Consent is the principle that a person must give permission before any treatment or examination can be instigated. Valid consent must be sought before the delivery of any aspect of treatment or care. The child or young person and their parents or legal carers should be fully informed and be given sufficient time to consider the information they have been received, along with the opportunity to ask any questions before any care is carried out. The child’s developing cognitive ability must be considered, this recognizes the rights of the child in self-determination.

Consent can be gained verbally, can be written or it can be implied. Verbal consent involves asking the child if they are happy to go ahead with treatment or care. This is usually used for less risky treatments and many day-to-day treatments and tests, for example, recording of vital signs.

Written consent is evidence that the child and parents/carers agree to the proposed treatment following the sharing of information. The consent form also requires the signature of the health professional who has appropriate knowledge of the procedure to be undertaken. This must be in accordance with local policy. Written consent is especially important when treatment carries risk, is lengthy or complex.

Implied consent is used in situations where the child makes it clear that they are giving consent. For example; the child pulls their sleeve up when asked if they will have their blood pressure recorded. The nurse should always tell the patient what she intends to do to avoid misinterpretation.

In order for consent to be informed, the child (in line with Fraser guidelines) and their parents/carers must be in receipt of the correct information. This includes being made aware of the risks and likely effects of the treatment. This information should be delivered in an age-appropriate language. Evaluating competency to give consent is an important part of the process. Children’s competence is not determined by their chronological age but by their maturity and understanding. Capacity should always be assessed when gaining consent. Competence is decision-specific and should be considered only in relation to the decision that needs to be made at that time. The test of competence that can be applied involves the child doing the following:

• understanding the treatment required;
  
• comprehending the implications of any such treatment effects and side effects/risks;
  
• retaining the information for long enough to make an informed decision;
  
• giving their consent freely.

The Mental Capacity Act, 2005, describes a person who lacks capacity as someone, therefore, who is unable to make a decision for themselves because of an impairment or disturbance in the functioning of their mind or brain. This can involve disability, a condition, trauma or the effects of drugs or alcohol.

Between the ages of 16 and 17 years, young people are permitted to consent to treatment under the Family Law Reform Act (1969). However, if they refuse to consent to treatment of a mental health issue, they cannot be admitted to hospital on the basis of consent given by someone with parental responsibility. They can be detained under the Mental Health Act of 1983.

A person with parental responsibility for a child could be: the child’s mother, the biological father, the legal guardian, a person with a residence order concerning the child, a local authority designated to care for the child, or a person with an emergency protection order for the child. If one parent with parental responsibility agrees and the other does not, the health professional will decide if the treatment will proceed or not. If there is disagreement, then legal advice will need to be sought.

There are a few exceptions where treatment can go ahead without consent. For example; if treatment is required in an emergency situation and the child is unable to give consent, or during an operation if the immediate need of an additional procedure to treat a life-threatening problem arises, or in the presence of severe mental health conditions and capacity to consent is diminished.

In the case of major trauma where the child may be unconscious, they may receive treatments that are essential to preserve life. In law, this is permitted as it is in the best interests of the patient.