PART 5: Pediatric Medico-Legal Dilemmas (Gillick, Fraser & Jehovah's Witnesses)

PART 5: Pediatric Medico-Legal Dilemmas (Gillick, Fraser & Jehovah's Witnesses)

• Core Dilemma: Navigating Parental Responsibility (PR), adolescent confidentiality, and life-threatening refusals of blood or antidotes in minors under 18.
• Parental Responsibility (Children Act 1989): Biological mothers and married fathers hold PR automatically. Unmarried fathers hold automatic PR if named on the birth certificate after 1 December 2003 (England/Wales). Local Authorities hold PR under Care Orders (s.31) or EPOs, not voluntary Section 20 accommodation. Grandparents and step-parents do not automatically have PR.
• Gillick vs. Fraser & The Asymmetry of Refusal: Gillick Competence applies to general medical consent in under-16s; the 5 Fraser Guidelines apply specifically to contraception/sexual health without parental consent (remembering that sexual activity under age 13 is statutory rape requiring mandatory safeguarding). While competent under-16s and 16–17s can consent to treatment, no minor under 18 has an absolute right to refuse life-saving treatment (Re R, Re W).
• MRCEM/FRCEM Exam Trap: In an exsanguinating child of Jehovah's Witness parents at 3:00 AM, do not wait for a High Court judge—transfuse O-negative blood immediately under the Common Law Doctrine of Necessity (documented by two consultants) to save the child's life.