Sir, I write to draw readers' attention to some issues raised by a recent publication regarding consent for paediatric surgery.1 The prospective study based at Southampton General Hospital involved adults consenting for 100 children due to have elective or emergency surgery under general anaesthetic. The adults were questioned about the possession of parental responsibility and their understanding of the concept on returning from the operating theatre.

The study found that in 4% of the cases, the consent was invalid. In those cases, the consent form had been signed by unmarried fathers, none of whom had acquired parental responsibility. The attitudes towards consent were perhaps surprising. Of the adults, 82% thought that cohabitation was a sufficient qualification to provide consent. Less than 15% recognised marital status as being relevant.

It seems that valid consent is often gained by luck rather than by judgement since natural mothers are often the adult to present with the child in the healthcare setting (75% of cases in this study).

In general dental practice, consent is given verbally the majority of the time. However, the same principles regarding the validity of the consent still apply as for written consent.2 When agreeing treatment plans in which irreversible procedures such as tooth extraction are planned, one must be particularly careful about obtaining valid consent. Only adults with parental responsibility (PR) can provide valid consent for an 'incompetent' child.1

Picture the scenario whereby an unmarried father presents with a child and extraction is indicated. It is likely the father fully believes he has the legal right to give consent for his child. The problem for the dentist is that if they perform an extraction on a child with invalid consent, legally the child has been assaulted. One could say 'what does it matter' if everyone is acting in the best interests of the child? A lawyer might not take such a relaxed view should any complications arise.

This is a problem area that should diminish with time. Unmarried fathers of children born after December 2003 automatically obtain parental responsibility (PR) if their name is registered on the birth certificate.3 For unmarried fathers of children born before this date, PR can be obtained with the consent of the court by a very simple and inexpensive procedure.1

The study1 concludes that there is a wide gulf between the standards set by the Children Act 19894 and common practice. It certainly made me consider perhaps one should place just a fraction more attention to who exactly is accompanying a child and whether they truly have parental responsibility.