Informed consent is a process and not a single event and it is considered good practice to invest time, effort and care into ensuring that all decisions to be made are ‘informed’ choices and the individual has an understanding of both the risks and benefits of any proposed treatment or intervention and also of not receiving that treatment or intervention.

Refusal of consent occurs for varying reasons. It is particularly important to ensure that the ‘informed consent’ process had been respected and that sufficient time is given for the individual to consider the consequences of selecting various options – including refusal.

When a child refuses treatment in his/her ‘best interests’, then parental consent may take precedence over the child’s refusal. Courts can also intervene when it is considered to be in the best interest of the child to have the treatment and also in cases where both the child and the parent refuse treatment.

Persons aged 18 years or over can always give consent for themselves unless they are deemed not competent to do so (England Wales and Northern Ireland).

Persons 16–18 years old are presumed in law to be competent and therefore can consent to treatment in the absence of parental consent. However, it is considered good practice to involve the family in decision making unless there is reason to believe that it may not be in the best interest of that child to do so ((England Wales and Northern Ireland).

Persons under 16 years of age cannot give consent unless deemed Gillick or Fraser competent – and this is a contentious area for some practitioners (England Wales and Northern Ireland). In Scotland, children of any age can consent to treatment unless they lack the capacity to do so (Larcher 2005).

The age of the child is not the sole indicator of whether he/she can make a decision. Information should be developmentally appropriate and delivered in a way that best suits the needs of the child (Gillick v. West Norfolk and Wisbech AHA (1985) 3 All ER 402 1985).

Parental responsibility: when a child is not competent to give consent for him/herself then the practitioner should seek consent from a person deemed to have ‘parental responsibility’. This may, or may not, be the child’s parents. Legally, consent is required from one person with ‘parental responsibility’ but it is considered good practice at all times to seek the views of the child or those close to the child affected by the decision-making process.

Parental responsibility ends when the child is 18 years old (England Wales and Northern Ireland) and at 16 years in Scotland, though parents can still give ‘guidance’ (Larcher 2005).