Assessing Children's Capacity to Consent: An Assessment Guideline

Purpose:  Valid consent must be given by a person capable in law to do so, must be informed, unambiguous, comprehensive and voluntary. Being capable to consent in legal terms means that the person has reached the age threshold stipulated in the law and has decisional capacity.   Central to obtaining consent from children is the ability of nurses to assess and arrive at a clinical judgement about a child’s maturity and mental capacity to give consent.   These assessments are a great responsibility that requires not only knowledge of the appropriate legislation but also the ability to perform maturity and mental capacity assessments on children of various ages. Currently, relevant to the South African context, such a guideline is required.   The purpose of the study is to report on the first round of a Delphi study to describe the essential elements to include in the assessment of children’s capacity to consent to health services.

Methods:  A Delphi technique was used involving a panel of experts in law, psychology, education, health as well as parents who would participate in four rounds using questionnaires designed for each round.  The focus of the questionnaires was to obtain expert consensus on the content to include when assessing a child’s mental capacity in consenting to health services. Experts in the field were identified and a snowball method used to identify further potential participants. A minimum sample of three experts per speciality area was included.   In round 1, open ended questions were posed to determine experts’ perspectives about the elements of inclusion in assessment of children’s mental capacity when consenting to health services.   Data was analysed qualitatively and grouped into specific themes categories and subcategories pertaining to the essential elements for assessing mental capacity to consent to health services by children. This information was then combined with that available in international and national literature to provide a framework to be used in the next 3 phases of an on-going Delhi study to obtain consensus on these elements of inclusion. 

Results:  Elements pertaining to the child’s age appropriate understand of relevant information, reasoning about treatment options, appreciation of the situation and consequences and the ability to communicate a choice were identified as a framework of assessment.

Conclusion:  Age appropriate assessment requires of the nurse to communicate effectively with children and the ability to assess their understanding, reasoning and appreciation of consequences in an age appropriate manner.  Clear age appropriate guidelines and multidisciplinary support are required for nurses to use in clinical practice.