The Bloomsbury Colleges | PhD Studentships | Studentships 2017 | Children's and parents' informed and voluntary consent to major medical and surgical treatment
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Children's and parents' informed and voluntary consent to major medical and surgical treatment

Principal supervisor: Professor Priscilla Alderson (UCL)

Co-supervisors: Dr Katy Sutcliffe (UCL)  Professor Susan James (Bbk)

Award includes tuition fees and a stipend of £16,257 including London Weighting (at 2016/17 rates, so slightly higher for 2017 entry)

100% FTE for 3 years, from September 2017.

This is one of ten annual PhD studentships awarded by the five Bloomsbury Colleges and promoting inter-collegiate research. The student will be based at the Social Science Research Unit (see http://www.ucl.ac.uk/ioe/departments-centres/centres/social-science-research-unit) in the UCL Department of Social Science (http://www.ucl.ac.uk/ioe/departments-centres/departments/social-science) working with the Department of Philosophy at Birkbeck (http://www.bbk.ac.uk/philosophy/).

Knowledge and skills to be developed:

This is an excellent opportunity for a doctoral student to develop interdisciplinary knowledge and practical experience in: the sociology and philosophy of children’s and parents’ consent to major treatment; critical realism; the latest advances in research synthesis methods; qualitative ethnographic research, interviewing, data analysis and report writing; the policies and organisation of related health services; work with advisory groups of young patients and parents; creating a project website and moderating online discussion groups. The post would suit an adventurous and flexible researcher.

Year 1: attend social science and philosophy doctoral courses and seminars, conduct literature reviews, plan the detailed research, set up project website (free training provided) and convene advisory groups, apply for research ethics committee approval and access to hospitals, complete upgrade. The student will share in selecting the two or three medical specialties to be studied. One possibility is children with sickle cell anaemia who need their spleen and sometimes their gallbladder to be removed. BAME candidates are encouraged to apply.

Year 2: Ethnographic observations in wards and clinics of how staff, parents and young patients negotiate major decisions; semi-structured interviews with 40 children aged 6- to 15-years having major treatment, their parents and 20 healthcare professionals; begin critical interdisciplinary data analysis informed by social science, philosophy and critical realism.

Year 3: Complete data analysis and write thesis, and other journal and conference reports as time permits.

Candidate Requirements:

Candidates must have a first class or upper second undergraduate degree or a Master’s degree in a relevant discipline, including but not limited to sociology, anthropology, philosophy or healthcare, as well as excellent spoken and written English. Experience of conducting qualitative social research and knowledge of the health services would be advantages. A clean Disclosure and Barring Services (DBS) check (formerly known as Criminal Record Bureau (CRB)) will be required.

Background to the research:

Patients’ informed voluntary consent to major treatment is vital: legally, to avoid litigation by non-consenting patients for battery or negligence; clinically, to observe agreed high professional standards; ethically, to respect patients as persons; and therapeutically, to promote more effective care by encouraging patients’ questions, willing informed cooperation with treatment, and trust in its efficacy.

Questions arise about how far children can and should be informed and involved in major decision-making. In English law, consent to treatment can be given by children <16 years if they are assessed as ‘Gillick competent’: having ‘sufficient understanding and intelligence to understand fully what is proposed’ and ‘sufficient discretion to enable [them] to make a wise choice’.

UK-led respect for Gillick competent minors’ consent is undermined by US-and EC-led concepts of assent, when patients aged up to 18-years may not necessarily be informed or consulted. Medical and ethics journals debate confusions about current law and guidance on children’s consent, which further complicate the great challenge for clinicians and parents: to inform and involve child patients respectfully and supportively.

Parents’, children’s and clinicians’ reported views on the age of competence to give consent/refusal range widely, from 21-years downwards (1). Heart-lung transplant teams, for example, tend to wait until the informed child aged from about 6-years is willing, in order to avoid imposing treatment on a resisting child (1). Effective care for young children with diabetes depends on their informed involvement (2). However, respect for children’s consent is controversial. Some experts ignore the views of all patients aged under-18-years. Others, concerned about clinicians’ current confusion, highlight 'the need for a comprehensive review of legal policy and practice in this area’ (3). Debates are influenced by current policies and attitudes relating to childhood (4).

This interdisciplinary study aims:-

  • to clarify philosophical, legal and clinical confusions around children’s consent;
  • to provide evidence of the views and experiences of a range of young patients and adults on effective and less effective methods of sharing decision-making;
  • to study degrees of children’s and parents’ sharing of information and decision-making;
  • to reduce children’s suffering from fear, ignorance and coercion;
  • to promote respect for their informed voluntary involvement as far as each child prefers;
  • to discover the different ages when children and adults believe that children are as competent as their parents to consent to major medical treatment, or refuse it.

Significance of the research

  • Collaboration between UCL-IOE sociology and Birkbeck philosophy supervisors will deepen inter-related theoretical and practical understandings of minors’ consent.
  • The research will examine and clarify views and experiences of what does/does not ‘work well’ to address young patients’ hopes and fears, their autonomy and preferences, to promote shared decision-making,  and reduce confusions in present law, ethics and practice.

The disseminated analysis and evidence will inform families, and also professionals working in relevant medical, nursing, legal, ethics and policy specialties.

Key References:

[1] Alderson P. (1993) Children’s Consent to Surgery, Open University Press, plus many widely-cited papers.

[2] Alderson P, Sutcliffe K, Curtis K. (2006) Children as partners with adults in their medical care, Archives of Disease in Childhood, 91: 300-303.

[3] Brierley, J. and Larcher, V. (2016) Adolescent autonomy revisited: clinicians need clearer guidance, Journal of Medical Ethics, doi:10.1136/nedethics-2014-102564.

[4]   Alderson, P. (2016) The Politics of Childhoods Real and Imagined: Practical Application of Critical Realism and Childhood Studies. London: Routledge.

Further details about the project may be obtained from:

Principal supervisor: Professor Priscilla Alderson (p.alderson@ucl.ac.uk)

https://iris.ucl.ac.uk/iris/browse/profile?upi=DPALD60

Co-supervisors: Dr Katy Sutcliffe (katy.sutcliffe@ucl.ac.uk)

https://iris.ucl.ac.uk/iris/browse/profile?upi=KSUTC11

Professor Susan James (s.james@bbk.ac.uk)

http://www.bbk.ac.uk/philosophy/our-staff/academics/susan-james

Further information about PhDs at UCL IOE is available from:

The Bloomsbury DTC Administrator: isabelle.jerome@ucl.ac.uk

Application forms and details about ho to apply are available from:

The Bloomsbury DTC Administrator: isabelle.jerome@ucl.ac.uk

Closing date for application is:

9 March 2017