BOOKS: Consent, Rights and Choices in Health Care for Children and Young People By the British Medical Association BMJ Books 280 pages £19. 95

Parents sometimes reject medical opinion and refuse treatment of babies and young children which doctors have judged to be in their best interests. In these cases the law may sometimes have to intervene.

At the other end of the scale, older children may oppose their parents'wishes and refuse consent to a treatment. Again, the law may have to be involved.

Health professionals often need and seek guidance about ethical and legal issues concerning the examination and treatment of children and young people less than 18 years of age, particularly in relation to competent adolescents.

Attitudes to minors and to the rights accorded to them are changing, and questions are being asked, for example, about consent, refusal of treatment and confidentiality.

Following many enquiries from doctors to its medical ethics department about these issues, the British Medical Association has produced this book to reflect the implications of these changing attitudes, and answer some of these questions.

Written with advice from an expert advisory group which included eminent paediatricians, ethicists and legal experts, it sets out to address day-to-day issues and offer guidance regarding the legal position in England, Wales, Northern Ireland and Scotland in the sphere of medical and nursing care.

Each chapter is designed to be free-standing and convey as complete a picture as possible, allowing the reader to dip into it with a specific question in mind. Chapter headings include:

An ethical approach to treating children and young people;

The law on children, consent and medical treatment;


Involving children and assessing a child's competence;

Refusal of treatment and decisions not to treat;

Mental health care of children and young people;

Sensitive or controversial procedures;

Research and innovative treatment;

Healthcare in schools Summary of good practice.

Writing books which involve seeking advice or consensus from 'expert committees' is not always the easiest of tasks, and the writers and editor of this book should be congratulated.

I found it clear and well written, with avoidance of jargon - perhaps because although intended primarily for health professionals, it was also drafted to be accessible to patients and their families, and other non-health professionals.

I particularly liked the layout of the chapters, which are broken down into headings and subheadings, making it easy to seek out specific information.

There are also useful examples of cases when decisions or judgements regarding treatment or otherwise are made in the law courts.

For instance, the Gillick case regarding the prescribing of contraceptives by doctors to children under 16 years; and the testing of a baby for HIV against the parents'wishes.

Summaries of the main points are included in each chapter and the final chapter also encapsulates the advice contained throughout the book.

This is certainly a book that should be available to all professionals involved in the healthcare of children and young people.