The General Medical Council
178 Great Portland St.
London
W1W 5JE
8/1/07

Consultation on Children and Young People;
Doctors` Roles and Responsibilities
Dear Sir/ Madame,

Thank you for inviting a consultation on this important topic. The Medical Ethics Alliance is a coalition of Hippocratic and World Faith medical bodies. The well being and rights of children in health care is a subject that we take very seriously.

In general, we support the draft document which clearly reflects the current legal position but the emphasis could be improved. In fact, the role of the person with parental responsibility is crucial, and we think this does not come across clearly enough. The draft does not appear to reflect paediatric practice, where the all important role of parents is central. Instead, there is an over emphasis on autonomous decision making by the child. An example of where this may give rise to difficulties is when a decision to undertake necessary but burdensome chemotherapy has to be taken. The child, or even a young person, may understandably be more concerned with the immediate unpleasantness of the treatment.

We would be interested to know whether parent groups were involved with this draft? Their input would be relevant and important. Within the text, there should be a clearer acknowledgement that the parents are the usual and normal source of decision making, and should virtually always be in agreement with the course of action proposed. This includes decisions on whether to withhold or withdraw treatment. There is now a body of case law, some of it from the European Court of Human Rights, to the effect that parents who do not agree, are entitled to seek a judgement from the courts. We, as an Alliance, are concerned that there may not be an equality of arms or resources when parents are in dispute with NHS Trusts.

It would be helpful if the role of the courts were better covered. For example, a reference to the powers held by the courts over a child or young person who is in their charge, or subject to Family Proceedings such as Care Orders or Wardship. If that was included, it would not only be informative, but would illuminate the role of parents, for the Judge in a Wardship case, or other statutory authority, only shares parental rights, and does not have superior rights. A mention of the role of the Official Solicitor in representing the interests of the incompetent would have been useful. The courts only intervenes when parents cannot, or will, not exercise their responsibilities towards the child, or if there is a dispute about what may or may not be lawful. The courts are also equipped and experienced in making decisions that are the child's “best interests”, which is the paramount consideration.

In paragraphs 64 -69, relating to sexual activity, we think it was insufficient to give qualified advise about reporting child rape to the statutory authorities. Sexual intercourse at or below 13 years is statutory rape and even if the perpetrator was not abusive or coercive, should always be reported. It is then a matter for that authority, which can well exercise all due considerations, to decide if a charge should be laid before a court. We note from Home Office reports that vulnerable children are being entrapped into prostitution with the average age for males being 14 years, and females 15 years.

We were puzzled by the term “non therapeutic” treatment used in connection with children who lack capacity in par. 23, as this is a contradiction in terms. We do not think that the section on “best interests”, is adequate as there is no reference in it to treatment that would benefit or preserve their life of a child or young person. We think this is contrary to the Mental Capacity Act 2006. It may be that an input from groups who represent the interests of disabled children would be helpful in this regard.

Summary;

In general, we support the draft document but feel it does not do justice to the vital role of parents, and is weak on the legal defence of children and young persons, and places an unrealistic emphasis on child autonomy. That is in no way to lessen their rights, but in the clinical situations that arise, it is not always possible to make decisions based mainly on their choices. In fact, we found the explicit comparison of children's rights with those of adults to be unhelpful.

Yours sincerely,

Dr Anthony Cole
JP FRCPCH
Chairman

PS Please acknowledge this contribution in your final report.