This chapter explains the law surrounding consent for the medical treatment of children, when children can give consent themselves, who can give consent of their behalf and when a refusal of consent should be respected. It also considers guidelines relevant for the practice of restraint in paediatric anaesthesia. Finally, it discusses the unique features of the ethics of research involving children, including the levels of risk that are deemed acceptable.

While the law has developed greater protection for the growing competence of adolescents, they have not been recognised as autonomous in the same way as adults. This difference in treatment is especially clear in medical decision-making. The law has been willing to accord young people the right to consent to treatment in their best interests, but has been far more reluctant to accept full adolescent autonomy, including the right to refuse such treatment. This chapter considers the assessment of young people’s competence to make decisions concerning their medical treatment. It then considers the authority of parents and courts to overrule adolescents’ decisions to refuse treatment. There are strong reasons to argue that parents should no longer have such authority, which is increasingly out of step with medical practice and developments in children’s rights. The jurisdiction of the courts to do so is well-established but will only provide an adequate safeguard if sufficient weight is placed on young people’s rights to bodily integrity and decision-making. The chapter concludes by considering the application of these principles in the context of adolescent’s use of contraception and abortion.