How did the 1989 Children Act affect Medical Ethics?

By Alexandra Morgan, Year 12 North London Collegiate

The Children Act 1989 was instrumental in ensuring the safety of children living in the UK, introducing measures such as the regulation of care for children and ensuring that court cases involving children are conducted without any potentially detrimental delays.

However, the Children Act poses multiple new dilemmas when we consider medical ethics involving children, and the most pertinent question stemming from that being how far legal courts should respect a child or their guardian’s wishes for them to refuse medical treatment. At first the answer may appear to be obvious – a court should ensure that a child receives potential life-saving treatment, even if this treatment was previously refused by them or their parents. The argument forms when we begin to consider both the moral and religious implications, why this ethical dilemma is still so prominent in our societies today. In the UK, a child aged 16 or over is able to consent to their own treatment, whereas those under the age of 16 will require the consent of their parents if they are to have medical treatment, unless the child is considered to be ‘Gillick competent’ (i.e. prove that they have a full awareness of the treatment and provide sound reasons for why they are consenting/refusing it). However, even though children do have these basic rights when it comes to medical treatment, it can be overrun in courts on the basis of the Children

Act, as refusing potential live-saving treatment can be seen to jeopardise the welfare of the child, which the Act aims to protect.

We must initially consider why a child might be refusing treatment, and what the implications may be if their wishes were ignored. Ian McEwan’s 2014 novel ‘The Children Act’ follows a judge who is faced with the dilemma of whether she should rule that a male seventeen year old Jehovah’s Witness should have a live-saving blood transfusion, even though he refuses treatment on the basis that his religion forbids it. His parents also back his decision, showing how they believe that refusing this treatment would be the most loving action for their son. However, the boy’s right to refuse treatment was eventually overruled by the Children Act and he was forces to have the treatment anyway. Although his life was saved, we are able to see the moral and social implications this had, suggesting why the Children Act and medical ethical often come into conflict.

Although we have seen how the refusal of treatment from children may stem from both moral and religious roots, Ian McEwan’s novel also raises multiple other questions concerning children and medical ethics. Firstly, should a court really overrule a child’s right to dictate what they do with their bodies? And secondly, is it really fair that a court can force a seventeen-year-old to have treatment, but an eighteen-year-old will not face the same legal challenges if they refuse treatment? These two questions reside in both courts and hospitals alike, and while the decision of the court wholly depends on situation the child is in, the common law system that the UK adopts often refers to previous rulings of similar cases to come to their final decision, and ultimately boils down to one key question. Is the right of the child to choose or the welfare of the child more 14