Devereux J A, Jones D P, Dickenson D L
Keble College, Oxford.
BMJ. 1993 May 29;306(6890):1459-61. doi: 10.1136/bmj.306.6890.1459.
A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice.
当医生面对拒绝接受医学上建议治疗的儿童或年轻人时，就会出现两难困境。许多人将吉利克案解释为，年龄足够大且智力足够的儿童可以有效同意或拒绝接受治疗。上诉法院最近关于儿童拒绝接受治疗的裁决使这个问题变得模糊不清，并破坏了吉利克裁决和1989年《儿童法》的精神。现在的情况是，如果有行为能力存疑的儿童患者接受治疗提议，就会被认定为理性的，但如果他或她不同意，则可能被认定为无行为能力。从业者已被提醒注意法律在儿童同意和拒绝问题上目前表现出的异常情况。本文从医学、伦理和法律的角度审视了这些裁决的影响。从业者应仔细审查每一个儿童护理案例，如有疑问应寻求法律建议。
