End of life care: Children and young people who have capacity

1. 99. You must decide whether the child or young person is able to understand the nature, purpose and possible consequences of investigations or treatments you propose, as well as the consequences of not having treatment. Only if they are able to understand, retain, use and weigh this information, and communicate their decision to others, can they consent to an investigation or treatment.
2. 100. The capacity to consent depends more on young people’s ability to understand and weigh up options than on age. When assessing a young person’s capacity to consent, you should bear in mind that:

1. (a) at 16 a young person can be presumed to have capacity to consent
2. (b) a young person under 16 may have the capacity to consent, depending on their maturity and ability to understand.

1. 101. It is important that you assess maturity and understanding on an individual basis, and with regard to the complexity and importance of the decision to be made. You should remember that a young person who has the capacity to consent to straightforward, relatively risk-free treatment may not necessarily have the capacity to consent to complex treatment involving high risks or serious consequences. The capacity to consent can also be affected by their physical and emotional development and by changes in their health and treatment.
2. 102. You should listen to and respect children and young people’s views about their health and consider how best to support them to reach an understanding of the clinical issues, so far as they are able. You should involve them as much as possible in discussions about their care, whether or not they are able to make decisions for themselves. You should not withhold information about their diagnosis and prognosis that they are able to understand, unless they ask you to, or if you judge that giving it might cause them serious harm. In this context ‘serious harm’ means more than that the child might become upset or decide to refuse treatment.
3. 103. You should work constructively with the child or young person if possible, and with their parents or carers and other members of the healthcare team, and strive to reach a consensus on treatment options and on what course of action would be in their best interests. You should be aware of the arrangements for advocacy^xxv and mediation where you work so that you can advise the child and their parents where to get help and support in making their decision if they want or need it.