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Kiddie Refusing Rx

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15 yaer old boy refusing treatment for liver failure?

1)Parental consent

2)Boy`s own consent ( To assess if he can consent despite being under age)

3)MHA

4)Mental capacity act (common law)

Please advise if I am missing any relevant issue here.

Thanks.It is giving me nightmares!

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Hi,

i think u can mention concept of

Best interests acc to Mental capacity act 2007 and

use of Independent Mental Capacity Advocate.

Also....u have to say very clearly....all medics are to be trained in Capacity assessment...if its not underlying mental disorder....its not for u to do anything...

surgeons shud take their decision....

also mention....very imp....it will be multi disciplinary team decision...., seek ur consultant, seek legal advisor from trust....

is the child Gillick Competent??

i think they might look for thses buzz words..

all the best

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DoH consent to treatment guidelines:

No-one can decide for an 18yr old with capacity- if they refuse treatment it can only be overridden by court.

Children of 16 and 17 are presumed to be legally competent, but if they refuse treatment it can be overridden  by someone with parental responsibility (PR), or the courts.(Children Act 1989)

In a child of less than 16, you have to assess their capacity, making every effort to help them achieve this- don't just assume young age/ LD= incapacitous. If they have capacity, (ie they are Gillick competent) they decide for themselves. Good practice to encourage a consensus to be reached by child and parent, though.

If they accept treatment, they cannot be overridden by someone with PR.

If they refuse treatment, they can be overriden by someone with PR, or the courts (which may be preferable because of the effect on family of parents forcing Rx on a child who is refusing).

If they don't have capacity, cos too young, or can't understand (eg don't realise or believe they'll die), one person with parental responsilbilty consenting is enough for treatment. If both parents have responsibility, best practice to get a consensus. If the consequences of a decision are serious (ie life or death), consider seeking court order anyway.

If lacking capacity because of mental illness (eg depression fwith chronic physical illness leading to suicidality/ not caring about death), one can treat liver failure and depression with PR consent under Children Act or courts instruction under Children Act. Can use Mental Health Act to treat depression, but not liver failure (I can't think of a mental illness that causes liver failure  :-/) Mental Health Act better practice in terms of the safeguards it brings with it for patient, but often seen as stigmatising in kids.

No one can give consent on behalf of a child unless they have parental responsibiity (permission of grandma is no use if mum is alive and well), or parents have devolved this (eg to teachers or childminders) for limilted circumstances. Dads who are not married to mum at conception or birth don't get parental responsibility automatically, but can get it by later marriage, court order, legal agreement etc. If mum doesn't have capacity (drugs, booze, distress, LD) and child doesn't, make a 'best interests' decision as per Mental Capacity Act for non-life-and-death stuff, or if life and death but decision too urgent to apply for Courts.

And thanks for the opportunity, Lad- I've been meaning to look this one up for weeks! :)

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This same PMP has come up several times. Very useful to have the above discussion.

Important to call it as an emergency and to be dealt with immediately.

www.julyan.co.uk/resources/mrcpsych_tips.doc

www.oxfordpsychcourse.com

have more info on approaching PMPs

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that was very comprehensive and useful Ros, it just answered so many doubts that kept going on in my mind.

gee thanks Ros!

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You're welcome! Like I said- posting it helps me to remember it :)

Incidentally, I just found out that the new MHA is going to take away the right of a parent to override a 16/17 yr olds refusal of treatment...but that's not til spring...

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Ross and Dorian

you are helpful as usual. thank you very much :)

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