7 Active Inclusion of Children and Young People
109. Children and young people need information in order to participate in their health care. Participation helps children and young people feel more in control and can help them cope better with illness and treatment.
110. Practitioners should assess the maturity of the child or young person to provide the level and detail of information appropriate to help them in decision making. In particular practitioners should understand the wide variability between chronological age and development stage in times of acute stress. It is recommended that practitioners should:
- Assess how much the child or young person is able to understand
- Be ready to explain and follow up any cues from the child or young person
- Listen carefully to the child or young person and give the information in the detail they need
111. Research shows that even very young children, if properly informed, can be involved in their health care 28. While younger children may not be able to share in all the decisions, they may have strong views on how things are done, for example how medicine is given to them, i.e. pain relief in tablet form or injection. Involving a child or young person in how they are treated can give some feeling of control. This can increase confidence and help in the treatment and recovery process.
112. Sometimes difficulties may arise between respect for the wishes of parents and the rights of the child or young person to have information and be involved in decision making. Staff need to work individually with each child or young person and their family or carers and the rights of the child or young person must be considered.
113. Scotland is a diverse nation and our society is enriched by a wide variety of different cultures. It is important that cultural diversity is respected and emergency care staff should take appropriate steps to adhere to the wishes of children and young people and their families or carers wherever possible.
114. It is important to recognise that a substantial number of children, young people and their families will not have English as their first language. This must be taken into consideration during clinical care and when providing written information.
The Rights of Children and Young People
115. It is very important that health care practitioners understand the rights of children and young people which are governed by various statutes and guidance. While it is not the intention of this report to provide legal advice, health care practitioners should be aware of the following legislation and guidance in terms of the ability of children and young people to consent to and refuse to consent to treatment:
The Age of Legal Capacity (Scotland) Act 1991
Section 2. (4) A person under the age of 16 years shall have legal capacity to consent on his own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending him, he is capable of understanding the nature and possible consequences of the procedure or treatment.
116. The following Act is also important in terms of the right of a child to refuse examination or treatment.
The Children (Scotland) Act 1995
Section 90. Nothing in this Part of this Act shall prejudice any capacity of a child enjoyed by virtue of section 2(4) of the [ 1991 c. 50.] Age of Legal Capacity (Scotland) Act 1991 (capacity of child with sufficient understanding to consent to surgical, medical or dental procedure or treatment); and without prejudice to that generality where a condition contained, by virtue of -
(a) section 66(4)(a), section 67(2) or section 69(9)(a) of this Act, in a warrant; or
(b) section 70(5)(a) of this Act, in a supervision requirement, requires a child to submit to any examination or treatment but the child has the capacity mentioned in the said section 2(4), the examination or treatment shall only be carried out if the child consents.
117. These areas are also reinforced by the:
United Nations Convention on the Rights of the Child (1989)
Article 12 (para 1)
States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.