Parental consent

People with parental responsibility

Where a person exercising parental responsibility is giving consent for a child’s treatment, it is very important that they have the necessary information both about the proposed procedure and the child, in order to take a proper view as to the child’s best interests. This may be particularly relevant if consent is being given by a person with parental responsibility who does not have day-to-day contact with the child. 

If a child is not competent to give consent for themselves, you should seek consent from a person with ‘parental responsibility’. This will often, but not always, be the child’s parent. Legally, you only need consent from one person with parental responsibility, although clearly it is good practice to involve all those close to the child in the decision-making process.
The Children Act 1989 sets out who has parental responsibility and these include:
  • the child’s parents if married to each other at the time of conception or birth;
  • the child’s mother, but not father if they were not so married unless the father has acquired parental responsibility via a Court Order or a Parental Responsibility Agreement or the couple subsequently marry;
  • the child’s legally appointed guardian – appointed either by a court or by a parent with parental responsibility in the event of their own death;
  • a person in whose favour a court has made a Residence Order concerning the child;
  • a local authority designated in a Care Order in respect of the child (but not where the child is being looked after under section 20 of the Children Act, also known as being ‘accommodated’ or in ‘voluntary care’);
  • a local authority or other authorised person who holds an Emergency Protection Order in respect of the child.
Foster parents, step-parents and grandparents do not automatically have parental responsibility.

If the mother is herself under 16, she will only be able to give valid consent for her child’s treatment if she herself is “Gillick competent” to take the decision in question. Whether or not she is able to give valid consent on behalf of her child may therefore vary, depending on the complexity of the decision to be taken.

If a child is a ward of court, all “important steps” in the child’s life must first be approved by the court. If possible it will be helpful to keep copies of the wardship papers with the child’s medical record, so that it is clear what, if any, treatment may be provided without reference to the court (for example routine treatment for asthma).

While only a person exercising parental responsibility can give valid consent, persons with parental responsibility can arrange for some or all of that responsibility to be met by others. Parents might, for example, give authority for someone who cares for their child on a regular basis, such as a grandparent or childminder, to give consent under defined circumstances (for example in emergencies or for routine treatments for coughs and colds). Where such explicit authority has been given, the consent of the person with the authority will be valid and you will not need to try to contact those with parental responsibility as well, unless you have reason to believe that the parent’s view might differ. The Children Act does not specify that such authority should be given in writing, but clearly it is helpful for healthcare workers if it is. Where a child with complex health needs is regularly cared for away from home (for example if they attend a residential school), it will be good practice for a healthcare plan to be clearly agreed between the child, the parents, and the clinicians regularly involved in caring for the child at home and elsewhere. This will enable any significant differences of opinion to be identified and resolved in advance, rather than under pressure in a medical emergency.

The Children Act also allows a person who does not have parental responsibility for a child but who ‘has care’ of a child to ‘do what is reasonable in all the circumstances of the case for the purpose of safeguarding or promoting the child’s welfare’. This might apply, for example, to childminders or teachers, where explicit authority to consent on behalf of a child has not been given by the person with parental responsibility. However, it would rarely be ‘reasonable’ for those with care of a child to consent to treatment on the child’s behalf if a parent could be contacted instead. In an emergency, it would certainly be reasonable for a teacher or childminder to take a child for appropriate medical care, which could then be lawfully provided on the basis that the care was in the child’s best interests and no-one with parental responsibility could be contacted.


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