Decision-making and the child’s autonomy
Decision-making in paediatric palliative care can be complicated by considerations related to the autonomy of a child.
The capacity to act autonomously evolves as a child grows and develops. Although a young child may not be able to make decisions about major health issues, they can make decisions about certain aspects of their medical care (eg pain management, venipuncture sites), and empowering them to do so can help give them a sense of control. The child’s preferences and insights should be actively sought, and used to guide decision-making.
Adolescents develop an increased ability to make their own decisions as they grow older. While some states have legislation relating to the age at which a minor can consent to medical treatment, in practice, there is no fixed age at which a young person is automatically capable of consenting to medical treatment. In common law, the assessment of competence is based upon the young person’s ability to demonstrate sufficient maturity and intelligence to fully understand the nature and implications of a proposed treatment; this is known as ‘Gillick competence’1Bird, 2011. As a young person’s ability to make decisions increases, the parents’ right to consent decreases, although there will be a period of overlap.