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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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The continuity between Ed Miliband and Jeremy Corbyn

The left say that the former leader created crucial intellectual and political space for them.

One of the errors in the leaked list ranking Labour MPs by favourability to Jeremy Corbyn was the inclusion of Ed Miliband in the "negative" category. Most in the party believe the former leader is better described as sympathetic to his successor. In recent interviews he has defended his leadership more robustly than many shadow cabinet members and has offered him private advice.

Last year I reported on speculation that Miliband could return to the shadow cabinet (a rumour heard again this week). Those close to the former leader continue to dismiss the possibility but he will appear with Corbyn today at a pro-EU climate change rally in Doncaster - the first time the pair have shared a platform. "Ed's more engaged than he's been for a long time," a friend told me.

Though Miliband did not vote for Corbyn in last year's leadership election (sources say he backed Andy Burnham), there is notable continuity between their political projects. In interviews with me, shadow chancellor John McDonnell and Momentum chair Jon Lansman have spoken of how the former leader created crucial intellectual and political space for the left. Those on the party's right make the same point - if rather less positively. A former shadow cabinet member told me that "the left of the party was indulged for five years and wasn't challenged".

It was under Miliband that Labour first identified as an "anti-austerity" party, with the then leader addressing a 2011 anti-cuts march. Though this stance was later abandoned, as emphasis was put on the need for public spending reductions (with room left to borrow for investment), it provided Corbyn with an opening to exploit.

It was also Miliband who denounced the Iraq war and promised a new approach to foreign policy, declaring in his 2010 conference speech: "Our alliance with America is incredibly important to us but we must always remember that our values must shape the alliances that we form and any military action that we take." His refusal to support the government's proposed intervention in Syria in 2013 was hailed by him as preventing a "rush to war". By promising "a different kind of foreign policy - based on a new and more independent relationship with the rest of the world", and opposing all recent military actions, Corbyn has travelled further down a road taken by Miliband. 

The Labour leader's promise to give greater power to party members similarly follows Miliband's decision to give them the ultimate say over the leadership (the system that enabled Corbyn's victory). Rail renationalisation, limits on media ownership and opposition to privatisation were also stances either fully or partly embraced between 2010 and 2015. 

Many of those who voted for Corbyn backed Miliband in 2010 or joined after being attracted by his radical moments. For them, Corbyn, the only candidate to position himself to Miliband's left from the outset of the contest, was his natural successor. It was these left-leaning members, not Trotskyist entryists, who enabled his landslide victory. 

The continuity extends to personnel as well as policy. Simon Fletcher, Corbyn's director of campaigns and planning (formerly chief of staff), was Miliband's trade union liaison officer, while Jon Trickett, the shadow communities secretary (and key Corbyn ally), was a senior adviser. If Miliband is more open to the Labour leader's project than many other MPs, it may be because he recognises how much it has in common with his own.

George Eaton is political editor of the New Statesman.