Out-patient clinic attendance consent from children and young people: Ethical aspects and practical considerations

There is a growing awareness of the importance of children's participation in making decisions about their own health care. Although there have been calls for a change in the law regarding children's consent to treatment, there is a limited amount of empirical research on this subject from clinical practice in the UK. We review some of the legal and ethical discussion on this subject, as well as related research. In our naturalistic survey at a Child and Adolescent Mental Health (CAMH) out-patient clinic, 4/42 consecutive cases were unaware of their appointment and 14/42 came unwillingly. The findings show that some children and young people do attend CAMH out-patient services unknowingly and unwillingly. This indicates that we should be ethically concerned about the involvement of children and young people in the consent process surrounding attendance and that the theoretical concerns about children's consent need to be practically explored more fully in CAMH settings. Overriding young people's objections to attendance can only be justified if the intervention offered has a sound empirical basis or if professionals can prove that parents overriding their child's wishes have taken valid objections to the intervention into account.