differential treatment of acceptance and refusal.

Keywords

Psychiatry and lawethicschildhood experienceconsent and capacityhuman rights
Type
Article
Information
BJPsych Advances , Volume 30 , Issue 3 , May 2024 , pp. 168 - 176
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

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