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Children's Autonomy and Gillick Competence: Ethical Issues Children's Treatment Decision Making (1)

Updated on June 22, 2012

Children can be adorable, but making decision for them can be tough.

Making treatment decision for children who have mental issues can be difficult. It can be more than what you think. When your child says "No, I don't want that," you obviously do not want to hurt your child, and you steal cookies from cookie monster and give to your child. However, you want to him to be good, and without doing treatment is not good for him. Such dilemma can be very frustrated.

Many treatments employ in mental health care are considered as controversial. Some people raise a question if these treatments are morally desirable. More precisely, certain cases show that some treatments, such as electroconvulsive treatment (ECT), are not effective on children.

It is not effective because it is difficult to determine if children are sufficient to understand relevant information and make a decision related to the treatment. The children’s decision can lead to the treatment ineffective.

In order to make the treatment more effective, some people claim that parents and health care providers are permissible to make decisions for the children.

Life can be easy if nobody wants to argue. Pearce disagrees that parents and health care providers have permission to make decisions for the children. He argues that if the children can be determined as competence, their decision is valid because they understand the nature of their conditions.

This article, I will examine Pearce's argument with a well-known legal caseGillick v West Norfolk and Wisbech Area Health Authority.

Cookie Monster Question Time

Gillick v West Norfolk and Wisbech Area Health Authority

Mr. Gillick, a mother of five daughters holds that if a doctor gives a contraceptive treatment, included any device for birth control, to any of her daughters without her consent, the doctor will be unlawfully acting. In fact, if the court holds that parental consent is necessary, the under-age pregnancy can increase, but if parental consent is not necessary, the decision would be encouraging under-age sex.

However, the House of Lords holds that minor under the age of 16 can possibly give valid consent to treatment if they have “sufficient maturity to understand what is involved.”[1]In this circumstance, Mrs. Gillick has no power to veto the treatment. Moreover, Lord Scarman states,

[A]s a matter of law the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed.[2]

In other words, while determining children can make any valid decision, age should not be the determination factor. Rather, the determination factor should be primarily on “intelligence.”

Pearce: Respect children's decision

The decision in theGillickcase nevertheless implies although the parents think that certain treatment is not effective, they are not permissible to make any decision for their children regarding the treatment because children can have the ability to consent to the treatment.

In fact, children are often considered as different from adults. In children stage, they make significant developmental leaps in the cognitive, physical, etc domains in a very short period of time than in any other stage of life. It apparently can affect our determination of their abilities to understand what they really need. In order to assess children’s ability,

Similarly, Pearce claims that the central condition is the children’s “stage of cognitive development.”[3]He holds that children should have reached “the stage of maturity”[4]when they can give valid and full consent.

Substantially, their abilities have to include the appreciation of “their own needs and the needs of others.”[5]For making full decision regarding their treatments, competent children should have the ability of understanding nature of their condition and rationale for treatments. In other words, they should know the treatment’s significance risks and benefits. Additionally, Pearce holds that the competent children are able to understand issues related to “the passage of time,”[6]which is, they have to notice what could possibly happen in the future as a result of having the treatment.

Respect Autonomy: This is not the way.
Respect Autonomy: This is not the way.

Autonomy Principle

Both theGillickcase and Pearce’s view in fact are primarily based on the autonomy principle,[7]which means, it is important to respect “the decision-making capacities of autonomous persons.”[8]While a patient has an ability to make a decision, such decision should be respected.

Pearce argues that although parents have rights and responsibilities to protect their children from harm, they also “have the right to give” the children support and guidance. Similarly, he argues that health care providers often have the right to give the best treatment for their patients, but they also have a responsibility and duty “to guide patients towards treatments that they believe are in that person’s best interest.”[9]

A Small Break

In certain degree, I think Pearce andGillickcase is correct. We indeed have to respect children when they are able to make decision. But, is it really all like that simple? Consider the following questions:

  • Are children expressing their wishes or true wishes while making decision?
  • Do they have rationality and enough knowledge of the available treatment for them?
  • Do adults make decisions for their children about their children's welfare?

Before I move to the second part of this topic and pass more cookies to children from Cookie Monster, think about these questions.

Citation

[1]Gillick v West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402 (HL).

[2]Ibid; Lord Scarman’s reasoning is often considered as the test of “Gillick’s competency”.

[3]Pearce, J.,Consent to Treatment During Childhood: The Assessment of Competence and Avoidance of ConflictinAn Anthology of Psychiatric Ethicsedited by Green, S.A., & Bloch S. Oxford: Oxford University Press (2006), p.291.

[4]Ibid, p. 291.

[5]Ibid, p. 291.

[6]Ibid, p. 291.

[7]Courts, especially in US, Canada, and UK, are often based on the autonomy principle to concern medical cases.

[8]Beauchamp, T.L.The Philosophical Basis of Psychiatric EthicsinPsychiatric Ethicsedited by Green S.A., and Bloch, S. Oxford: Oxford University Press (2006). p. 33.

[9]Pearce, J.,Consent to Treatment During Childhood: The Assessment of Competence and Avoidance of ConflictinAn Anthology of Psychiatric Ethicsedited by Green, S.A., & Bloch S. Oxford: Oxford University Press (2006), p.291.

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