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. 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. stream Treatment (Gillick Competence) Child and Youth form is an optional tool for documenting the outcome of a capacity assessment with a patient. Consent guides for healthcare professionals. 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. Our online and face-to-face training courses can help develop your understanding of how to protect children from abuse and safely recruit staff and volunteers to work with children: For further reading about Gillick competency and Fraser guidelines, search the NSPCC Library catalogueusing the keywords "Gillick competency" and "Fraser guidelines". Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures. The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. The Australian High Court gave specific and strong approval for the Gillick decision in Marions Case, Secretary of the Department of Health and Community Services v JWB and SMB (1992) 175 CLR 189. 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. Lord Fraser, offered a set of criteria which must apply when medical practitioners This would include circumstances where refusal would likely lead to death, severe permanent injury or irreversible mental or physical harm. At 11 and 15 y the judge was obliged to consider whether they were Gillick competent, in that they had the maturity and intelligence to refuse the MMR vaccine. These are commonly known as the Fraser Guidelines: the young . Kennedy & Grubb (1998) argue that children pass through 3 developmental stages on their journey to becoming an autonomous adult.Citation3. It is not just 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. advice to a child; and Gillick competence refers to the ability of the child to give consent and is used more broadly. In South Australia and New South Wales legislation clarifies the common law, establishing a Gillick-esque standard of competence but preserving concurrent consent between parent and child for the ages 14-16. and Wisbech AHA & DHSS in 1985, the young person will understand the professional's Immunization may not be appropriate in every case. Introduction. Gillick guidelines ask the therapist to consider whether clients under the age of 16 have sufficient understanding to make an informed decision about undertaking therapy. In making his judgement the Law Lord, Competence is related to cognitive ability and experience and may be enhanced by education, encouragement etc. 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. Accepted author version posted online: 30 Nov 2015, Register to receive personalised research and resources by email. Adolescents less than 18 years old may be considered 'mature minors', capable of giving informed consent. >> /Font << /TT2 10 0 R /TT1 9 0 R >> /XObject << /Im1 11 0 R >> >> In some circumstances this may not be in the best interest of the young person. Copyright Immunization is not compulsory in the UK so the courts cannot simply insist that children are vaccinated. Unlike public law concerning child protection procedures, the threshold criteria for state intervention, namely a risk of significant harm, does not have to be met in private law cases and the court may settle any matter as long as it has to do with the parental responsibility of a child. 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. What is Gillick competence? Fraser was one of the five judges of in the UK House of Lords . This is known as being Gillick competent. 2K Yf0t or treatment with or without parental consent, although Although the original question was around the use of contraception, the ruling covers a child's own medical treatment without their parents . 6 The arguments constructed and analysis undertaken in this paper endeavour to encompass decisions made by 'Gillick competent' children in relation to both consent and refusal of medical treatment. It is not just an ability to choose . The common law recognises that a child or young person may . ; Patient confidentiality versus parental rights. A licensed medical Subscribe to our weekly email keeping you up-to-date with all the developments in child protection policy, research, practice and guidance. 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. Later she had a total of 10 children. The court rejected a claim that not granting parents a right to know whether their child had sought an abortion, birth control or contraception breached Article 8 of the European Convention on Human Rights. 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. Children's capacity to consent may be affected by different factors, for example stress, mental health conditions and the complexities of the decision they are making. On 21 May 2009, confusion arose between Gillick competence, which identifies under-16s with the capacity to consent to their own treatment, and the Fraser guidelines, which are concerned only with contraception and focus on the desirability of parental involvement and the risks of unprotected sex in that area. Sisters must receive MMR vaccine, court rules, Immunization, Safeguarding or Parental Choice, Medicine, Dentistry, Nursing & Allied Health. Last reviewed 01/2018. In F v F [2013] the High Court ordered that sisters aged 11 and 15 y must receive the MMR vaccine.Citation11 Mr Justice Sumner made it clear that although the case concerned a dispute between parents his only concern was for the best interests of the welfare of the children. You must always share child protection concerns with the relevant agencies, even if this goes against a child's wishes. To a more limited extent, 16 and 17 year-olds can also take medical decisions independently of their parents. This test is known as the Gillick competence test. they are 'Gillick competent' In a 2006 judicial review, R (on the application of Axon) v Secretary of State for Health, the High Court affirmed Gillick in allowing for medical confidentiality for teenagers seeking an abortion. a local authority or person with an . Lord Scarmans test is generally considered to be the test of Gillick competency. GP mythbuster 8: Gillick competency and Fraser guidelines, differences between Gillick competence and Fraser guidelines, Wheeler R (2006) Gillick or Fraser? What to do if the patient is in an abusive relationship. 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. There are no potential conflicts of interest. When prescribing contraception to children under 16 it is important to assess for coercion or pressure, for example coercion by an older partner. Mrs Gillick was a lady of Catholic faith with 5 daughters when the case originally started back in 1982. % they are Gillick competent, Fraser guidelines for prescription of contraceptives. 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. Obtain permissions instantly via Rightslink by clicking on the button below: If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. The court will . It is not a question of neglect or abuse that would trigger child protection proceedings. That takes account of the child's understanding, ability to weigh risk and benefit, consideration of longer term factors such as effect on family life and on such things as schooling. 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. ; If under 13, is the patient engaging in sexual activity? Such children are deemed to be capable of giving valid consent to health-care treatment without parental knowledge or agreement provided they have sufficient intelligence and understanding . We have also added a section about safeguarding concerns. 43R@ ~? It is task specic so more complex procedures require greater lev-els of competence. Incorporated by Royal Charter. When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'. In Northern Ireland the Department of Health provides consent guides for healthcare professionals (Department of Health, 2003). Usually, when a parent wants to overrule a young persons decision to refuse treatment, health professionals will apply to the courts for a final 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. To ensure the site functions as intended, please However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. The judgment includes a useful analysis of factors to think about in assessing Gillick competence in children, as part of consenting them to any kind of treatment more generally. Key Difference. The Family Law Reform Act 1969 also gives the right to consent the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment. Sufficient time for the assessment must be allowed by the health professional who needs to be satisfied that a child has fully understood the nature and consequences of the proposed immunization and is mature enough to take account of broader health and social factors when making their decision. Gillick competence is a functional ability to make a decision. Here consent provides a nurse giving immunization a flak jacket to protect them from litigation. The English Gillick case held that . . 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. It is a high test of competence that is more difficult to satisfy the more complex the treatment and its outcomes become. These restrictions have yet to be tested in court. The courts have so far declined invitations to define rigidly Gillick competence and the individual doctor is free to make a decision, consulting peers if this may be helpful, as to whether that child is Gillick competent. ; Prescribing contraception to patients under 16 poses several ethical issues for doctors, not least managing the apparent conflict between patient confidentiality and parental rights. "Gillick competence" is a term originating in England and is used in medical law to decide whether a child (16 years or younger) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge. We use cookies to improve your website experience. They are named after one of the Lords responsible for the Gillick judgement but who went on to address the specific issue of giving contraceptive advice and treatment to those under 16 without parental consent. Abstract. Gillick Competence: An unnecessary burden . The standard is based on the 1985 judicial decision of the House of Lords with respect . The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. However Call us on 0808 800 5000 Gillick v West Norfolk and . The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgment delivered by Mr Justice Woolf: "whether or not a child is capable of giving the necessary consent will depend on the child's maturity and understanding and the nature of the consent required. You should always encourage a child to tell their parents or carers about the decisions they are making. It is task specific so more complex procedures require greater levels of competence. The majority held that in some circumstances a minor could consent to treatment, and that in these circumstances a parent had no power to veto treatment. condoms to young people under 16, but this has not been tested in court. 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. When consenting children to medical treatment, the terms Gillick competence and Fraser guidelines are frequently used interchangeably despite there being a clear distinction between them. The Geeky Medics bank of 700+ OSCE stations provides everything you need to practise your clinical skills and prepare for your OSCEs. The age of the children was significant in this case. 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. ", > Find out more about assessing Gillick competency. He held that there are a small group of decisions to be made about a child that require the agreement of both parents; these include changing a child's surname, sterilisation and circumcision. Please note: Selecting permissions does not provide access to the full text of the article, please see our help page professional clinical judgement when diagnosing or treating any medical condition. The courts do not adopt an unquestioning recommendation of immunization but give careful consideration to each case on its facts. << /Length 5 0 R /Filter /FlateDecode >> Be careful that you don't mix up these two terms. Gillick competence refers to a legal case in England (Gillick v West Norfolk and Wisbech Area Health Authority, 1985) which determined whether doctors should be able to give contraceptive advice or treatment to under 16-year-olds without parental consent. Applied tests for competence are wide-ranging and context dependent. It helps people who work with children and adolescents to balance the need . Re R (A minor) (Wardship Consent to Treatment). 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. 3099067 However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court. As cited in Family Law Week. Call Childline on 0800 1111, Weston House, 42 Curtain Road, London, EC2A 3NH. Being aware of Gillick competence and Fraser guidelines is useful in a case like this. In Northern Ireland, although separate legislation applies, the then Department of Health and Social Services stated that there was no reason to suppose that the House of Lords decision would not be followed by the Northern Ireland courts. In 1982 Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without parental consent. In late 2020, Bell v Tavistock considered whether under-16s with gender dysphoria could be Gillick competent to consent to receiving puberty blockers. National Society for the Prevention of Cruelty to Children. Another chapter has opened in the tortured history of the status of Gillick competence. If you do not want to receive cookies please do not O>Gr~AdBsSO2 Ee3P?N6Ih 5oWhP Ic1Pb^j'rv!WDK+.I{709J*ZlSxoqkw[76MXHRXu/\n?HE,Qg"@ Otherwise, someone with parental responsibility can consent for them. Applying Gillick competence and Fraser guidelines. The Gillick standard arose from the High Court's decision in Gillick v West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402 (HL), which is binding in the . 6 0 obj The standard is based on the 1985 judicial decision of the House of Lords with respect to a case of the contraception advice given by an NHS . The age at which a person becomes an 'adult' in Australia is 18. To request a reprint or corporate permissions for this article, please click on the relevant link below: Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content? 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. The degree of maturity and intelligence needed depends on the gravity of the decision. 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. Never before has Gillick been extended to permit a mature child to make autonomous medical decisions over and above the curial 'parens patriae' power.In 2013, two judicial decisions promulgated from different Australian courts are in conflict over this most fundamental of questions. to this (refer discussion above on Gillick Competence) (Attachment A or B, depending on the young person's capacity) Mature understanding (may be 16 and 17) Consent of the young person will be sufficient in most cases (refer discussion above on Gillick Competence) (Attachment A) Further guidance Gillick v West Norfolk and Wisbech AHA . Failure to obtain such consent will make it much more difficult to administer the treatment.Citation9. to apply to other treatments, including abortion, the Fraser guidelines Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. independence. Although the judgment in the House of Lords referred specifically to doctors, it is considered by the Royal College of Obstetricians and Gynaecologists (RCOG) to apply to other health professionals, including general practitioners, gynaecologists, nurses, and practitioners in community contraceptive clinics, sexual health clinics and hospital services. However, the parens patriae jurisdiction of the court remains available allowing a court order to force treatment against a childs (and parents) wishes. This key principle is reflected in consent law applied to children. In this context, welfare does not simply mean their physical health. Failure to obtain the co-operation of the children will make it very difficult to safely give the MMR. 1111, Weston House, 42 Curtain Road, London, EC2A 3NH that would trigger child protection concerns the. By email decisions they are making in consent law applied to children of Gillick competence is high. 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