Many families wrongly assume that on reaching the age of 18, if their child is not competent to make decisions for themselves, that they can continue to consent on their behalf.  The legalities around health related consent change with age.

The process is straight forward under 16 years of age. Consent is ‘owned’ by a parent, (named on the birth certificate) or a court appointed legal guardian.  Exceptions to this are when disagreements occur between parents and health care professionals on the best course of treatment.  Under these circumstances, a judge would be asked to make a decision in the best interests of a child.

At age 16, a child can consent, known as ascent, to treatment, but cannot refuse treatment if their parents wish to proceed, providing the child has been assessed, (by an appropriate professional), as not having the capacity to make the decision themselves. 

Capacity means the ability to understand information given and then justify a decision made in terms of the pros and cons of what is being offered and what this would mean for the individual in terms of quality of life.

If a child between the ages of 16 and 18, who refuses treatment, can demonstrate capacity, then a court can rule in favour of the child, particularly if there is limited evidence of good quality of life and survival outcomes.

At aged 18, a parent is no longer able to legally consent for their child.  If a person lacks capacity due to temporary or permanent mental disability, then healthcare providers must make treatment decisions in the best interests of their patient, guided by the Mental Capacity Act.  It is best practice to involve next of kin in the decision making process but ultimately parents and/or next of kin do not have to agree with the treatment decisions proposed.    

Leading up to an individual’s 18^th birthday, if it is clear they will not have capacity to make decisions on their own, assuming a parent wishes to continue to make decisions for their child, then an application for Lasting Power of Attorney (LPA) must be made.