Antidepressants fluoxetine photographed in the US. Photo: Getty Images.
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When are we mature enough to make life-or-death decisions about our body?

This 16-to-17 age band can pose the most acute ethical dilemmas, as a case in my area illustrated all too starkly.

It is straightforward to provide medical care to a child of, say, four. You seek consent from a parent and usually they grant it; then, you roll up your sleeves and do what is necessary, insulating yourself the best you can from any howls of protest from the patient. Yet fast-forward ten years to when your patient has reached the foothills of adulthood and things are more complex.

It was only in 1985 that the right of a child under 16 to consent to medical treatment was legally established. Victoria Gillick, a mother of five girls, sought to prohibit doctors from providing contraception without her knowledge to any of her daughters while they were under 16. The case went to the House of Lords, where Lord Fraser ruled that, providing that a child had sufficient maturity and understanding, they could consent to medical treatment irrespective of age.

Doctors now regularly gauge this understanding and maturity – the so-called Fraser competence of a minor – and, where established, involve them in decisions about their care. While doctors are expected to encourage parental involvement, it need not be insisted on if the child does not wish their parents to be informed.

Parents cannot overrule consent given by a Fraser-competent child. Paradoxically, if a competent minor withholds consent for care that is felt to be in their best interests, a parent or a court can override their decision. Such cases are rare but they illustrate an important point: we are prepared to grant autonomy when our children agree with the prevailing orthodoxy but we are reluctant to allow them the freedom to make perverse decisions. This must have its roots in an appreciation that medical procedures are often scary and, no matter how competent our children appear to be, they may still be too influenced by fear to be allowed free rein.

No such protection applies beyond the age of 18. Once we reach adulthood, we can decide whatever we like, even if refusing consent to treatment will result in our death. Perhaps the most difficult challenge comes when dealing with patients who are 16 or 17. These adolescents are legally presumed, by virtue of their age, to have the capacity to consent. Yet, unlike over-18s, they can still have a refusal to consent overridden by someone with parental authority or by a court. This 16-to-17 age band can pose the most acute dilemmas, as a case in my area illustrated all too starkly.

The patient was a youth we’ll call Ross, whose mood had been low for some time, probably as a result of bullying. Eventually, his parents persuaded him to see his GP and accompanied him to the surgery. However, Ross wanted to consult with the doctor by himself and his parents, respecting his nascent autonomy, stayed in the waiting room.

During the consultation, it became clear that Ross was severely depressed and he confessed to the doctor something that no one, not even his parents, knew: he had recently tried to commit suicide. The GP recognised that the attempt had been no mere “cry for help” and made an urgent referral to the Child and Adolescent Mental Health Services (CAMHS).

Contact should have been made the following day but because of a transcription error, the wrong mobile number was given and Ross never received the promised call. Instead, a computer-generated letter giving details of an appointment was sent out, which Ross subsequently opened. He never attended. Before the appointment date, his body was found hanging in his bedroom by his mother.

One focus at the inquest was the GP’s decision not to breach Ross’s confidentiality and inform his parents of the depth of his depression and his suicide risk. Had they been made aware, his parents said, they would have ensured that someone was with him constantly. They were also ignorant of the details of the proposed CAMHS involvement, so they had no idea that an attempt to reach him by a phone had failed. When Ross’s appointment letter was looked at after his death, it was found to be formal and stark – a style that parents would be familiar with but was inappropriate for an emotionally vulnerable youth.

Lessons have been learned about reducing the potential for errors in the urgent referral process and about having more adolescent-friendly stationery and letter content. Many people will also have sympathy for Ross’s parents’ impassioned plea that it should be made mandatory for a 16- or 17-year-old’s parents to be informed in these cases, irrespective of the child’s wish for confidentiality. They believe an adolescent with significant depression is a special case in which only qualified autonomy is appropriate.

Set against this is the reality that mental health issues affect around 15 per cent of children and adolescents and, in many cases (though not in Ross’s), family dysfunction, sometimes even abuse, is the underlying problem – a problem that might only become apparent with time and trust. To force doctors to breach confidentiality in those circumstances could have its own equally disastrous consequences.

This article first appeared in the 13 February 2014 issue of the New Statesman, Can we talk about climate change now?

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One Day Without Us reveals the spectre of Britain without immigration

Imagine a country without its NHS workers, its artists and even its consumers. That's why immigrants are striking today. 

What’s the best way of making yourself heard in politics? Protesting in the street, or contacting the media? Writing to politicians? A badge?

One option, of course, is to walk out - and give people a chance to recognise what they’d be missing if you weren’t there. In the labour movement, that’s long been an option – a last-case option, but an option nevertheless – when your contribution isn't being recognised.

A strike is a tit-for-tat negotiation and a warning shot. “I’ll work properly when you employ me properly”, it says, but simultaneously: “Here’s what you’d lose if I stopped”. Done right, the worker’s absence can shift the power balance in their favour.

Normally, people strike according to their role, in pursuit of certain conditions – the tube strikes, or last year’s teacher's strike.

Yet there is also a long and rich history of walk-outs whose terms are broader and boundaries hazier. One of the most famous is surely the 1975 Women's Strike, in Iceland, during which 90 per cent of the country's women refused to participate in either paid or unpaid work.

In 2016, the formula was repeated in Poland, where women went on strike to protest against a draconian change being proposed to the country's already-strict abortion laws. (It worked.)

Immigrant strikes, too, have a history. In 2006, for instance, a coalition of Los Angeles Catholic groups, unions and immigration reform groups proposed a boycott in opposition to a bill which, among other things, called for new border security fences to be built between America and Mexico. (Ahem.)

The action grew to become a national event, and on May 1, the “Great American Boycott” took place, with immigrants from Latin America and elsewhere leaving work, skipping school and refusing to buy or sell goods.

Now, with Donald Trump in the White House and Brexit looming, some have decided it’s time for another strike. Enter “One Day Without Us”.

Today, immigrants here in Britain will strike not for pay conditions or holiday allowances, but for basic recognition and respect. Across the country, businesses will close and immigrants will leave work, many of them to take place in alternative actions like rallies or letter-writing campaigns.

The name of the protest pulls no punches. This, it says, is what it would be like if we all went away. (Subtext: “like some of you want”.)

Because – and let’s be honest here – it’d be bad. In hospital this summer, I was treated by migrants. After 24 hours in NHS, I took a count, and found that only about one in five of the staff who had treated me were identifiably English. Around 4.6 per cent of NHS staff nationally are from the EU, including 9 per cent of doctors. Immigrants clean buildings, make our food, and provide a whole host of other vital services.

One Day Without Us, then, could do Britain a huge favour - it provides us with a quick preview function before anyone ups and leaves for good, taking the heart of our health service, or our food supplies, with them.

In recognition of this, some businesses are actively giving their workers the day off. One 36-year-old owner of a support services company, for instance, is giving her staff a paid holiday.

“Not all my colleagues are taking up the offer not to come in”, she explained. “Some, both British and foreign-born, would prefer to work. That’s fine, I wanted to give colleagues the freedom to choose.

 “It will cause some inconvenience and I’ve had to explain to clients why we aren’t offering all our services for one day, but I feel doing this is the only way to show how much this country relies on migrants. I may be a businesswoman, but I’m a human being first, and it hurts my heart to see how foreign-born colleagues are being treated by some people in the current political climate."

The woman, whose staff is 65 per cent foreign born, has asked her company not to be identified. She’s heard her staff being abused for speaking Polish.

Of course, not everyone is able to walk out of work. I write this from Chicago, Illinois, where last week activists participated in an American predecessor to One Day Without Us called “Day Without Immigrants”. Type “Day Without Immigrants" into Google followed by the word "Chicago" and you will find reports of restaurants closing down and citizens marching together through the city.

But search for just "Day Without Immigrants", and the top stories are all about participants being fired.

One Day Without Us, then, encourages any form of engagement. From human chains to sessions during which participants can write to their MP, these events allow immigrants, and supporters, to make themselves known across the country.

Businesses and museums, too, are involved. The Tate, for instance, is offering free tours showing visitors artworks created or influenced by migrants, showing Londoners which of the paintings that they’ve seen a dozen times only exist because of immigration.

Because paintings, like people, come from everywhere, whether or not you remember. Britain is a mongrel country, and so its art and culture are as mongrel as its workforce: a persistent thread through the country’s history.

We risk a lot forgetting this. At its best, assimilation provides a way of integrating without forgetting one’s own unique identity. In a world where immigrants risk threats or violence, however, invisibility can be the best option. For some, it is better not to be recognized as an immigrant than be abused as one.

Those of us who don’t risk threats have a duty to recognise this. I dislike the glibness of “we are all migrants” – maybe, technically, but we’re not all getting slurs shouted at us in the high street, are we? Still, I also don’t like anyone forgetting the fact that their existence, in all probably, is contingent on someone once being given clemency in a place that was their own. The movement of people is woven into the fabric of society.

Of course, it is impossible to say how successful One Day Without Us will be, or how many people’s lives will be directly affected. But I hope that, even as a gesture, it works: that people think of what would be missing from their lives without immigration.

We ignore it at our peril.

You can view all the One Day Without Us events on the organisers’ website, or contribute to a fund to support businesses which are closing for the day here.

Stephanie Boland is digital assistant at the New Statesman. She tweets at @stephanieboland