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NHS urged to rethink children's rights

A radical reappraisal of children's right to participate in decisions about their medical treatment is needed throughout the NHS, says a report published this week.

The report, published by the Institute for Public Policy Research, acknowledges individual clinicians' excellence in including children in health care decisions. But it is critical of what it perceives as a more general trend away from child consultation towards decision making by parents or health care professionals.

"There is a tendency among health care professionals to underestimate children's ability to cope with complex and distressing knowledge. The health care professional may therefore act defensively, excluding or dismissing children's views," said one of the study's authors, Dr Priscilla Alderson, senior research officer at the Institute of Education in London.

The report also calls for urgent clarification of the law regarding children's consent to medical treatment. After the 1985 Gillick ruling, which suggested that children understand many aspects of consent and that decisions should be taken with their cooperation whenever possible, several legal rulings in 1992 excluded children once more from decision making about treatment.

"We have to provide a new legal system which is practicable and workable and which supports good practice, rather than the law constantly intervening to change health care decisions," said coauthor Jonathan Montgomery, senior lecturer in law at the University of Southampton.

The study recommends an enforceable code of practice for health care professionals that would ensure that those children who want it are given information on proposed treatment and that their views are "genuinely taken into account."

"The emphasis is on partnership and participation, involving children, parents, and health care professionals from an early stage in treatment, rather than focusing on an all or nothing question later on," Mr Montgomery said. The code would promote the participation of children of all abilities in decision making, even if they cannot, or choose not to, take responsibility for decisions.

The report also recommends a change in the law to enable children to consent to, or refuse, treatment if they are competent to understand the treatment and its consequences.

A further change of emphasis is recommended as a future procedural guideline--that all children aged over 5 should be presumed competent unless expressly considered otherwise. Even if young children are unable to make a decision with serious consequences, they may be well equipped to make a minor decision concerning their proposed medical treatment.--ALISON BOULTON, freelance journalist, London

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