Consent for children and adolescents who have an intellectual handicap.

Annotation Consent for children and adolescents who have an intellectual handicap Every day paediatric practice probably raises a few queries concerning consent. Parents give their consent by proxy, based on what they believe is best for their child, determined largely by medical information and family custom. But there are several well known conundrums: there is the child with no living parents, the abandoned, handicapped child in the long stay hospital, the child in foster care, and the child who is at risk from his own family. There is also the child who cannot have blood transfusions for religious reasons. An unaccompanied minor is the term for a child refugee who may well have parents but in the havoc of war has become detached and is alone in a foreign country. Most of these situations are resolved by relying on precedent, and in the minority, by the use of legal procedures such as wardship or reception into care. Current dilemmas concerning consent Several incidents in the last 10 years have caused concern. There is the debate on how much information is necessary for consent to be fully informed, the question of minors who wish to give consent for contraception but expect confidentiality, and the dilemma of those who have reached their majority but remain unable to consent because of intellectual handicap.' Then there is the question of who can consent when the operation has eugenic overtones, such as sterilisation or abortion of both minors and adults who are unable to consent. The child with intellectual handicap Consent by proxy from caring parents will be the norm for intellectually handicapped children under 16 years, but if necessary the child can be made a ward of court or be received into care. While the procedures are no different for the handicapped child and his or her parents, there may be particular difficulties because of the presence of handicap. Parents, for example, may have difficulty in deciding to consent to a life saving operation on a multiply handicapped child, either at birth or later on. The outcome of standard surgical or medical intervention may be unclear because of the handicaps or parents may be asked for permission to involve their handicapped child in research procedures. Perhaps the most iniquitous of all is that they may be asked to sign a compulsory prospective 'cover all' consent form if their child is admitted to residential care, …