Consent, Capacity and the Reluctant Teenager
A 15-year-old boy attends with his mother for an extraction of a grossly decayed lower first molar. The dentist explains the procedure to the mother and asks you to 'get him to sign the consent form'. The boy is quiet, avoids eye contact, and when asked directly says 'I don't want it out'. His mother says he is 'just being difficult' and that she consents on his behalf. You are aware the tooth is causing him pain and that delaying risks infection. The dentist has stepped out to take a call.
1. How should you respond to the request to obtain the boy's signature?
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You should not pressure him to sign, and you should not treat the mother's signature as sufficient on its own.
- A 15-year-old may have capacity to consent or refuse if he can understand, retain, and weigh the information. His stated 'I don't want it out' must be explored, not overridden.
- The dentist, not the nurse, is responsible for the consent discussion and for assessing capacity. Your role is to facilitate that conversation and ensure the boy's view is heard.
- Getting a signature under pressure from a parent would be coercive and would not constitute valid consent.
Judgement tested: recognising the limits of your role and refusing an instruction that would undermine the patient's autonomy.
2. The dentist returns and the boy still refuses. What should happen next, and how do you support the process?
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Next steps:
- The dentist should have a private, age-appropriate conversation with the boy to understand his concerns (fear of needles, pain, missing school).
- Capacity should be formally considered. If he has capacity and refuses, his refusal should be respected, and alternatives discussed (analgesia, temporary dressing, reassessment).
- The mother should be supported to understand that her son's views carry weight, without being made to feel blamed.
Your supporting role:
- Create space and privacy for that conversation.
- Document accurately what was said, by whom, and the outcome.
- Ensure the boy knows he can ask questions and that his concerns are taken seriously.
The exam tests whether you can hold a line between parental pressure and patient autonomy while remaining supportive to the family.