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Overriding competent medical treatment refusal by adolescents: when “no” means “no”
  1. Carolyn Johnston1,2
  1. 1
    King’s College London School of Medicine at Guy’s, King’s and St Thomas’ Hospitals, London, UK
  2. 2
    Kingston University, Kingston Upon Thames, UK
  1. C Johnston, Room 413, Henriette Raphael House, Guy’s Campus, London SE1 1UL, UK; Carolyn.johnston{at}

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In 2007 the General Medical Council (GMC) published 0–18 years: guidance for all doctors1 which briefly sets out the relevant ethical and legal principles for medical treatment of young people under 18 years of age. It recognises that “Children and young people are individuals with rights that should be respected” (paragraph 7) and that they should be engaged in dialogue about their care. However, a dilemma for both the medical and legal communities is whether a young person’s refusal of medical treatment should be respected where this would put him/her at risk of death or serious harm. The GMC guidance states that “You should seek legal advice if you think treatment is in the best interests of a competent young person who refuses” (paragraph 31). The aim of this article is to explain the legal position and to demonstrate the views of professionals involved with young people, gained through interviews, about the balance between respecting autonomy and acting in the young person’s best interests.

If a patient under 18 years is found to lack capacity, then he/she can be treated in accordance with his/her best interests. The Mental Capacity Act 2005 sets out the statutory test for capacity for those aged 16 and over. Under 16s are assessed by application of the “Gillick” test. In the case of Gillick v West Norfolk and Wisbech A.H.A Lord Scarman endorsed the importance of adolescent autonomy. A young person under 16 years who “achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed”2 is competent to consent to medical treatment (and parental consent is not also needed). It was assumed as a corollary that a competent refusal of treatment would also be respected. Many argue that “in logic there can be no difference between …

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  • Competing interests: None.

  • Ethics approval: Research ethics approval was obtained for this study.