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930). 4 P rinc iple s o f se lf - de t e rmina t io na • Every adult has the right to make his/her own decisions and to be assumed to have capacity unless proved otherwise. • Everyone should be encouraged and enabled to make his/her own decisions, or to participate as fully as possible in decision-making. • Individuals have the right to make eccentric or unwise decisions. • Proxy decisions should consider best interests, prioritizing what the patient would have wanted, and should be the ‘least restrictive of basic rights and freedoms’.
2). 3). Occasionally, a medical case is subject to criminal law: for example, when a patient dies in circumstances that could constitute manslaughter. 4). People are able to make choices only if they have capacity. The assessment of capacity is a significant undertaking; a patient's freedom to choose depends on it. 930). 4 P rinc iple s o f se lf - de t e rmina t io na • Every adult has the right to make his/her own decisions and to be assumed to have capacity unless proved otherwise. • Everyone should be encouraged and enabled to make his/her own decisions, or to participate as fully as possible in decision-making.
Sharing decisions, and paying attention to the needs of the child as a member of a family, are the most effective and ethical ways of practising. As children grow up, the question of whether a child has capacity to make his or her own decisions is based on principles derived from a case called Gillick v. West Norfolk and Wisbech Area Health Authority, which determined that a child can make a choice about his or her health where: • the patient, although under 16, can understand medical information sufficiently • the doctor cannot persuade the patient to inform, or give permission for the doctor to inform, his or her parents • a minor is seeking contraception, in cases where the patient is very likely to have sexual intercourse with or without adequate contraception • the patient's mental or physical health (or both) is likely to suffer if treatment is not provided • it is in the patient's best interests for the doctor to treat without parental consent.