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Page URL: https://practice.orangatamariki.govt.nz/our-work/assessment-and-planning/assessments/conducting-an-assessment/consent-for-medical-examinations-and-treatment/
Printed: 28/11/2020
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Last updated: 09/11/2020

Consent for medical examinations and treatment

When tamariki or rangatahi in our care need medical examinations or treatment we get the appropriate informed consent and keep te tamaiti or rangatahi and their family/whānau well informed.

Upcoming changes for this guidance

This content will be strengthened so it more completely reflects our commitment to the principles of mana tamaiti, whakapapa and whanaungatanga along the continuum of oranga, to ensure responsiveness to tamariki and whānau Māori. In the meantime, we each need to consider how we can apply these principles to our practice in this topic area.
Practice for working effectively with Māori

Involving te tamaiti or rangatahi and family/whānau early

We involve te tamaiti or rangatahi and their family/whānau as early in the process as possible. This gives them time to talk things over with wider family/whānau and others, seek advice from medical professionals, ask questions and make an informed decision in the best interests of te tamaiti or rangatahi.

Child/young person and family consult

Policy: All About Me plan

For tamariki Māori, we get guidance from the kairaranga ā-whānau, a senior Māori practitioner or a bicultural practitioner.

Kairaranga ā-whānau

For Pacific children or young people, seek appropriate cultural advice which can be guided by Va'aifetū.

Working with Pacific peoples: Va'aifetū

Rights to make decisions about their own lives

Rangatahi aged 16 years or older who are able to give consent can consent or refuse to consent to medical procedures. A female tamaiti of any age can consent or refuse to consent to a procedure to terminate a pregnancy (unless there’s a reason they are not deemed to be competent). 

Tamariki or rangatahi under 16 years may be considered competent to give consent to medical procedures if they are assessed as ‘Gillick competent’. In some cases it may also be necessary to check if te tamaiti or rangatahi 16 years or older is competent.

We need to use our professional judgement to decide if an individual tamaiti or rangatahi has the capacity to make a decision about a medical procedure and if they sufficiently understand what they are being asked to consent to.

If tamariki and rangatahi are competent to make decisions – Gaining permission to talk to tamariki and rangatahi

If we decide te tamaiti or rangatahi is ‘Gillick competent’, we make comprehensive notes about what has informed this decision and record it in CYRAS. Even when te tamaiti or rangatahi has capacity to consent, we need to inform the parents/guardians of significant decisions affecting their tamaiti or rangatahi.

When te tamaiti or rangatahi cannot consent to a medical treatment or examination, we uphold the mana of te tamaiti or rangatahi by telling them in an age appropriate way what is happening and why, and consider their views on what might happen.

Explaining rights and entitlements to tamariki and rangatahi

If te tamaiti or rangatahi is not capable of consenting in their own right to medical procedures, the process for getting consent will depend on the type of medical treatment te tamaiti or rangatahi requires.

Routine medical procedures

Routine medical procedures are procedures that a New Zealand tamaiti or rangatahi generally needs to have their day-to-day care met, for example, visiting a GP if unwell, and routine checks such as dental check-ups and Plunket or Wellchild/Tamariki Ora checks.

The day-to-day caregiver (not a guardian) can consent to these routine medical examinations/treatments.

Policy: All About Me plan

Non-routine medical procedures

These procedures include immunisation, injections, examinations under anaesthetic, internal examinations, examination of the anal/genital region, and examinations relating to alleged sexual abuse, and operations.

We require a guardian to give consent to these important medical procedures. And when a medical examination requires any internal examination of the genital or anal area, te tamaiti or rangatahi is required to give consent if they are considered competent.

Where there is more than one guardian, we should get the agreement of all guardians and in writing, if possible. 

Te tamaiti or rangatahi can have an adult of their choice present during any examination.

Supporting tamariki and rangatahi

This will be a difficult process for te tamaiti or rangatahi – discuss with them about having someone with them at the examination for support and reassurance.

Engaging tamariki about their health information – Supporting tamariki with their health needs

Confidentiality

Under the Gateway process we offer confidentiality to te tamaiti or rangatahi and their parents or guardians when they share information. There are exceptions to the confidentiality offered when there are concerns about the safety of te tamaiti or rangatahi, such as, self-harm, harm to someone else, or the potential to be harmed by another person.

In these circumstances, we should discuss with te tamaiti or rangatahi the reasons for sharing information before we share it. When a medical examination is part of an investigation, we should tell te tamaiti or rangatahi what the information will be used for and who will have access to it and why.

When we collect and use information within the Gateway assessment process we are governed by the Privacy Act 2020 (replacing the Privacy Act 1993 on 1 December 2020), the Oranga Tamariki Act 1989 and to an extent the Official Information Act 1982 and the Health Act 1956.

Personal information must be kept safe and secure and only released where there is authority to do so.

Legal aspects relating to the Gateway assessment process

Policy: Sharing information

Engaging tamariki about their health information – Supporting tamariki with their health needs