• As part of the admission process you need to take Ieuan’s blood pressure. From whom do you obtain consent?

As Leuan is 11 years old you need to consider whether he is ‘Gillick competent’ in relation to this procedure. You would need to establish his level of understanding of your request to examine him and seek his agreement. See Sophie scenario for discussion regarding Gillick competence.

• Leuan’s appendicitis has been confirmed by the surgeon and they want to take him to theatre to remove his appendix. From whom should consent for this procedure be obtained?

Although Leuan was able to consent to the recording of his blood pressure, in order to be Gillick competent to consent for the appendectomy he needs to have the necessary emotional and intellectual maturity to understand the nature of the proposed procedure, as well as any possible side effects along with the risks and possible complications, and also the risk associated with not having the treatment. The person requesting the consent, the surgeon or their nominee, needs to determine if they consider Ieuan to have Gillick competence regarding the operation. If there is any doubt regarding this, although the planned procedure should still be discussed with him, consent should be obtained from his mother.

Leuan is likely to be in pain and this could affect his ability to understand what is being said to him. Therefore, it may be considered best practice for consent to be obtained from both Ieuan and his mother.

• Whilst Leuan is in the recovery ward following his successful operation, his father telephones the ward and asks for information regarding his son. What should you tell Leuan’s father?

Confidentiality exists for all individuals regardless of age. A person with parental responsibility has a right to information about their child where it is needed for them to provide care for that child. Leuan is going to need care to help him recuperate from his operation, so someone with parental responsibility for him does need to receive the appropriate information.

However, the question to be asked is who has parental responsibility for Leuan?

Natural mothers have parental responsibility for their children as a matter of right. For children born since 15 April 2002 in Northern Ireland, 1 December 2003 in England and Wales, and 4 May 2006 in Scotland, if the father’s name is registered on the birth certificate of the child they will have parental responsibility along with the mother. Prior to these dates, fathers only had parental responsibility automatically if they were married to the mother of the child at the time of the child’s birth.

Leuan is 11; therefore, if his father is named on his birth certificate, he will have parental responsibility regardless of whether he was/is married to Ieuan’s mother or not.

Therefore, it would appear likely that both Leuan’s mother and father have parental responsibility for him. However, it is possible that Leuan’s mother and father have divorced and that Leuan lives with only his mother and that there is a court order that has removed parental responsibility from his father. Leuan’s mother would be able to confirm this. As Leuan’s mother is present on the ward, waiting for Leuan to return from theatre, the best course of action is to ask the father to hold a moment and then ask her if she would speak with his father.

If she will not speak to Leuan’s father, you need to ascertain if the father still has parental responsibility for Leuan. If he does, you should inform Leuan’s mother that you will need to share information with his father, unless there any reasons to withhold some or all of the information, such as domestic violence or child abuse.

If there are no reasons to the contrary, you should tell Leuan’s father of the relevant aspects of Leuan’s admission and treatment, even if Leuan’s mother does not want him told. Involving a senior colleague at this point to check your understanding of the legal position would be sound practice

If there are reasons to withhold information, you should tell Leuan’s father that you are not able to provide any information at present and seek guidance from someone more senior.