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Consent in children’s intensive care: the voices of the parents of critically ill children and those caring for them
  1. Phoebe Aubugeau-Williams1,2,
  2. Joe Brierley2
  1. 1University College London Medical School, University of London, London, UK
  2. 2Paediatric Bioethics Centre, University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
  1. Correspondence to Dr Joe Brierley, Paediatric Bioethics, Great Ormond Street Hospital for Children, London WC1N3JH, UK; joe.brierley{at}gosh.nhs.uk

Abstract

Despite its invasive nature, specific consent for general anaesthesia is rarely sought—rather consent processes for associated procedures include explanation of risk/benefits. In adult intensive care, because no one can consent to treatments provided to incapacitated adults, standardised consent processes have not developed. In paediatric intensive care, despite the ready availability of those who can provide consent, no tradition of seeking it exists, arguably due to the specialty’s evolution from anaesthesia and adult intensive care. With the current Montgomery-related focus on consent, this seems untenable. We undertook a qualitative study in a specialist children’s hospital colocated paediatric/neonatal intensive care (same medical team) in which parental acceptance of admission and entailed procedures is considered implied by virtue of that admission. Semistructured interviews were carried out with both staff and parents to investigate their views about consent, the current system and a proposed blanket consent system, in which parents actively consent at admission to routine procedures. Divergent views emerged: staff were worried that requiring consent at admission might prove a further emotional burden, whereas parents found providing consent a way of coping, feeling empowered and maintaining control. Inconsistencies were found in the way consent is obtained for your routine procedures. Practice does seem inconsistent with contemporary consent standards for medical intervention. Our findings support the introduction of a blanket consent system at admission together with ongoing bedside dialogue to ensure continuing consent. Both parents and staff expressed concern about avoiding possible harmful delays to children due to parental emotional overload and language difficulties.

  • minors/parental consent
  • paediatrics
  • law
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Footnotes

  • Contributors PA-W undertook the interviews as part of an iBSc supervised by JB. She analysed the data and wrote the first draft. JB designed the project and finalised the manuscript.

  • Funding This study was funded by Great Ormond Street Hospital Children's Charity (Ethics grant X0951416)

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The GOSH Clinical Research and Adoptions Committee, UCH NHS Health Research Ethics Committee (HRA), and UCL Research Ethics Committee all approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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