Changing up a gearyoung people’s sexual health and well-being Young people’s rights

10th September 2008

Priscilla Alderson Professor of Childhood StudiesSocial Science Research Unit

Institute of EducationUniversity of London www.ioe.ac.uk/ssru/

Which are the most important rights for young people’s well-being?

Who uses UNCRC?

At the end of your life, what do you think you might

look back on as the most important aspect of your life?

Young people –

Adults with full adult rights 18+

Young people 16-18 (Family Law Reform Act 1969; marriage; army; school leaving)

Children 0-10/12 and young people 10/12-17 HR Act 1998, Children’s Rights UNCRC 1989; Gillick.

UNCRC ‘3 Ps’

Provision rights – health care, education, adequate standard of living

Protection rights– from harm, abuse, neglect,

discrimination, violence, torture, inhuman or degrading treatment,

exploitation, and arbitrary punishment, arrest, detention or interference (Articles 1- 3, 5-11, 18-19, 22-23, 30, 32-40).

UNCRC ‘3 Ps’

Participation rights - Freedoms of information and expression, thought, conscience and religion, association and peaceful assembly (Articles 12-17); Rights to life and survival, to privacy and family life, to a legal identity, to cultural life and the arts, and due legal process (Articles 6-8, 12-17, 31, 37, 40); The whole UNCRC is imbued with respect for the child’s person, worth and dignity, and with the social, economic and political means of promoting these within a ‘free society’ (Article 29).

To express views

To the child who is capable of forminghis or her own views the right to expressthose views freely in all matters affectingthe child: the views of the child beinggiven due weight in accordance with theage and maturity of the child UNCRCR:12)

Freedom of expression [including]freedom to seek, receive and impartinformation and ideas of all kinds,regardless of frontiers, either orally, inwriting or in print, in the form of art,or through any other media of the child’s choice” (UNCRC:13).

Four levels of decision making

1. To be informed

2. To form and express views.

3. To influence a decision.

4. To be the main decider aboutproposed research/treatment/care.

1-3 Children Act 1989, Children Act Scotland 1995.; DH 1990UN Convention of the Rights of the Child (1989)

4 Gillick v Wisbech and W Norfolk HA 1995

PA+JM 1996

The Gillick Guidelines

’As a matter of law the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when they child achieves a sufficient understanding and intelligence to understand what is proposed’ and ‘sufficient discretion to enable him or her to make a wise choice in his or her own interests.’ Gillick v Wisbech & West Norfolk AHA (1985) 3 All ER 423

 

The Fraser Guidelines1. That the girl (although under 16 years) will understand his (the practitioner’s) advice;2. That he cannot persuade her to inform her parents or allow him to inform her parents that she is seeking contraceptive advice; 3. That she is very likely to begin or to continue having sexual intercourse with or without contraceptive treatment;4. That unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer. 5. That her best interests require him to give her contraceptive advice, treatment or both without the parental consent.

‘No. 2. That he cannot persuade her to inform her parents’ is not a test of competence.It denies that most decisions are made by competent children/young people with their parents.Lord Fraser speaks about contraception but Lord Scarman stated that ‘Gillick’ applies much more broadly and he makes no mention of Fraser’s guidance. Fraser and Sexual Offences Act 2003 protect professionals who advise minors ‘in good faith [they are not committing a criminal offence of aiding and abetting unlawful intercourse with girls under 16’.

Reproductive and sexual decisions may cover medical and surgical treatment (termination) and merge into social, personal, life-course, relationship, and privacy (ContactPoint) decisions. What is competence to make decisions?How is it assessed?Status – age/ mental state

Outcome – practitioner agrees with decision

Function – practitioner agrees with person’s methods and reasoning in decision making.

Assessing competenceFour standards in the person giving consent

1. Mental competence

2. Sufficient information

3. Sufficient understanding to make a reasoned choice

4. Voluntariness and autonomy

These are also four standards to assess

in the people asking for consent

Informed consent/refusal (Helsinki)Involves knowing about the intervention’s:

* purpose, nature and duration* methods and means* hoped for benefits* harms, costs and risks* alternatives* effects on health and person

Informed consent also involvesknowing the person’s rights to:

• discuss questions• have time to consider• have access to parents, if wish to• have respect for confidentiality• have written information• have a named contact• refuse or withdraw from treatment • signify consent or refusal

Informed consent Two way

* expert practitioners

on conditions, treatments, processes, outcomes

* expert young people on their needs for services and their life choices - unique and essential knowledge - social and bodily experiences - emotions and relationships- values, hopes and fears - practical realities

The need for time, space, trust, listening

To balance physical and social health

Consent and negotiation

A test of child’s fixed competence? Or of adults’ ability to nurture competence?

One way information giving and assessing? Or two way exchange of information and decision making?

An event? Or a process of sharing knowledge and control and choices?

Adults have the right to decide because they can:  

1 Understand and process information;  2 Exercise their rights reasonably and make

reliable decisions based on lasting values; 3 Have the wisdom/discretion to decide

in a child’s best interests; 4 Have personal autonomy and the resolve to

stand by their decisions without blaming others for mistakes or failures;  

5 Form and express views and have ‘public’ autonomy - other people respect their autonomy and rights.  

Can young people do this?In our Consent to Major Surgery research (120young people aged 8 to 15 years) and Type IDiabetes research (children aged 3-12 years), manyof these very experienced children were seen by adultsand by themselves as highly competent.  

Some key research conclusions

* Child development age/stage theory (now often <25+), slow steps from zero at birth to mature adulthood, can be misleading and unhelpful

* Understanding and maturity relate far more to experience than to age or ability

* Disadvantaged young people may know far more than sheltered privileged ones (international studies)

* Normative assessments( that measure and judge people against a norm) are less useful than ones that listen to each person’s reasoning and values.

Some key research conclusions

• Beliefs about childhood and youth are social constructions. • In UK today, the government and media emphasise that young people are ignorant, helpless, expensive dependents, unreliable, over-emotional, volatile. Adults – wise, calm, informed, responsible.• Women used to be seen this way. Their wellbeing and economic and political status improved when they were respected as real people, equal to men, no longer mainly protected and provided for but partners in the public world. (3Ps)

An overview of child well-being in (21) rich countries UNICEF 2007

• Material well-being• Health and safety• Educational well-being• Family and peer relations (trust, ‘just talking

with parents’, ‘kind and helpful peers’)• Health and risk behaviours, violence • Subjective well-being (health, liking school,

personal satisfaction)Six inter-related themes

Average ranking for all 6 positionsLowest marks give best results

Netherlands

Sweden

Denmark

Finland

Spain

Switzerland

Norway

Italy

Ireland

Belgium

Germany

4.2

5.0

7.2

7.5

8.0

8.3

8.7

10.0

10.2

10.7

11.2

Canada

Greece

Poland

Czech rep.

France

Portugal

Austria

Hungary

US

UK

11.8

11.8

12.3

12.5

13.0

13.7

13.8

14.5

18.0

18.2

Health and wellbeing are political as well as personal

(WHO 2008 Closing the gap in a generation).

Inequalities of income and status kill.

Higher mortality in Glasgow than in India, Philippines, Mexico.

Low paid, boring insecure jobs, stress and frustration when basic rights are denied,

are deadly.

NEETS.

Pregnancy in late teens – does not necessarily reduce life chances;extended family may be around; young men may stop offending; Health risks in mid-life, IVF, neonatal care.ECM – towards full time 40 years+ women’s

employment - male model.Aim to increase GNP. But as ‘goods’ increase so do ‘bads’: childhood and youth mortality and morbidity.

Health and wellbeing flourish in equalrights-respecting, redistributing societies

where benefits and services are widely shared – as in Sweden. Not when controls and small benefits are‘targeted at the “hard-working families” or “workless households”.

How can we promote young people’s wellbeing in the UK by:Challenging negative stereotypesChanging life chancesTransforming economic, family, education, community and crime policies?