Consent, competence and confidentiality for children and young people: Case problems from osteopathic practice

Consent and confidentiality are important elements of osteopathic care, but for children and young people these issues are often more complicated. The ethics and law of consent and confidentiality for children are different from adults and they are often contradictory and counterintuitive. We present four clinical scenarios drawn from clinical experience to help illustrate the common difficulties of competence, consent and confidentiality for children. These include: an 11 year old boy consenting for himself; a 13 year old girl who discloses that she is sexually active; a 5 year old boy presenting with his father; and a 15 year old boy who requests information is not shared with his mother. Each case is followed by questions relating to the case, and the essential points of competence, consent and confidentiality for children and adolescents are discussed. In osteopathy all children who are mature enough to understand the diagnosis and osteopathic treatment and make reasoned decisions about their care should be considered Gillick competent and be able to consent to treatment, refuse treatment, and have a right to confidentiality.