The issue has a tremendous impact on paediatric practice, and all those who care for children should have a clear understanding of the legal and ethical consensus. From the late 1960s to the early 1990s changes in the law on consent progressively increased the rights of those under 18 to self determination - always dependent on their capacity to understand the implications of their decisions. The case of Gillick v West Norfolk and Wisbech Area Health Authority established that children under 16 years could give legally effective consent to medical treatment, independent of their parents wishes, provided they had sufficient understanding and intelligence. Lord Donaldson ruled that no one under 18 years has an absolute right to make his or her own decisions on medical, treatment especially when that treatment is refusal. Re W may have been an extraordinary case, but the ruling could be viewed as a licence to bulldoze children into treatment regardless of their personal wishes, fears, or capacity to understand the implications of their decision.
Children do have some rights from international and national legislation.
The United Nations Convention on the Rights of the Child advocates the right of every child to self determination, dignity, respect, non-interference, and the right to make informed decisions. In theory, the pronouncements of the United Nations and the European Charter are at variance with the current English law. In practice in almost all circumstances this apparent conflict will not matter. Clearly those rare life or death decisions in which the minor refuses treatment must be resolved in the courts. This does not eliminate the medical professionals' responsibility carefully to consider the views of the child in conjunction with those of the parents or guardians.