Adolescent consent for research and sensitive services — branching viva

Stem

The examiner will test whether you can run a consent encounter for both research and sensitive services under pressure, holding the lawful limits of confidentiality. [1] [11]

Branch 1 — Research-consent principles

Examiner: What must be in place to enrol an adolescent ethically in a research study? [2]

Strong answer: Three elements — the young person's assent, parental permission, and research-ethics-committee approval. The committee judges risk, benefit, privacy and whether a waiver is justified. A young person's dissent usually prevails even when parents permit. [2] [3]

Examiner: Distinguish consent, permission and assent. [1]

Strong answer: Consent is the decision of someone with capacity; parental permission authorises care or research for a child who lacks capacity; assent is the child's age-appropriate agreement, sought even when a parent gives permission. [1] [7]

Branch 2 — Waiver of parental permission

Examiner: A researcher wants to run an anonymous survey of adolescent substance use and asks you whether parental permission can be waived. How do you decide? [6]

Strong answer: A research ethics committee — not the clinician — grants the waiver, when the study is minimal risk, the waiver will not adversely affect rights or welfare, it is impracticable without it, and the data are sensitive such that parental notification would distort results or endanger participants. This anonymous substance-use survey fits. You still seek the young person's assent, protect the data, and offer help if risk surfaces. [6] [2]

Examiner: What about an interventional, greater-than-minimal-risk trial? [3]

Strong answer: Parental permission plus assent is the default; capacity for the more complex decision is assessed specifically, and the committee scrutinises risk-benefit closely. [3] [2]

Branch 3 — Sensitive-services consent and capacity

Examiner: A 15-year-old requests contraception and asks that her mother not be told. How do you proceed? [14]

Strong answer: Create time alone, state conditional confidentiality, and assess capacity for this decision — understands, retains, weighs, communicates, with teach-back and a voluntariness check. She may consent under a statute-based minor-consent provision where one applies; plan confidential return of results before acting, and encourage family involvement where safe and she agrees. [14] [1]

Examiner: How is capacity different from age? [7]

Strong answer: Capacity is task-specific and capacity-based, not age-gated, using the Gillick or mature-minor principle. The same young person may consent to contraception yet lack capacity for a complex trial. Re-assess each decision. [1] [7]

Branch 4 — Override inside a research interview

Examiner: During a research interview she discloses an active suicide plan for tonight and begs secrecy. [11]

Strong answer: Override ethically. Secure immediate safety, do not leave her alone, remove means if safe, and escalate to emergency or crisis teams. Tell her what must be shared and why, share the minimum necessary, involve parent or carer and safeguarding as required, and document the reasoning. Follow the study's safety and reporting plan and notify the investigator and ethics committee as the protocol requires. [11] [10]

Examiner: How do you preserve the relationship after the breach? [10]

Strong answer: An ethical override — told in advance, proportionate and explained — can preserve trust. Stay engaged for follow-up so the breach does not become abandonment. [10] [1]

Examiner extras

• Capacity is task-specific; do not stamp "capable" once for all decisions. [7] [5]
• Research doubles the confidentiality stakes — the sensitive answer plus the act of being asked. [5] [8]
• Portal, billing and explanation-of-benefit leaks are modern failure modes; anticipate them. [12] [11]
• Never use family members as interpreters for sensitive or research content. [11] [9]