From whom should consent be obtained for a 15-year-old requiring a lumbar puncture?

From the Guidelines

For a 15-year-old requiring a lumbar puncture, consent should typically be obtained from the parent or legal guardian, though the adolescent's assent should also be sought, as the law presumes that individuals under 16 may have the capacity to consent depending on their maturity and understanding, as stated in the Gillick competence principle 1. The Gillick competence principle, as outlined in the case of Gillick v West Norfolk and Wisbech AHA 1986 AC 112, suggests that children can give their own consent to treatment if they have sufficient maturity and understanding of the proposed intervention 1. However, in the context of a 15-year-old, it is generally recommended to obtain consent from the parent or legal guardian, as the law presumes that individuals under 16 may not have the full capacity to consent, unless they can demonstrate sufficient understanding and maturity, as assessed on a case-by-case basis 1. Some key points to consider include:

• The capacity to consent for medical treatment depends more on the young person’s ability to understand and weigh up options than on age 1.
• A young person aged 16 or 17 is presumed to be capable of consenting to their own medical treatment, and any ancillary procedures involved in that treatment, such as anaesthetic 1.
• If the 16 or 17-year-old is capable of giving valid consent then it is not legally necessary to obtain the authority of a person with parental responsibility for that person, though often the young person may welcome the involvement of family in decision-making 1.
• For individuals under 16, the Gillick competence principle applies, and consent should be obtained from the parent or legal guardian, unless the child can demonstrate sufficient understanding and maturity to provide their own consent 1. In the case of a 15-year-old requiring a lumbar puncture, the most appropriate approach would be to obtain consent from the parent or legal guardian, while also seeking the adolescent's assent, as this approach respects the developing autonomy of the adolescent while acknowledging the legal authority of parents/guardians in medical decision-making. When obtaining consent, healthcare providers should explain the procedure, risks, benefits, and alternatives to both the parent/guardian and the adolescent in age-appropriate language, as recommended by the Association of Anaesthetists of Great Britain and Ireland 1. Ultimately, the decision to obtain consent from the parent or legal guardian, or to seek the adolescent's assent, should be made on a case-by-case basis, taking into account the individual's maturity, understanding, and capacity to provide informed consent, as outlined in the guidelines for obtaining valid consent for medical treatment 1.

From the Research

Consent for Lumbar Puncture in Minors

The question of who should give consent for a 15-year-old requiring a lumbar puncture is addressed by considering the age of the patient and the legal requirements for informed consent.

• In the case of minors, the law typically requires that consent be obtained from a parent or guardian, as minors are not considered legally competent to make medical decisions on their own.
• However, as minors approach the age of majority (18 years), their ability to provide informed consent for medical procedures may be considered, depending on the jurisdiction and the specific circumstances.

Relevant Studies

Studies have investigated the process of obtaining consent for lumbar puncture in pediatric patients, including the concerns and understanding of parents 2, 3, 4, 5.

• A study published in 2021 found that most parents had little knowledge about lumbar puncture and that the most common parental concern was paralysis 2.
• Another study from 2010 found that risks, benefits, alternatives, and explanation of the LP procedure are not adequately documented on consent forms in the pediatric emergency department 3.
• A 2019 study demonstrated that an educational video can improve parent understanding and perception of the safety of lumbar puncture, addressing concerns such as pain, infection, and neurological injury 4.
• A qualitative study from 2012 identified fear of complications, perception that the procedure is unnecessary, and distrust of the motives behind the request for consent as reasons why some parents refuse consent for lumbar puncture on their child 5.

Application to the Scenario

Given the age of the patient (15 years), the correct approach regarding consent would involve both the patient and their parents, as the patient is considered a minor but is approaching the age of majority.

• The most appropriate answer is to take patient consent and parents' assent, as this reflects the principle of involving minors in decision-making about their healthcare while still requiring parental involvement for legal and ethical reasons 6.

Key Points

• For minors under 15, parental consent is typically required.
• For minors between 15 and 18, both patient consent and parental assent are often required.
• For individuals over 18, only patient consent is required.
• The process of obtaining consent should include a clear explanation of the procedure, its risks and benefits, and any alternatives, to ensure that the patient and their parents can make an informed decision.