Page 103 - Registrar Orientation Manual 2016

Document reference:
1969
Effective date:
30 Mar 2010
Expiry date:
01 Jun 2013
Page:
11 of 24
Title:
Informed consent
Type:
Policy
Version:
03
Authorising initials:
5.2. The impact of medication on
competence to consent
the court to overturn a refusal of consent by the Chief Executive in respect of important matters that affect the child. (Section 116).
 Appendix B, 6 sets out the legislative requirements relating to the age of persons who can give consent under specific circumstances.
 A child's capacity to make an informed choice may be diminished by their reaction to being in hospital or experiencing pain. While every effort should be made to support the child, their guardians' consent to the treatment will be sufficient if, for health reasons, treatment should not be postponed.
 If the child is considered competent by the health professional and there are no other concerns, then the child’s consent is sufficient to proceed with treatment.
 However, if the child’s decision is different from the parents wishes or if there are concerns about the child being coerced, then the health professional should seek legal advice.
 If the child is not considered competent to consent:
- a legal guardian can consent on the child’s behalf.
- If the legal guardian refuses to consent to treatment, and in the
view of the doctor treatment is necessary, then there are other means of proceeding lawfully without the consent of a guardian and these must be used. Seek advice from Legal Services..
- If there is a difference of opinion about treatment between a competent child and their guardian(s) you should seek advice from Legal Services.
 Informed consent for sterilisation of an intellectually impaired child is a complex legal issue, and the legal position in New Zealand is unclear. Staff shall obtain legal advice in this circumstance.
 Medication given for pain relief, in anaesthesia, or to treat psychiatric illness may impair a patient's judgement and thus their competence to consent.
 Equally, although consciousness may sometimes be impaired by medication, there is often an improvement in concentration and thinking ability with the relief of symptoms such as pain, anxiety and depression. Conversely, unrelieved pain, anxiety or depression may of themselves impair competence.
 Where practicable, discussion about treatment should take place before the administration of any medication liable to affect competence. However, consent for further treatment will sometimes be necessary from patients who have, for instance, received medication for pain relief. Sound clinical judgement must be exercised in these circumstances.
 When a patient's competence has clearly been impaired by