Should only one parent be entitled to consent to treatment?

drkpower

This could also be in the medical or legal fora, but Im punting that this forum might get the most reasoned response...... (slluuurrrppppp....;)).

The problem is this. As most parents will know, when little Johnny needs any kind of treatment, almost invariably one parent (or even Granny:eek:) will go to the doctor and will provide the requisite consent. This happens with trivialities, and extends often to treatment for illnesses and vaccinations and very often to more substantial operative procedures. AFAIK (and this is where doctors currently in practice might help clarify), it is quite rare for a doctor to insist that both parents be consulted and asked to authorise treatment (unless, of course, both parents happen to be there). There is usually an assumption that the other parent will agree with what the other parent says. This usually a very reasonable assumption, but it is an assumption nevertheless.

So, leaving aside the other very interesting question of whether this is legal (answer: probably no), is this right? Is this appropriate? Should each parent be consulted for healthcare decisions, and without both, should treatment be withheld/postponed (except in emergencies) ? Or can you seperate out the 'straightforward' procedures (that just need one parents consent) from the 'difficult ones' (which need two) ?

It is a practice that has gone on for so long (with dubious legal backing) and with the potential for such massive disagreement, that I am surprised ive never seen it discussed in any meaningful way.

The issues are somewhat different where divorce (and custody Orders), unmarried mothers etc come into it so lets park that for the moment.

metrovelvet

I think for the common cold and gp visits for things like infections, probably not. It would probably create a huge administritive and legal minefield.

For major and not so major things like surgery or treatments, vaccinations, physical therapy, chemo, [ particularly in the WITHOLDING of them ] two parents should be involved.

As for your post script, I don't think you can leave the divorced and single parents out of the discussion as they are a significant part of the parenting population.

seamus

So difficult to come up with any kind of standard answer on this.

Common sense would tend towards saying that if it's something minor, then either parent should be consulted. But if it's something huge, then both parents can be consulted.

However, I can think of two very easy counterarguments to those. In the minor case, you may have a dubious or unnecessary vaccine or antibiotic as treatment. One parent has an objection, but the other doesn't. Should the parent without the objection be allowed to authorise this minor treatment.

On the major item, you have a ridiculously sick child who needs life-saving treatment. One parent agrees with the treatment, the other has a religious or moral objection to the treatment - all other treatments are ineffective or have a much higher risk of death. Should one parent be allowed to block life-saving treatment on the basis of ignorant objection?

These are effectively the same question asked in two ways - should an individual parent be allowed to block or approve their child's treatment based on their ignorance or irrational fear?

Personally I would tend towards the "what's best for the child" argument. In the case of minor stuff like injections and the like, a single parent should be allowed to authorise any treatment (provided that it's actually a medical or other approved treatment and not voodoo or such).

In the case of live-saving treatment, the parents should be allowed to object, but where a treatment stands a good chance (> 70%) of extending the child's life or improving their quality of life, a quorum of doctors should be permitted to override the parent's wishes.
This should be enshrined in legislation - the parents must be allowed to add their own choice of doctor to this quorum and the doctors involved must be safe from litigation unless the parents can show in court that a quorum was not reached or the success chances of the treatment were overstated.

metrovelvet

seamus wrote: »

So difficult to come up with any kind of standard answer on this.

Common sense would tend towards saying that if it's something minor, then either parent should be consulted. But if it's something huge, then both parents can be consulted.

However, I can think of two very easy counterarguments to those. In the minor case, you may have a dubious or unnecessary vaccine or antibiotic as treatment. One parent has an objection, but the other doesn't. Should the parent without the objection be allowed to authorise this minor treatment.

On the major item, you have a ridiculously sick child who needs life-saving treatment. One parent agrees with the treatment, the other has a religious or moral objection to the treatment - all other treatments are ineffective or have a much higher risk of death. Should one parent be allowed to block life-saving treatment on the basis of ignorant objection?

These are effectively the same question asked in two ways - should an individual parent be allowed to block or approve their child's treatment based on their ignorance or irrational fear?

Personally I would tend towards the "what's best for the child" argument. In the case of minor stuff like injections and the like, a single parent should be allowed to authorise any treatment (provided that it's actually a medical or other approved treatment and not voodoo or such).

In the case of live-saving treatment, the parents should be allowed to object, but where a treatment stands a good chance (> 70%) of extending the child's life or improving their quality of life, a quorum of doctors should be permitted to override the parent's wishes.
This should be enshrined in legislation - the parents must be allowed to add their own choice of doctor to this quorum and the doctors involved must be safe from litigation unless the parents can show in court that a quorum was not reached or the success chances of the treatment were overstated.

There is an added complication to this when the health issue is time sensitive.

drkpower

Just to clarify, cases involving emergencies that constitute a grave threat to life, health or welfare of the child are a little different in that Irish law* already supports a right of a doctor to dispense with parental consent (whether be one or both parents).

What I am talking about are conditions that are not as severe as that, but which may be very significant nonetheless, where, as a matter of routine iun Ireland (AFAIK), one parent only is asked to consent, and the views of the other are not sought.

I like the idea of seperating out the serious from non-serious treatments/procedures, and that is very easy to do in 95% of cases, but it is impossible to do it for many other issues, where one parent's view of what is a 'routine' 'non-serious' treatment is not shared by the other (vaccinations, being a case in point, unfortunately).


* - The courts have stated that, when it comes to a grave threat to the welfare, health or life of the child, a court would displace the decision making authority of the parents. Similarly, professional guidance would support a right of a doctor to overrule a parent himself in these scenarios. Of course it also said that state interference with family decisions should be very much the exception rather than the rule.

drkpower

metrovelvet wrote: »

As for your post script, I don't think you can leave the divorced and single parents out of the discussion as they are a significant part of the parenting population.

They are, but different rules apply to them re custody and therefore rights to consent to treatment. Parents in these cases do not usually have equal rights to custody and decison-making. Married parents do. Whether those rules are correct is another - but, admittedly, linked -issue.

angelfire9

When our daughter had a tonsillectomy (?sp) at age 5 both parents were asked to consent mainly I reckon cos the doctor thought I was loopy insisting on an operation for a 5 year old they wanted to wait til she was 7

metrovelvet

drkpower wrote: »

They are, but different rules apply to them re custody and therefore rights to consent to treatment. Parents in these cases do not usually have equal rights to custody and decison-making. Married parents do. Whether those rules are correct is another - but, admittedly, linked -issue.

Just to clarify. My son has had medical treatment outside and inside Ireland.

Inside Ireland, fairly routine stuff, vaccinations, GP, PHN checkups etc so I have never had to sign a consent form.

In the case of more serious procedures, like surgery or chemo, does the parent have to sign a consent form and if so is it given to both the parents to sign or just one? Does the form have a section for the mother and te father or just one for "parent".

CDfm

I imagine most doctors do not check.

Certainly in Ireland schools have an obligation to consult advise both/parents guardians but do not even on school registration.

The situation is similar with doctors they have a legal obligation but don't.It also means that one parent can withold treatment or go for alternative treatments without consulting the other.

So it is not always a positive power it is also a negative one.

I currently know of one situation where the mother is witholding consent for the father getting a second opinion and a child is going untreated for a medical condition.

metrovelvet

^ I think the witholding of treatment/consent is more of a concern.

CDfm

Surely a doctor should seek/is legally obliged to seek the consent of both parents and make sure both parents are involved in a decision.

Same as passports.

You have situations , Jehovah Witnesses wont consent to blood transfusions and the hospitals go straight to court. In the general scheme of things these are extreme circumstances.

Chemo for a child to prolong life by a few days/weeks would be such an issue or maybe amputation of a limb where parents could diagree. I can also see areas where a child might have psychological issues and need medication etc where both should be consulted. Cosmetic surgery is another area.

metrovelvet

CDfm wrote: »

Surely a doctor should seek/is legally obliged to seek the consent of both parents and make sure both parents are involved in a decision.

Same as passports.

You have situations , Jehovah Witnesses wont consent to blood transfusions and the hospitals go straight to court. In the general scheme of things these are extreme circumstances.

Chemo for a child to prolong life by a few days/weeks would be such an issue or maybe amputation of a limb where parents could diagree. I can also see areas where a child might have psychological issues and need medication etc where both should be consulted. Cosmetic surgery is another area.

I think the Irish legal team don't want to open this hornet's nest. It can come down to choosing consultant or even methodology in an operation.

Even things like Ritalin for ADD can be up for dispute.

drkpower

CDfm wrote: »

Surely a doctor should seek/is legally obliged to seek the consent of both parents and make sure both parents are involved in a decision.

Arguably they are obliged to consult both parents in respect of every teatment decision, no matter how trivial. But usually, for purely practical reasons, they dont. I would be very surprised if doctors didnt insist on consulting both parents when it comes to 'serious' decisions/procedures.

But the problem arises when it comes to determining what is a 'serious' issue. While a doctor will obviously have a view in that regard, the ultimate decision as to what is a 'serious' decision is one for the parents to take. But if the doctor doesnt consult both parents in the first place, how are they to determine whether the case is 'serious'?

AFAIK, in the UK they have detailed guidelines as to what procedures/treatments must have the consent of 2 parents, and others where the consent of one is sufficient. That would probably be a very helpful way to proceed here.

CDfm

metrovelvet wrote: »

I think the Irish legal team don't want to open this hornet's nest.

Certainly, but what about the law and doctors - have doctors got sued. I know of one child psychiatrist who was facing disciplinary procedures and left the country.

It can come down to choosing consultant or even methodology in an operation.

Well I wouldn't know about that and could not imagine anyone having a view on that.

Even things like Ritalin for ADD can be up for dispute.

And well they should be

metrovelvet

CDfm wrote: »

Certainly, but what about the law and doctors - have doctors got sued. I know of one child psychiatrist who was facing disciplinary procedures and left the country.




Well I wouldn't know about that and could not imagine anyone having a view on that.



And well they should be

I know of one father taking legal action against a hospital and mother for treating the child with what he deems as unnecessary procedures. I cant remember how he found out about it as I think he was kept in the dark.

CDfm

drkpower wrote: »

Arguably they are obliged to consult both parents in respect of every teatment decision, no matter how trivial. But usually, for purely practical reasons, they dont. I would be very surprised if doctors didnt insist on consulting both parents when it comes to 'serious' decisions/procedures.

But the problem arises when it comes to determining what is a 'serious' issue. While a doctor will obviously have a view in that regard, the ultimate decision as to what is a 'serious' decision is one for the parents to take. But if the doctor doesnt consult both parents in the first place, how are they to determine whether the case is 'serious'?

AFAIK, in the UK they have detailed guidelines as to what procedures/treatments must have the consent of 2 parents, and others where the consent of one is sufficient. That would probably be a very helpful way to proceed here.

Do you have a link to the guidelines

metrovelvet wrote: »

I know of one father taking legal action against a hospital and mother for treating the child with what he deems as unnecessary procedures. I cant remember how he found out about it as I think he was kept in the dark.

Thats proper order as there is a lot of secrecy over whats what.

I think there should be a definition of what reasonable is