Consent-tick-sheet View as plain text This list is based on UK regulatory guidelines and best practice (General Medical Council) and is aimed at most common situations. Its aim is to help parents and medical staff ensure that parental consent to any intervention has lawfully been obtained and to encourage best practice. Children should be included in the process as appropriate to their level of maturity. Has valid consent been obtained from the patient? – Has required information been given in ways the parent/child can understand? This should include diagnosis & prognosis, any uncertainties, treatment options incl. option not to treat, purpose of each treatment, incl. any risks and likelihood of success, side-effects & complications, in particular serious adverse outcomes. – Has the information been given in a balanced way, disclosing any conflicts of interest? Has the parent / child been encouraged to ask questions? – Have staff checked if the information is understood and whether more information is wanted? – Has the parent or child been told they can change their mind at any time? – Have they been given time to decide? – No pressure has been put on parents and their decision has been respected? – Are the medical staff involved suitably trained, have sufficient knowledge of the proposed investigation or treatment, incl. risks involved, and understand the GMC guidelines? – If consent is given by a competent minor, has all relevant information been provided and discussed before they were assessed as competent to understand such information? Conflict between parents Normally consent of only one parent suffices in law but in some cases, such as vaccination, sterilisation & circumcision both parents need to consent. If medical staff are aware of conflicting views between parents in such cases, treatment cannot proceed. A court needs to decide. Conflict between parents and medical staff If parents of a competent minor refuse treatment which is thought to be in the child’s best interest, only a court can override this refusal. A child’s best interest is not merely what is clinically indicated, but includes their own views, parents views, cultural and religious beliefs and values and the views of other professionals. antipyretics View as plain text Consent is a charity supporting parental healthcare decisions. We aim to be a balanced voice for parents, facilitating and promoting better understanding between parents and healthcare professionals. Most parents are not medically trained and rely on doctors for accurate diagnosis and treatment recommendations. However, it is also now common for parents to form their own opinions and to make decisions on behalf of their child which may be contrary to the medical advice they have received. The supreme court in the case of Montgomery said in 2015: “The social and legal developments which we have mentioned point away from a model of the relationship between the doctor and the patient based upon medical paternalism. they also point away from a model based upon a view of the patient as being entirely dependent on information provided by the doctor. What they point towards is an approach to the law which, instead of treating patients as placing themselves in the hands of their doctors (and then being prone to sue their doctors in the event of a disappointing outcome), treats them so far as possible as adults who are capable of understanding that medical treatment is uncertain of success and may involve risks, accepting responsibility for the taking of risks affecting their own lives, and living with the consequences of their choices.” This statement sums up well the change in attitude among patients over recent decades, as acknowledged by the courts. Parents have a duty to make decisions in the best interest of their child. In extreme cases doctors can ask a court to override a parental decision. They cannot, however, override it themselves. The clinical Manual of Fever in children describes the excessive fear of fever among both parents and doctors as “fever phobia” and finds such fears “unfounded”. It points out that: There is considerable evidence that fever promotes host defence against infection, i.e. is an important defence mechanism. Complications and mortality are closely related to severity of underlying disease, not level of fever. Fever does not climb up relentlessly and does not normally exceed 42 C. Temperature above 42C suggest hyperthermia (different causes, symptoms and management to fever). Febrile seizures only occur in genetically susceptible children and are not usually dangerous. Fever does not damage the central nervous system. The principle complication of fever is dehydration, which can be prevented by providing extra fluid to the child. Antipyretics do not prevent febrile seizures. Antipyretics have no positive influence on the underlying disease and may be counterproductive. The analgesic effect of the drug makes the child feel better. This does not mean we have reduced the severity of the disease. However it may encourage the child to take more fluids. NICE guidelines broadly confirm this position: Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose. Do not use antipyretic agents with the sole aim of reducing body temperature in children with fever. Consider using either paracetamol or ibuprofen in children with fever who appear distressed. When using paracetamol or ibuprofen in children with fever: continue only as long as the child appears distressed , consider changing to the other agent if the child’s distress is not alleviated ; do not give both agents simultaneously ; only consider alternating these agents if the distress persists or recurs before the next dose is due. It is important to note that these guidelines are, in effect, asking doctors to use paracetamol (acetaminophen) and ibuprofen as analgesics, not as fever lowering agents. Many parents may feel that the benefits of fever as a defence against infection outweigh the use of paracetamol and ibuprofen to relieve distress. Medical professionals should not confuse the refusal of antipyretics with the refusal of antibiotics in case of a diagnosed serious bacterial infection. Here an antibiotic may save lives while an antipyretic will often lead to a higher chance of adverse outcomes. Refusing antipyretic medication is therefore usually reasonable and can be as a sign of a well-informed parent. Much re-education is still needed in correcting our society’s view on fever and these parents should therefore be welcomed. However they rely on doctors and their expertise to quickly diagnose and treat serious underlying conditions. Heinz Eichenwald, professor of paediatrics at the South Western Medical School, University of Texas – Bulletin of the World Health organization 2003, 81 (5): “Fever represents a universal, ancient, and usually beneficial response to infection, and its suppression under most circumstances has few, if any, demonstrable benefits. On the other hand, some harmful effects have been shown to occur as a result of suppressing fever: in most individuals, these are slight, but when translated to millions of people, they may result in an increase in morbidity and perhaps the occurrence of occasional mortality. it is clear, therefore, that widespread use of antipyretics should not be encouraged either in developing countries or in industrial societies.” Pregnancy-and-childbirth1.2 View as plain text Consent in Pregnancy and Childbirth In the UK it is unlawful to administer any medical treatment without first obtaining valid consent. This principle also applies to expectant mothers and their unborn babies. A mother- to-be cannot be forced to agree to any appointment, examination or treatment, nor to give birth in hospital. An unborn fetus is not a child in law and therefore the Children Act 1989 does not apply. There is no “best interest of the child” test, nor can any decision by the mother-to-be constitute a safeguarding issue until the child is born. is it legal to “free birth”, refuse scans, refuse recommended c-section etc? Yes. You do not have to accept any examination or treatment and you can give birth without any help (unassisted or “free” birth) if you really want to. However, any person helping you give birth may commit an offence if they are not a doctor or registered midwife. Pressure to agree to interventions It is becoming increasingly popular to have “natural” pregnancies and births with minimal medical intervention, including giving birth at home or other non-hospital setting. There is no evidence that this poses an increased risk in most pregnancies. As with all medical interventions you should receive relevant information and be allowed to decide without undue pressure. Although you have the right to refuse all medical intervention, this doesn’t necessarily mean it is a good idea, especially if your pregnancy does not count as low-risk. Your doctor or midwife will have a duty to inform you of the possible consequences of declining a procedure and you should listen to them. However, if you persist in your decision, they must not exert undue influence. If you agree to a treatment because you were told that otherwise you will not be seen again at the hospital or practice or that they will inform social services, your consent will not have been freely given and the medical intervention will be unlawful. Mental Capacity Medical treatment can be given in an emergency without consent if you do not have the mental capacity to make your own decisions at that time, for example if you are unconscious, drowsy, intoxicated or suffer from a mental health condition. Medical staff have to take into account (but not necessarily adhere to) any birth plan and opinions from your next of kin. Intervention without your consent should be exceptional. It is rare that a woman giving birth can be seen as lacking capacity. In particular a person does not lack capacity solely because their choice is seen as unwise. state intervention Once your child is born, the legal situation changes and state authorities can and do obtain court orders in advance of birth, if they believe your baby is at risk of suffering significant harm. However, this should very rarely affect your birth choices and is usually used in cases where parents are known to social services and are unable to offer their babies acceptable levels of care. Even if a pregnant woman was to decline any and all medical attention during pregnancy and childbirth, this could not necessarily be interpreted as posing a risk to the child after birth. We have published separate guidance on parental healthcare decisions and state intervention. vaccinations-v1.2 View as plain text To Whom It May Concern Subj. parental vaccination decisions Consent is a charity supporting parental healthcare decisions. We aim to be a balanced voice for parents, facilitating and promoting better understanding between parents and healthcare professionals. Our charity is being contacted by many parents who tell us they feel pressured or even harassed by their GP surgery for declining, delaying or selectively accepting vaccinations for their children. The vast majority of healthcare professionals respect parental vaccination decision just as their professional standards require. We are making the following points only because a small minority do not. Professional Standards The General Medical Council requires doctors to treat patients with respect and to be polite and considerate. These requirements still apply, even if staff fundamentally disagree with a parent’s decision. It is unprofessional to accuse parents of neglect, exert pressure by inducing fear or guilt, label them selfish, suggest their decision will result in financial loss to the practice or to repeatedly raise the matter at unrelated appointments and/or through unwanted phone calls and messages. Unfortunately all the above continue to be reported to us. Safeguarding Non-vaccination in the absence of any other concerns does not and never has constituted a safeguarding issue. It is therefore inappropriate to threaten a parent with referral to the Local Authority on safeguarding grounds for this reason alone. It causes stress and resentment among patients and diverts social service resources away from real safeguarding issues. Removal of Patients Parents have reported being told they will be removed from the surgery’s list and refused further treatment should they continue to decline vaccinations. Such action is only justifiable if the doctor-patient relationship has permanently broken down, despite real efforts from the surgery to restore it. Justifying such a measure on grounds of non-vaccination is against General Medical Council and British Medical Association guidelines.