Consent, parental responsibility and mature-minor frameworks — OSCE

Objectives

1. Confirm who holds parental responsibility and how to weigh conflicting parental views for an urgent decision. [1]
2. Seek age-appropriate assent and manage dissent in a frightened school-age child. [2] [12]
3. Disclose material risks, benefits and alternatives in plain language with teach-back. [1]
4. Apply the emergency principle and escalate appropriately if disagreement threatens the child. [1] [9]

Candidate brief

A 12-minute station. A 6-year-old with suspected meningitis requires a lumbar puncture. The mother present consents. The father phones mid-station and refuses, demanding you wait. The child is tearful and pulling away from the bed. The nurse asks you what the plan is. The child is haemodynamically stable but the team is concerned about delay. [1]

Expected actions

• Greet the child by name first; acknowledge fear before discussing the procedure with the parent. [12]
• Confirm the mother's relationship and parental responsibility; do not assume authority from presence alone. [1]
• Explain the lumbar puncture in child-friendly terms: what, why, what it feels like, and how you will keep them comfortable and still. [2] [12]
• Use teach-back: ask the parent to restate the purpose and the main risks and alternatives. [1]
• Seek the child's assent and document behavioural dissent; plan topical anaesthesia, positioning and distraction rather than forcing. [2]
• Take the father's call: explore his specific concern, offer to involve the senior clinician, and explain the plan and the reason urgency matters. [1] [9]
• If disagreement persists and delay risks harm, escalate to the consultant, involve ethics or legal services per local policy, and apply the emergency principle where the threshold is met. [1] [9]
• Document who consented, the capacity and assent findings, the material risks disclosed, the dissent, and the escalation. [1]

Examiner prompts

• "Father on line two: do not touch my child." → Explore the concern, explain urgency, involve senior. [1] [9]
• "Will it paralyse her legs?" → Disclose the real material risks honestly without dismissing the fear. [1]
• "She's crying, just do it quickly." → Reframe: read behavioural dissent, build in preparation and comfort. [2] [12]

Marking foci

• Identifies parental responsibility and manages conflicting parental authority appropriately. [1]
• Seeks assent and reads behavioural dissent, not just verbal agreement. [2]
• Discloses material risks and alternatives with teach-back. [1]
• Applies emergency principle and escalation pathway when delay risks harm. [1] [9]
• Documents the consent basis, capacity and assent findings, and dissent. [1]