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Table 3 Summary table of international laws, guidelines and regulations upon ethical decision-making in relation to children

From: When to stop? Decision-making when children’s cancer treatment is no longer curative: a mixed-method systematic review

Organization or country

Laws (L)

Specific provision concerning withholding and withdrawing treatment.

Consent requirements

Competence

Standard for surrogate decision-making

Guideline (G)

 

Regulation (R)

    

UNICEF

[G] The United Nations Convention on the Rights of the Child (1989). [16]

___________

Child means a person <18 years of age unless, under the law applicable to the child, majority is attained earlier.

___________

The child’s best interests.

Article 1.

Articles 3, 18

The views of the child being given due weight in accordance with the age and maturity of the child. Article 12.

World Medical Association

[G] Declaration of Ottawa on the right of the child to health care (1998). [17]

To protect every child from unnecessary diagnostic, procedures, treatment…

The wishes of the child being given due weight in accordance with her/his capacity of understanding. Principle 9.

“The mature child, in the judgment of the physician, is entitled to make his/her decisions about healthcare.” Principle 9.

The child’s best interests.

Principles 4,11

Principle 4.

European Union

[G] European Convention on the exercise of Children’s Rights (1996). [18]

___________

Child means a person <18 years of age unless under the law applicable to the child, majority is attained earlier.

It is left to States (the judicial and administrative authority) to define the criteria enabling them to evaluate whether or not children are capable of forming and expressing their own views. Articles 3,6.

The child’s best interests.

European Community

Council of Europe

Article 1.

Articles 1,3.

Children have the right to express their own views providing they have sufficient competence. Articles 1, 3.

European association for children in hospital

[G] Charter for children in hospital (1988). [19]

Children shall be protected from unnecessary medical treatment. Article 5.

Children have the right to express their own views providing they have sufficient competence. Article 4.

___________

___________

United Kingdom

[G] British Medical Association 2010. [20]

Futility is the legal and ethical justification for the withdrawal and withholding of treatment. Card 7

All people aged ≥16 are presumed in law to be competent to give their consent to medical treatment. Card 2

In cases of disagreement, the views of the court should be sought. Card 6

The ability to understand that there is a choice and consequences

The child’s best interests. Card 5

The ability to weigh the information and arrive at a decision.

A willingness to make a choice.

Card 2

[G] General Medical Council. 2010

There is no obligation to give treatment that is futile and burdensome. Legal annex.

Child means a person <18 years of age. Paragraphs 74. Yet they can consent at 16 years. Legal annex.

To assess capacity Paragraph 74.

The child’s best interests. Paragraphs 74,76,77,81.

GMC’s guidance [21]

To involve children and young people in decisions Paragraphs 74,79.

 

In cases of disagreement, the views of the court should be sought. Paragraph 82.

[G] Royal College of Paediatrics and Child Health 2004. [22]

Brain Death.

Young people aged over 16 years are presumed in law to be competent to give their consent to medical treatment, but not necessarily dissent decisions. Section 2.4 (2.4.1)

The ability to understand information and to form and express personal views.

The child’s best interests.

Permanent vegetative state.

 

Section 2.6(2.6.1)

Section 2.3(2.3.1.2)

There should be a presumption of competence, unless a child is obviously incompetent. Section 2.6(2.6.1)

The wishes and views of the child being given due weight in the light of their

knowledge and understanding.

Section 2.3(2.3.1.1)

The “no chance” situation.

In cases of disagreement, the views of the court should be sought. Section 2.3(2.3.1.2)

The “no purpose” situation.

The “unbearable” situation.

United Kingdom

[L1] The Children Act (England and Wales) 1989.

___________

Child means a person <16 years of age. [L2] Section 2(7).

The ability to understand and to make an informed decision.

The child’s best interests.

[L2] Children Act (Scotland) 1995.

Child ≤12 years of age shall be presumed to be of sufficient age and maturity to form a view”. [L2] Section 16(2)

[L1] Section 1(1)

[L3] The Children Order (Northern Ireland) 1995. [23]

[L1] Section 43(8) and 44(7)

[L2] Section 16(1)

[L2] Section 16(1, 2)

     

[L3] Article 3(1)