Law, Ethics and Safeguarding Flashcards
What counts as a child in England (and Wales)?
Anyone up to the age of 18
Though 16-17 are strange ages and Gillick competency (?) means you they may have greater levels of autonomy
What are the most important pieces of legislation for paediatrics?
Children’s act 1989 - contains information on safeguarding and parental responsibility
Children’s act 2004 - contains the services (mainly social and council) that are available to children
Mental health act 1983 - same as with adults, sometimes children need to be detained for treatments e.g. for eating disorders
Mental capacity act 2005 - only applies to those age 16+
What is parental responsibility?
Outlined in the Children’s act 1989
A parent is responsible for the welfare of their child
Biological mother is the only guaranteed parent and will always have parental responsibility; father is not initially responsible at birth but can become a parent within a few weeks of birth after child and details are registered
Responsibility can also be given to other guardians or teachers etc.
(MORE DETAIL?)
What is safeguarding?
Outlined in the children’s act 1989
GET SOME DETAIL ON PROCESSES E.G. CHILD PROTECTION MEDICALS, SOCIAL SERVICES ETC
What is the law surrounding neonatal resus?
24+ weeks - resuscitate; 23-24 weeks - parental choice (most will say yes); less than 23 weeks - don’t resus (will be protected legally from not doing so)
Even babies delivered at 22wks 59mins or born at 22wks and crying/breathing and a crash call goes out, even if parents are begging you - you legally don’t have to attend the delivery or perform resus
About 1/2 babies delivered at 23wks will survive birth canal, 1/2 of this will make it to the resuscitaire (neonatal resus trolly/equipment), 1/2 of these will survive to the ward and 1/2 of these will survive to go home (though chances are probably slightly better now as data comes from decades ago but is a good rule of thumb and useful to explain to parents)
What are some other potential ethical issues in paediatrics?
Taking blood - removal of autonomy - even up until age 16 and the child is deemed competent, doctors will still often take blood if they feel they need to
Medical students - beneficence/non-maleficence - having students poke at you for their education while not benefitting you medically
People refusing vitamin K (or wanting less effective oral) - B/N-M/autonomy - risks of bleeding for infant
Vaccination - B/A - heard immunity reasons, healthcare spending
Research - B/N-M/A - parental consent gained, may involve taking child out of school, unknown side effects, placebos
What is Gillick competence?
Based on a case
Contraception
Judgement expanded to anyone that can:
How do you investigate a child with a suspected NAI?
Skeletal survey
Ophthalmology - in young infants, to look for retinal haemorrhages i.e. shaken baby syndrome
Full body examination - torn frenulum? Also genital and anal examination
Photos should be taken if there is something to see
What are the rights of the child with respect to treatment?
Under 16:
Can consent to but not refuse treatment, irrespective of whether they demonstrate capacity or not
They may have capacity but wishes do not have to be respected if serious issue and doctor thinks otherwise e.g. wanting to leave hospital whilst being investigated for appendicitis
At 16-17:
Can be treated as an adult and presumed to have the capacity to decide If a competent child refuses treatment - someone with parental responsibility or a court may authorise investigation or treatment which is in the child’s best interests
