Paeds Cases · professional-practice-and-evidence
Consent, parental responsibility and mature-minor frameworks — OSCE
OSCE station: obtaining parental permission and child assent for a lumbar puncture in a school-age child, managing dissent and disagreement.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A 6-year-old with suspected meningitis needs a lumbar puncture; the mother consents, the father phones to refuse, and the child is frightened and pulling away.
Objectives
- Confirm who holds parental responsibility and how to weigh conflicting parental views for an urgent decision. [1]
- Seek age-appropriate assent and manage dissent in a frightened school-age child. [2] [12]
- Disclose material risks, benefits and alternatives in plain language with teach-back. [1]
- Apply the emergency principle and escalate appropriately if disagreement threatens the child. [1] [9]
References5ShowHide
- [1]COMMITTEE ON BIOETHICS Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456514
- [2]Katz AL, Webb SA Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
- [3]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment. N Engl J Med, 1988.PMID 3200278
- [9]Diekema DS Revisiting the best interest standard: uses and misuses. J Clin Ethics, 2011.PMID 21837884
- [12]Levetown M Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics, 2008.PMID 18450887