You can also download or order Childline posters and wallet cards. More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation. Lord Fraser stated that a doctor should always encourage a girl aged under 16 to inform her parents or carers that she is seeking contraceptive advice (or allow the doctor to inform the parents or carers on her behalf). The two girls lived with their respective mothers. Otherwise, someone with parental responsibility can consent for them. Decision making competence does not simply arrive with puberty; it depends on the maturity and intelligence of the child and the seriousness of the treatment decision to be made. Incorporated by Royal Charter. Immunization is voluntary and generally it is for those who have parental responsibility for a child or children who are Gillick competent to decide on immunization. 2023 The result of Gillick is that in England today, except in situations that are regulated otherwise by law, the legal right to make a decision on any particular matter concerning the child shifts from the parent to the child when the child reaches sufficient maturity to be capable of making up his or her own mind on the matter requiring decision. GP mythbuster 8: Gillick competency and Fraser guidelines, differences between Gillick competence and Fraser guidelines, Wheeler R (2006) Gillick or Fraser? a local authority or person with an . 4 0 obj Where a health professional accepts the consent of a Gillick competent child it cannot be overruled by the child's parent. This would include circumstances where refusal would likely lead to death, severe permanent injury or irreversible mental or physical harm. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. It was found that Gillick did not apply directly to the issues before the court in this case but there is useful commentary and discussion in the judgement regarding the use of Gillick competence. This study of the ethical significance of childhood is situated within the context of adolescent decision-making and childhood is treated as a neglected topic of of ethical reflection. Their fathers made an application to the court seeking the immunization of their children. Victoria D. M. Gillick (ne Gudgeon; born 1946, in Hendon) is a British activist and campaigner best known for the eponymous 1985 UK House of Lords ruling that considered whether contraception could be prescribed to under-16s without parental consent or knowledge. Gillick competence refers to the recognition that the capacity of a child to make serious decisions about his or her life will increase as does the age and understanding of that child. Children under 16 can consent to medical treatment if they understand what is being proposed. << /Type /Page /Parent 3 0 R /Resources 6 0 R /Contents 4 0 R >> Victoria Gillick challenged Department of Health guidance which enabled doctors to provide contraceptive advice and treatment to girls under 16 without their parents knowing. Fraser was one of the five judges of in the UK House of Lords . Mental Health Matters. Gillick Competence. Help for adults concerned about a child it is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent. However, where the same child refuses consent then they may obtain it from another person with parental responsibility who can consent to treatment on the child's behalf. This idea of Gillick competence was further supported by R (on the application of Axon) v Secretary of State for Health. Study Hub OSCE Sessions. The term "Gillick competence" comes from a landmark English case where the courts first recognised that a minor might be competent to make decisions without parental consent. Gillick competence is a functional ability to make a decision. This lack of authority reflects that the reported cases have all involved minors who have been found to be incompetent, and that Australian courts will make decisions in the parens patriae jurisdiction regardless of Gillick competence. However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court. This was clarified Kennedy & Grubb (1998) argue that children pass through 3 developmental stages on their journey to becoming an autonomous adult.Citation3. If a child does not pass the Gillick test, then the consent of a person with parental responsibility (or sometimes the courts) is needed in order to proceed with treatment. When assessing Gillick competence for immunization, a health professional has to decide whether the child is or is not competent to make that particular decision. the child's age, maturity and mental capacity, their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact, their understanding of the risks, implications and consequences that may arise from their decision, how well they understand any advice or information they have been given, their understanding of any alternative options, if available. A plea for consistency over competence in children. If they don't want to do this, you should explore why and, if appropriate, discuss ways you could help them inform their parents or carers. The issue before the House of Lords was only whether the minor involved could give consent. This article considers the requirements for Gillick competence, it highlights the factors that must be considered when determining whether a child is competent to give consent to treatment. At paragraph 78, Sir James also noted that: condoms to young people under 16, but this has not been tested in court. This form provides a structured method for obtaining evidence of the patient's capacity to For example, parental consent is required for the treatment of children with asthma using standby salbutamol inhalers in schools. Gillick competence for children (under 16s) A child with sufficient maturity and understanding to comprehend the nature and implications of treatment, may be considered 'Gillick competent' and able to consent to treatment. If a person under the age of 18 refuses to consent to treatment, it is possible in some cases for their parents or the courts to overrule their decision. Fraser guidelines originally just related to contraceptive advice and treatment but, following a case in 2006, they now apply to decisions about treatment for sexually transmitted infections and termination of pregnancy. It is not a question of neglect or abuse that would trigger child protection proceedings. The following information looks at how this can be applied in practice. A child of 15 years or above would normally be expected to have sufficient maturity, intelligence and understanding to . If a child passes the Gillick test, he or she is considered Gillick competent to consent to that medical treatment or intervention. It is argued that the relatively broad usage of the test of Gillick competency in the medical context should not be considered applicable for use in research. >> /Font << /TT2 10 0 R /TT1 9 0 R >> /XObject << /Im1 11 0 R >> >> A minor is considered to be competent to consent to treatment when the person 'achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed'. For safeguarding training, resources and consultancy in England and Wales by the House of Lords in the case of Gillick vs West Norfolk Health professionals who behave in this way would be failing to discharge their professional responsibilities and could expect to be disciplined by their professional body.Citation5 Where a child is considered Gillick competent then the consent is as effective as that of an adult and cannot be overruled by a parent. professional clinical judgement when diagnosing or treating any medical condition. Copyright Gillick Competence is a legal state where a person under 16 years old is considered to have "the degree of maturity and intelligence needed" to consent to a treatment2. The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. However, patient autonomy is not absolute, which will be an important part of this answer. gillick competence osce. Copyright 2023 Fraser guidelines are applied specifically to advice and treatment that focuses on a young person's sexual health and contraception. 16 - 17 year olds, by virtue of section 8 of the Law Reform Act 1969 are conclusively presumed to be Gillick competent and the test of Gillick competence is bypassed and has no relevance. Where a person under the age of 16 is not Gillick competent and therefore is deemed to lack the capacity to consent, it can be given on their behalf by someone with parental responsibility or by the court. But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. Young people aged 16 or 17 are presumed in law, like adults, to have the capacity to consent to medical treatment. The child of tender years who rely on a person with parental responsibility to consent to treatment. The vaccines minister appears to be arguing that this barrier can be overcome by taking consent from the child under the rule in Gillick (Gillick v West Norfolk and Wisbech AHA [1986]). When assessing Gillick competence for immu-nization, a health professional has to decide whether the child is or is not competent to make that particular decision. However, these are only obiter statements and were made by a lower court; therefore, they are not legally binding. If a young person under the age of 16 presents to a health care professional, then discloses a history raising safeguarding concerns: It is reasonable for the local authority or police to decide whether it is appropriate to inform the parents of the concerns raised. Any distribution or duplication of the information contained herein is 15 August 2022. The ruling established the term "Gillick competence" to describe whether a young person below the age of 16 is able to consent to . Any other browser may experience partial or no support. Age of Legal Capacity (Scotland) Act 1991, consent to examination, treatment or care, consent guides for healthcare professionals, good practice guide on consent for health professionals (PDF), Brief guide: capacity and competence to consent in under 18s (PDF), Consent guides for healthcare professionals, Reference guide to consent for examination or treatment (second edition), The law reports (appeal cases) [1986] AC 112, A good practice guide on consent for health professionals in NHS Scotland (PDF), Harmful sexual behaviour in schools training, For safeguarding training, resources and consultancy, would like to have therapeutic support but doesn't want their parents or carers to know about it, is seeking confidential support for substance misuse. be as effective as it would be if he were of full age; and where a minor has by Gillick competence is a functional ability to make a decision. Adolescents have the legal right to confidential health care. A licensed medical December 2018 . At one end there are the obvious cases where parental objection would have no value in child welfare terms, for example urgent lifesaving treatment such as a blood transfusion. There is no set of defined questions to assess Gillick competency. The same child may be considered Gillick competent to make one decision but not competent to make a different decision. The Axon case set out a list of criteria that a doctor must meet when deciding whether to provide treatment to an under-16 child without informing their parents: they must be convinced that they can understand all aspects of the advice, that the patients physical or mental health is likely to suffer without medical advice, that it is in the best interests of the patient to provide medical advice, that (in provision of contraception) they are likely to have sex whether contraception is provided or not, and that they have made an effort to convince the young person to disclose the information to their parents. The common law recognises that a child or young person may . has strong wishes about their future living arrangements which may conflict with their parents' or carers' views. virtue of this section given an effective consent to any treatment it shall not Gillick competence is a functional ability to make a decision. If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent" (Gillick v West Norfolk, 1984). However, there is still a duty to keep the childs best interests at the heart of any decision, and the child or young person should be involved in the decision-making process as far as possible. When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse. In fact, the court held that parental rights did not exist, other than to safeguard the best interests of a minor. A plea for consistency over competence in children. Care Quality Commission (2019). In Queensland, a child can consent to a vaccination if they have the capacity to give or withhold consent. Autonomy - Doctors must respect the decision made by a patient. The United Nations Convention on Children's Rights (UNCRC; 1989) defines a child as any person under 18; however, by convention British courts refer to all persons under 18 as minors, those under 16 as children and 16 and 17 y olds as young persons.Citation2 The UNCRC requires that childhood is recognized as a developmental period and that our domestic laws must be developed in a manner consistent with the evolving capacities of the child (United Nations 1989, Article 5).Citation2 As children grow and develop in maturity, their views and wishes must be given greater weight and their development toward adulthood must be respected and promoted. Start typing to see results or hit ESC to close, Three things required for consent to be valid, The ultimate responsibility for ensuring the patient is consented properly lies with the. A short film about the story behind Gillick Competence and Fraser Criteria. Immunization may not be appropriate in every case. ; Patient confidentiality versus parental rights. Help for children and young people Re L (Medical Treatment: Gillick Competence). Consent guides for healthcare professionals. London: Department of Health and Social Care. This key principle is reflected in consent law applied to children. useGPnotebook. There is no lower age limit for Gillick competence or Fraser guidelines to be applied. That said, it would rarely be appropriate or safe for a child less than 13 years of age to consent to treatment without a parents involvement. Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. Find out more about how to recognise when a child has experienced abuse, and how to respond if a child discloses abuse to you. practitioner should be consulted for diagnosis and treatment of any and all medical conditions. There are no potential conflicts of interest. The United Nations Convention on the Rights of the Child requires that the evolving capacities of children are respected and this requirement is reflected in the law of consent where a child with the necessary maturity and intelligence can give valid consent to examination or treatment.Citation2. It is argued that Gillick competence is an unnecessary burden with an unethical foundation. Practitioners using the Fraser guidelines should be satisfied of the following: When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns: You should always consider any previous concerns that may have been raised about the young person and explore whether there are any factors that may present a risk to their safety and wellbeing. Where a person under the age of 16 is not Gillick competent and therefore is deemed to lack the capacity to consent, it can . If a person aged 16 or 17 years or a Gillick-competent child refuses treatment that refusal As cited in Childrens Legal Centre (1985) Landmark decision for childrens rights. Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to children's wishes with the responsibility to keep them safe. Subscribe to our weekly email keeping you up-to-date with all the developments in child protection policy, research, practice and guidance. However the Family Law Reform Act 1969 states: "The consent of a minor who has attained the age of sixteen years to any surgical, medical or dental treatment which, in the absence of consent, would constitute a trespass to his person, should be as effective as it would be if he were of full age; and . endstream Mental Health Matters, What is Informed Consent? they are 'Gillick competent' > Find out more about the Library and Information Service. Gillick competence refers to the fact that some children under the age of 16 are able to give consent. It lays down that the authority of parents to make decisions for their minor children is not absolute, but diminishes with the childs evolving maturity. In sum, it is now legal to decide whether a child is able to give consent to medical treatment on the basis of an assessment of the child's maturity and understanding of what is being proposed. ; If under 13, is the patient engaging in sexual activity? Your information helps us decide when, where and what to inspect. workers and health promotion workers who may be giving contraceptive advice and Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. The case went to the High Court in 1984 where Mr Justice Woolf dismissed Mrs Gillick's claims. If a Gillick-competent child consents to treatment, a parent cannot override that consent. The ethics of adolescent medical decision-making is a fraught area for medical ethics because it deals with the threshold boundaries between childhood and adulthood and Gillick adds a burden upon children and adolescent patients that is unwarranted and through which damage is . The young person will understand the professionals advice; The young person cannot be persuaded to inform their parents; The young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment; Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer; and. This test is known as the Gillick competence test. Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child (under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge. A child who is deemed Gillick competent is able to prevent their parents viewing their medical records. to apply to other treatments, including abortion, the Fraser guidelines If the nurse's judgement is that attempting to give the immunization in the face of continued resistance from the child then it is open to the nurse to refuse to proceed at that time. endobj In this article, we explore the implications of adopting 'Gillick competence'drawn from healthcare lawas the relevant test of sufficient maturity in the data protection law context. treatment can be given by a child under the age of 16 if s/he is 'Gillick competent'. It is not just an ability to choose . Please note: Selecting permissions does not provide access to the full text of the article, please see our help page . This case is one of many being heard by the Family Court following the decision in Re Jamie 2013 that whilst court authorisation is unnecessary for stage one treatment for gender dysphoria, the nature of stage two treatment requires the Court to determine the child's "Gillick competence" to make the decision. Gillick competence is concerned with determining a childs capacity to consent. A persistent rumour arose that Victoria Gillick disliked having her name associated with the assessment of childrens capacity, but an editorial in the BMJ from 2006 claimed that Gillick said that she has never suggested to anyone, publicly or privately, that [she] disliked being associated with the term Gillick competent'. 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Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. x0 In the current immunization case the court order is the flak jacket that would protect a nurse giving the MMR vaccination to the sisters. Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. Gillick competence is therefore the correct term, still used by judges and health professionals, to identify children aged under 16 who have the legal competence to consent to immunization, providing they can demonstrate sufficient maturity and intelligence to understand and appraise the nature and implications of the proposed treatment, including the risks and alternative courses of actions. Indeed the Court of Appeal ruled it essential that in hotly disputed cases the consent of both parents must be given before proceeding. Gillick competence for children under 16 years old Children under 16 years old can consent to medical treatment (but not necessarily refuse treatment) 'if they have sufficient maturity and judgement to enable them to fully understand what is proposed' - i.e. But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. Immunization he held was an area where there was room for genuine debate.Citation11. Consent is permission to touch and give the agreed treatment. If the young person still wants to go ahead without their parents' or carers' knowledge or consent, you should consider the Gillick and Fraser guidelines. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. Department of Health and Social Care (2009) Reference guide to consent for examination or treatment (second edition). A good practice guide on consent for health professionals in NHS Scotland (PDF). We have also added a section about safeguarding concerns. Mental Health Matters, What is the Mature Minor Doctrine? This study of the implications of Gillick competence argues it is an unnecessary burden with an unethical foundation. Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. << /Length 12 0 R /Type /XObject /Subtype /Image /Width 400 /Height 401 /Interpolate Help for children and young people Re L ( medical treatment: Gillick needs... When, where and what to inspect to children treatment: Gillick competence needs to be assessed on decision! You up-to-date with all the developments in child protection policy, research, practice guidance! Article, please see our help page treatment of any and all medical conditions R /XObject! In practice they understand what is Informed consent refers to the court that. 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