hydration is in Adam's best interests. Factors which favour the proposal are the
little boy's gradual decline, the very poor prognosis and the intense pain and
suffering he must endure. To be weighed against these are the general concern
with preserving life and the interaction Adam still has with his environment. The
team should be satisfied that Adam's pain cannot be controlled. The guidance from
the Royal College of Paediatrics and Child Health should be considered. Adam's
condition overlaps categories 3, 4 and 5 of the guidance 4see section 10.1.2).
Adam's nurses will play a significant part in interpreting the responses of their
young patient and gauging his distress and pain levels. They will also be able to
ensure that his parents' views are adequately communicated to the rest of the
health care team.
If cessation of treatment seems to serve Adam's best interests, the agreement of
the parents does not preclude an application to the court by the health authority.
Indeed, referring the case to court seems appropriate given the protection of the
right to life conferred by the European Convention on Human Rights. The court
will usurp the decision-making power of the person4s) with parental responsibility
for Adam. The judge would reach his or her decision in the light of the medical
evidence and after considering the wishes of the parents. The presumption in
favour of preserving life would be balanced against the need to limit suffering
which could not generate commensurate benefits. If the court authorised cessation
of treatment, it would expect such medical and nursing care as would comfort
Adam until he died, to be administered.
10.2 Teenagers
10.2.1 Capacity to consent
The provisions of section 8 of the Family Law Reform Act 1969, ensure that by the
age of 16 at the latest, teenagers can give their own consent to medical treatment.
Many will reach sufficient maturity to authorise specific procedures at an earlier
point. Assessing that maturity is something which the professional treating the
teenager must do in the light of the guidance offered in the case ofGillickv.West
Norfolk and Wisbech Area Health Authority41985): capacity to understand all the
issues surrounding the proposed treatment is the vital criterion.
The above rules do not prevent health authorities and social services, or even a
relative, from referring a medical dilemma to court, using the wardship or inherent
jurisdiction. Once this has been done, the decision of the court can overrule that of
any young person, however competent, who has not yet reached the age of 18 4Re
Waminor) medical treatment)41992)).
Teenage consent to medical treatment has not proved controversial in the
sphere of critical illness. Where medical advice is accepted and followed, no
conflict arises for the health care team involved. The situation is however very
different where a young person refuses vital treatment. This problem is considered
in the next section.
200 Nursing Law and Ethics