Giving Consent for Anesthesia Care  for Children

Consent for paediatric anaesthesia is governed by the Children’s Act of 2005, which gives clear guidelines for medical and surgical consent involving children. 

Children 12 years and Older: 

• Those that are sufficiently mature and mentally capable are able to consent to medical treatment and surgical operations (including anaesthesia) with the assistance of their parent or guardian. 
  • The child needs to show they understand the benefits, risks and social implications
  • Written consent must be obtained with a prescribed form
  • A parent or guardian must provide written assent (agreement) to accompany the child’s consent. 
  • Both the child’s consent and parental agreements are legally required. 

Children under 12 years:

• Those under 12 years or lacking the over 12 that lack sufficient maturity require the following:
  • Consent  from parent or guardian
  • In emergencies consent is given by the superintendent of the hospital
  • If parent/guardian refuses consent unreasonably or cannot be traced the matter is referred to Social Development or the High court/Children’s court where other authorised persons refuse or are unable to give consent

Who can give consent: 

The overriding principle in all situations is that the child’s best interest are of foremost importance and take precedence over everything. Before taking any decisions that could significantly change or adversely affect the child's health and well-being, the person holding parental rights must give due consideration to any views expressed by the child, bearing in mind the child’s age, maturity and stage of development. 

Consent parameters are as follows: 

1. Biological mother of child has full parental responsibilities regardless of marital status
2. Biological father has full parental responsibilities and rights if he married to the child’s mother or was married the child’s mother when child was conceived or born, was living with the mother in permanent life partnership when the child was born, has consented to be identified as the child’s father and contributes to upkeep or has had full parental responsibilities conferred by the court. 
3. When both parents have parental rights each may act without consent from the other, unless prohibited by the law or court order. 
4. Caregivers (people who take care of the child) cannot consent for surgical interventions. They may only consent for medical treatment if consent cannot be obtained from parents. 
5. In emergencies, treatment may proceed with consent from the superintendent of the hospital, if parental consent cannot be obtained. This is to preserve the life of the child or to save the child from serious or lasting physical injury or disability. 

Special Circumstances: 

• Minor parents (i.e. under the age of 18) - The child parent must be assisted by their own parent or guardian (i.e. grandparent of the child)). A parent may not withhold consent - in this event the matter is referred to the courts. 

How is Maturity assessed? 

• The media professional will assess the following: 
  • Cognitive development and understanding of risk and benefits
  • Ability to communicate reasoned decisions
  • Comprehension of long term consequences
  • Cultural and family context