Guidance
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 whānau or family well informed.Upcoming changes for this guidance
Informed consent
When a tamaiti or rangatahi needs a medical examination or procedure, we need to get informed consent. Depending on the situation, we might need to get consent from the parent or guardian, te tamaiti or rangatahi or the caregiver.
Before a person can give consent to any medical treatment, they must clearly understand:
- what is actually being proposed
- why the intervention is needed
- whether there are alternatives
- the benefits
- the implications for te tamaiti or rangatahi in terms of pain or invasiveness
- the risk of unexpected complications.
Involving te tamaiti or rangatahi and whānau or family early
We involve te tamaiti or rangatahi and their whānau or family as early in the process as possible. This gives them time to talk things over with wider whānau or family 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
For tamariki Māori, we get guidance from the kairaranga ā-whānau, a senior Māori practitioner or a bicultural practitioner.
For Pacific children or young people, seek appropriate cultural advice, which can be guided by 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 by a health care professional).
Tamariki or rangatahi under 16 years may be considered competent to give consent to medical procedures if they are assessed by a health care professional as 'Gillick competent'. In some cases, it may also be necessary for a health care professional to check if te tamaiti or rangatahi 16 years or older is competent.
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 supporting them in an age-appropriate way to understand what is happening and why.
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.
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.
Working with medical practitioners experienced in sexual abuse care
We should consult with the Police and follow the Child Protection Protocol procedures to assess a sexual assault. As part of the assessment, we arrange for a medical practitioner experienced in sexual abuse work to do an examination.
We arrange this to:
- address any health concerns – for example, injury, sexually transmitted infections or pregnancy (even if the assault happened in the past, sometimes tamariki and rangatahi will benefit from a MEDSAC doctor reassuring them that they are physically healthy and well)
- help the Police investigation through the collection of evidence, if appropriate
- provide a written report – the examination may be used to support proceedings in court.
Medical Sexual Assault Clinicians Aotearoa (MEDSAC) – doctors especially trained in determining sexual abuse
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
When we can't get consent
We should make all reasonable efforts to get consent for a medical examination from the parent or guardian and if appropriate te tamaiti or rangatahi. Even if the rangatahi or tamaiti is 16 or over, the parent or guardian must also consent to the examination. If examination or treatment is known about early and it's not urgent, we should get consent as soon as we can to avoid delays, usually through All About Me planning meetings or discussions.
If there's difficulty getting consent, we consult our supervisor and legal advisor about the next steps.
If there's difficulty getting consent – Gateway assessments
Legal provisions for medical examinations
Consent to procedures generally – section 36(3) of the Care of Children Act 2004
When parents or guardians disagree or refuse to consent
If parents or guardians disagree about the proposed examination or treatment, and/or refuse to give consent, we should make sure everyone has all the available information to help them consider the options and access to medical professionals who can answer their questions. If they still can't agree, then we consult our supervisor and legal advisor about what to do next.
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, 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 (DOCX 103 KB)
Engaging tamariki about their health information – Supporting tamariki with their health needs