Children’s ability to consent to medical management in South Africa

Abstract

Background. The South African Children’s Act No. 38 of 2005 requires paediatric medical consent from 12 years of age.
Objective. To determine children’s ability to provide informed consent for medical treatment.
Methods. Assessment used hypothetical treatment storyboards and structured interviews for assessment of 100 children (aged 10 - 17 years), and 25 adult controls, using a standardised scoring tool to test understanding, ability to deliberate treatment choices, and provide rational reasons. Statistical analysis involved multivariate analyses of variance (MANOVAs) and analysis of variance (ANOVA).
Results. The female:male ratios for children and adults were 1:0.92 and 1:0.98, respectively. Children ≥12 years were competent with regard to treatment choices (p<0.001), while 10-year-olds could deliberate reasonable outcomes, similar to adults (p<0.001). However, only children 12 years and older could provide rational reasons, where abstract concepts were not involved, whereas children who were ≥14 years old were able to provide rational reasons involving abstract concepts. The actual understanding of choices, compared with adults, was only observed in children older than 14 years (p<0.001). Gender was not a statistically significant denominator.
Conclusion. Children of 12 years and older are competent to make medical decisions, but the understanding of medical treatment choices under the age of 14 years is not clear.