Consent: giving permission for your child to have treatment

Consent in healthcare means the process of agreeing or giving permission to have treatment. There are various ways you can give your consent and different circumstances in which we will ask for your consent.

Please remember that we want you to have all the information you need to decide and feel you have made the right decision. This page from Great Ormond Street Hospital (GOSH) explains about consent and how we go about asking for agreement to treatment.

Wherever possible, part of the consent process should involve a joint discussion between you, the healthcare professional and your child. Consent should be given voluntarily – no one should pressure you into giving permission.

Consent should be informed – that is, you should have all the information you need to make a balanced decision, including the risks, benefits and any alternatives (including doing nothing) to the proposed treatment.

We cannot guarantee that the person carrying out the treatment will be the one to ask your permission, but they should be suitably trained and qualified, have sufficient knowledge of the treatment and understand the risks, benefits and any alternatives.

In many cases, a doctor will ask you for consent but some of our senior nurses are able to ask for consent as well.

You could give consent in the following ways:

• non-verbal – for instance, by holding out your child’s arm so a doctor can take their blood pressure, you are giving your consent in a non-verbal way
• verbal – by saying that you give permission for your child to have treatment
• written – by signing a consent form giving permission for your child to have treatment

We will ask you to give permission by signing a consent form when the treatment proposed is complex, has significant risks or may involve the need for a blood transfusion.

In addition, we will ask for written consent for all procedures given with a general anaesthetic.

Sometimes, we ask for your consent at an outpatient or pre-admission assessment appointment some time before the procedure is scheduled. In this case, we will always check that you are happy to continue on the day of admission.

In an emergency, where treatment is needed to prevent death or serious harm, we may try to take consent by telephone. This is one reason why it is so important to check that we have your current contact details. If this is not possible, we will continue to carry out treatment without asking for consent if it is in the best interests of your child.

This depends on your child’s age and whether they are competent or have capacity to make the decision whether to have treatment.

Children under 16 years old can give consent for themselves if they are judged to be capable of making the decision.

If your child under 16 years is judged competent and refuses treatment, this can be overruled by a person with Parental Responsibility, if the doctors think that is in their best interests. However, if your child under 16 is judged competent and agrees to treatment, this cannot be overruled by someone with Parental Responsibility.

If your child under 16 years is judged incapable of making the decision, either due to their age, their emotional maturity or learning disabilities, then a person with Parental Responsibility can give their permission. Parental Responsibility refers to the individual who has legal rights, responsibilities, duties, power and authority to make decisions for a child.

For young people aged 16 years or older, their ability to consent for themselves is judged by the Mental Capacity Act 2005.

Read more about the Mental Capacity Act.

If your child is aged 16 or 17 years old, the law states that they must be the person who is asked to give consent unless they are not able to make the decision. You can only give consent on behalf of your 16 or 17 year old child if they are legally unable to consent for themselves.

Parents cannot give consent for young people aged 18 years or over, even if they cannot consent for themselves. The only exception to this is if you have applied successfully for an Order from the Court of Protection.

If the adult patient lacks capacity and you don’t have an Order from the Court of Protection, the proposed treatment will be discussed with you, but the treating team will make the final decision in the best interests of the young person.

Ideally, we want everyone involved to agree a decision that is in the best interests of the child or young person. However, there will be circumstances where agreement is difficult, so additional people may be called in to provide a second opinion or act as an unbiased mediator.

There is a specialist Court service that parents and the hospital can go to together if ultimately a decision cannot be agreed. We will support you through this process. We only approach the Court as a last resort.

You can change your mind at any point after giving consent. If you do change your mind, we may ask you to record this on the consent form.

Changing your mind will not affect any care your child is given now or at any point in the future.

At GOSH, we want you to be sure about any decisions you make on behalf of your child. We promise that we will always try to:

• take you somewhere quiet
• make sure you have enough time – ask for more time if you need it
• give you as much information as you need – ask us to explain again if you do not understand
• make sure that the right person asks your permission

If you have any questions, please ask the healthcare professional asking for your consent.

You can also contact the Patient Advice and Liaison Service (Pals) office if you have any questions.

Telephone - 020 7829 7862

Email - pals@gosh.nhs.uk

Visit office in the main reception area at GOSH.