Jul
19

Bodily autonomy and informed consent – for kids?

Author // Lucy Atkinson
Posted in // Blog

In my Wise Hippo classes we discuss informed consent a lot. As the law stands, we all have the right to bodily autonomy – we have control over what happens to our bodies, and no medical procedure can be done to us without our consent. Consent must also be ‘informed’ – it must be clearly explained to us what the reasons are for the procedure offered, and the benefits and risks must be outlined to us before being asked to consent.

That’s all pretty sensible, right?

The legal age for giving consent to medical treatment is 16 under English law. Before that age, whoever holds parental responsibility must give consent for any treatment.

That is also pretty sensible.

Now, on the other hand as a parent, there is a strong argument for involving children in any decisions around medical care they receive in an age-appropriate way. It fits in with teaching about bodily autonomy and consent in a much wider sense. Of course as adults, my children’s father and I will be the ones who legally decide on any treatment that may be necessary for our children but certainly aged 7 and 9 I would involve them in any discussions.

And yet, I so nearly over rode what my son wanted, just because in that situation I didn’t want to cause a fuss. I had the instinctive reaction to be a ‘compliant patient’ that hits even the most assertive of us when we are confronted with a medical uniform telling us what we want, need or should have.

My son fractured his wrist at the weekend. I didn’t know it was fractured immediately; he fell off a small plastic table in a friend’s garden and landed on his wrist. My mummy sense kicked in to alert me something wasn’t right, but there was no reason to suppose it was urgent enough to drag him off to A&E right then, just before bedtime. In the morning, seeing his continued discomfort, that old mummy sense prompted me to take him along to get checked out.

Now, I am certainly not knocking the NHS here. I am so grateful that we have this amazing health service that is free at the point of contact so that I can get prompt medical attention without any worry. We were soon called into triage, where the nurse was lovely and efficient. She checked over all the important stuff, assessed the injury and then asked that old question. ‘How much does it hurt on a scale of 0 to 10?’

It’s a big question. I totally get why they ask it. It gets asked in labour too, where it is even more problematic. In this situation, my son has only ever experienced the usual cuts, bruises, scrapes and bumps. He doesn’t really have any concept of pain that is a 10. It was clearly causing him a fair degree of discomfort so he said it was an 8.

The nurse, being a caring sort of individual, immediately offered him some paracetomol to help with the pain. I say ‘offered’. Yes, it was asked as a question but it was one of those rhetorical questions where the only answer expected is ‘Yes’.

He said, ‘No thank you’. (He’s a polite boy, a real sweetie).

There was a silence. A bewildered one. ‘Oh’, the nurse said, recovering herself, ‘You know, that sweet syrupy pink stuff? Like Calpol?’

He didn’t say anything. And nor did I. The nurse started discussing with the student the dosage he should be given based on his age and weight. I looked at my son sitting there, still considering the question. I realised he hadn’t given his consent. And nor had I.

It was just a moment. I wanted it to pass, not to have to cause a scene. Just take the paracetomol, it’s not going to cause any harm.

But he hasn’t consented. And nor have I.

‘Honey’, I said. ‘Do you actually want any paracetomol? It’s okay to say No if you don’t want it.’

‘No thanks’, he said.

Right. I’ve checked in with him, now I have my answer I need to assert myself. Why is it so hard? I can do assertive in any situation – except here, in the submissive role of patient with this nice nurse who is only caring and doing her job. The nurse and student were both looking expectantly at me. ‘Is it okay if he doesn’t have any then?’ I asked nervously. I did a silly giggle and said, ‘You see, we kind of listen to our kids…..’

Yeah. I could have handled that so much more assertively, but ultimately he didn’t have the paracetomol, we got great care and attention, he has a splint which he thought was cool for all of 5 minutes until he realised he has 3 weeks over the summer holidays of not being able to do fun stuff.

And more importantly, we got to have a great chat about how I nearly hadn’t listened to him. I apologised, and said I had realised he didn’t really want it but had almost let it happen anyway. Then I had checked in with him, and stuck up for him to defend his choice. This is a small and unimportant issue – it really wouldn’t have made any difference to him if he had been given a small dose of paracetomol. But there are far wider consequences of what happened. He knows that it is okay to say No. He doesn’t have to do things, or allow things to happen to his body, just because an adult told him to.

Do you see where I’m going with this? This is about consent in all its forms. I’m teaching him to check in with people around him, to notice their body language and see if they are okay with what is happening. I’m teaching him to check in with himself, and how to speak up and say ‘No’ when necessary. I’m teaching him he doesn’t have to go along with peer pressure, or pressure from adults. I’m teaching him to speak up for others if he notices they haven’t consented to something.

We will continue to have these real life conversations throughout his childhood, and hopefully teenage and adult years. By talking, discussing, modelling, I want him to grow up knowing that no means no in whatever situation he finds himself in. I want him to have respectful, consensual physical relationships with others. I want to give him tools to protect himself if he did find himself in an uncomfortable or abusive situation.

I want him to know that in a medical situation he can ask for information, risks and benefits and then make an informed choice. I want him to support any partner he has who is pregnant and giving birth to also be aware of that too, and I want him to have the skills to support that imaginary future partner.

It starts in childhood. If we don’t assert ourselves and teach our children to assert themselves, then they will never be able to learn how to make good, informed choices about their bodies.

We carried on having that chat over the next day or so. We talked a lot about what paracetomol is, how it works and when it is good to choose to take it. We talked about how if you need to go to sleep and something is hurting it can help you get some rest. We talked about how if you take it and cover the pain up a bit then you might end up not resting the damaged bit as much and it might take longer to heal. So much learning about bodies and medicines and choice, because I listened to my instinct and allowed myself to feel slightly uncomfortable in the process. We talked about the nurse and the doctor he saw, and how great they are at their jobs, and how important it is that we are able to communicate clearly with them so they can help us.

Now, we’re going to enjoy the next couple of weeks of the summer holiday avoiding riding bikes, climbing and other fun stuff like that. But I know my boy is healthy, healing, and has learnt something important – also that he knows I’ve got his back. He is heard.

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Comments (2)

  • 20th July 2018 at 11:10 |

    Great blog Lucy and one that I will be sharing with my clients. So many important points here.

  • 20th July 2018 at 11:18 |

    Thank you Jacqueline.

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