Upcoming changes for this guidance
This content will be strengthened so it more completely reflects our commitment to practice framed by te Tiriti o Waitangi, based on a mana-enhancing paradigm for practice, and drawing from Te Ao Māori principles of oranga to support mana tamaiti, whakapapa and whanaungatanga. We each need to consider how we can apply these principles to our practice when reading this guidance. The following resources provide support:
Practice for working effectively with Māori
Our practice shift
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.
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).
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 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.
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.
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.
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.
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.
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.