Consent and confidential care for adolescents — formative SAQs

SAQ 1 — Consent, capacity and confidentiality (10 marks)

A 15-year-old presents requesting the contraceptive implant and asks that her mother not be told. She is otherwise well. ^{[5] [6]}

Questions

1. State the three pillars of valid informed consent and how they apply to this adolescent. (3 marks) ^[5]
2. Describe how you would assess her decision-making capacity at the bedside. (4 marks) ^{[6] [7]}
3. Give the conditional confidentiality script you would say aloud, including its lawful limits. (3 marks) ^{[4] [2]}

Model answer

Three pillars (3). Capacity — she can understand, retain, weigh and communicate the decision; information — she is told what the implant is, its benefits, risks, alternatives and the option of doing nothing; voluntariness — the choice is free of coercion. In an adolescent, distinguish the minor's own consent (if capable) from parental permission and the child's assent. ^[5]

Capacity assessment (4). Capacity is task-specific, not age-gated, using the Gillick/mature-minor principle. Walk her through the implant decision and check she understands and can restate (teach-back) the procedure, efficacy, risks and reversibility; that she retains it long enough to decide; that she weighs it in her own situation (for example future fertility, STI protection still needs condoms); and that she communicates a stable, voluntary choice. Check voluntariness and coercion. Document the reasoning. ^{[6] [7]}

Confidentiality script (3). "What we talk about privately stays private, unless I become worried you are not safe, that someone else is being hurt, or the law says I must act. If that happens, I will tell you what I need to do and we will plan it together." Limits: serious harm to self or others, abuse or assault, and other legal mandates. Encourage parent involvement where safe and she agrees. ^{[4] [2]}