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. 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. It is considered good practice for doctors and other health professionals to follow the criteria outlined by Lord Fraser in 1985 in the House of Lords' ruling in the case of Victoria Gillick v West Norfolk and Wisbech Health Authority and Department of Health and Social Security. be necessary to obtain any consent for it from his parent or guardian". Following a legal ruling in 2006, Fraser guidelines can also be applied to advice and treatment for sexually transmitted infections and the termination of pregnancy (Axton v The Secretary of State for Health, 2006). virtue of this section given an effective consent to any treatment it shall not Children under 16 may be considered 'Gillick competent' to make treatment decisions, but may need to demonstrate this. Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. It does not compel nurses to provide the treatment. We use cookies to improve your website experience. This mythbuster clarifies the principles, laws and guidelines used when we assess childrens ability to make decisions about their treatment, as well as the differences between Gillick competence and Fraser guidelines. Although a question of private law rather than state intervention into family life, the courts are still obliged to follow the provisions of the Children Act 1989 and consider the best interests of the welfare of that child. 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 rule in Gillick must be applied when determining whether a child under 16 has competence to consent. Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. It may also be interpreted as covering youth 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. The so-called Fraser Guidelines (some people refer to assessing whether For example, if a child or young person: Medical professionals need to consider Gillick competency if a young person under the age of 16 wishes to receive treatment without their parents' or carers' consent or, in some cases, knowledge. Equally a child who had competence to consent to dental treatment or the repair of broken bones may lack competence to consent to more serious treatment.Citation7 This could be because they do not understand the treatment implications or because they felt overwhelmed by the decisions they are being asked to make and so lacked the maturity to make it. If a Gillick-competent child consents to treatment, a parent cannot override that consent. 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. Consent is permission to touch and give the agreed treatment. 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. As cited in Childrens Legal Centre (1985) Landmark decision for childrens rights. Where a Gillick competent child refuses consent to immunization then a health professional may obtain consent from a person with parental responsibility instead. 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. If a child or young person needs confidential help and advice direct them to Childline. Consent for the medical treatment of patients under 18 years of age is generally provided by parents. NSPCC / All rights reserved. In complex medical cases, such as those involving disagreements about treatment, you may wish to seek the opinion of a colleague about a childs capacity to consent (Care Quality Commission, 2019). Let's make care better together. ; If under 13, is the patient engaging in sexual activity? There is no lower age limit for Gillick competence or Fraser guidelines to be applied. << /ProcSet [ /PDF /Text /ImageB /ImageC /ImageI ] /ColorSpace << /Cs1 8 0 R Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them. Gillick v West Norfolk and Wisbech AHA [1985] UKHL 7 (17 October 1985) 2016 In-text: (Gillick v West Norfolk and Wisbech AHA [1985] UKHL 7 (17 October 1985), 2016) 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. This is known as being Gillick competent. The following information looks at how this can be applied in practice. Otherwise, someone with parental responsibility can consent for them. This is known as an assessment of 'Gillick competency'. Since October 2006, the GMC development group at University College London in collaboration with the GMC have held 18 validation days to assess new knowledge tests and OSCE stations on ordinary doctors. By closing this message, you are consenting to our use of cookies. Indeed the Court of Appeal ruled it essential that in hotly disputed cases the consent of both parents must be given before proceeding. 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. Autonomy - Doctors must respect the decision made by a patient. Registered charity in England and Wales (216401), Scotland (SC037717) and Jersey (384). This is because we have an overriding duty to act in the best interests of a child. which, in the absence of consent, would constitute a trespass to his person, should This test is known as the Gillick competence test. When prescribing contraception to children under 16 it is important to assess for coercion or pressure, for example coercion by an older partner. % Mental Health Matters, What is Informed Consent? Includes the application of the information in the clinics. The age at which a person becomes an 'adult' in Australia is 18. GPnotebook no longer supports Internet Explorer. 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. 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. 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. This is intended to capture the moment when a child demonstrates sufficient . Yet even where, as in F v F [2013],Citation12 the courts order that children be given the immunization, the practicalities of actually doing so mean that the children remain unvaccinated. As such, medical staff will not make a disclosure of medical records of a child who is deemed Gillick competent unless consent is manifest. Applying Gillick competence and Fraser guidelines. While Gillick competence does not simply arrive with puberty and it cannot simply be presumed that a child is Gillick competent, it is not an overly time consuming process when undertaken confidently and competently. Oxbridge Solutions Ltd receives funding from advertising but maintains editorial 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. 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". Immunization he held was an area where there was room for genuine debate.Citation11. The issue before the House of Lords was only whether the minor involved could give consent. strictly prohibited. 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 judge concluded that neither child was competent due to the influence of the mother on their beliefs about immunization.Citation12, In Re B (Child) [2003] the Court of Appeal accepted that, in general, there is wide scope for parental objection to medical intervention. 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 specifically relate only to contraception and sexual health. All of her daughters were well below the age where their possibly giving consent themselves was likely to be an issue - one was a newborn. Here consent provides a nurse giving immunization a flak jacket to protect them from litigation. "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. When practitioners are trying to decide whether a child is mature enough to make decisions, they often talk about whether the child is 'Gillick competent' or whether they 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 . In law, a person's 18th birthday draws the line between childhood and adulthood (Children Act 1989 s105) - so in health care matters, an 18 year old enjoys as much autonomy as any other adult. 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. Browser Support The two girls lived with their respective mothers. How do I view content? The ruling established the term "Gillick competence" to describe whether a young person below the age of 16 is able to consent to . Accepted author version posted online: 30 Nov 2015, Register to receive personalised research and resources by email. When it comes to sexual health, those under 13 are not legally able to consent to any sexual activity, and therefore any information that such a person was sexually active would need to be acted on, regardless of the results of the Gillick test. In a landmark case, Victoria Gillick challenged Department of Health Guidance which enabled doctors to provide contraceptive advice and treatment to girls under 16 without their parents' knowledge. If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of. professionals, including nurses. Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. 'Gillick competence' refers to a young person under 16 with capacity to make any relevant decision. 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. Re R (A minor) (Wardship Consent to Treatment). However, this right can be exercised only on the basis that the welfare of the young person is paramount. has strong wishes about their future living arrangements which may conflict with their parents' or carers' views. It is argued that Gillick competence is an unnecessary burden with an unethical foundation. Treatment (Gillick Competence) Child and Youth form is an optional tool for documenting the outcome of a capacity assessment with a patient. BMJ, Gillick v West Norfolk & Wisbech AHA & DHSS [1983] 3 WLR (QBD), Axon, R (on the application of) v Secretary of State for Health [2006] EWHC 37 (Admin), He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment, He/she cannot be persuaded to tell her parents or to allow the doctor to tell them, He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment, His/her physical or mental health is likely to suffer unless he/she received the advice or treatment. 2023 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. Although people with parental responsibility were generally free to act alone when making decisions for their children this freedom was not unfettered. Treatment cannot generally proceed without it. Copyright 2023 However, Scots Law has gone beyond Gillick with the enactment in 1991 of the Age of Legal Capacity (Scotland) Act (the 'Scottish Act'). 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. In late 2020, Bell v Tavistock considered whether under-16s with gender dysphoria could be Gillick competent to consent to receiving puberty blockers. 6 0 obj Microsoft is encouraging users to upgrade to its more modern, children The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. Where a health professional accepts the consent of a Gillick competent child it cannot be overruled by the child's parent. Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. He also commented more generally on parents' versus children's rights: "parental right yields to the child's right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring 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. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). 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. 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'. 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. 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. This first came into effect in England when Mrs. Gillick, a social activist filed a case with the Department of Health and . Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child (a person under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge.. Lord Donaldson stressed that consent also has a second equally important clinical purpose: The clinical purpose (of consent) stems from the fact that in many instances the co-operation of the patient, and the patient's faith or at least confidence in the efficacy of the treatment, is a major factor contributing to the treatment's success. or without contraceptive treatment, unless the young person receives contraceptive An interesting aside to the Fraser guidelines is that many[weasel words] regard Lord Scarmans judgment as the leading judgement in the case, but because Lord Frasers judgement was shorter and set out in more specific terms and in that sense more accessible to health and welfare professionals it is his judgement that has been reproduced as containing the core principles, as for example cited in the RCOG circular. You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to. She felt her rights as a parent had been undermined by a set of government guidelines issued to doctors, and she was . In Queensland, a child can consent to a vaccination if they have the capacity to give or withhold consent. To date no court has found a child in need of life sustaining treatment competent to refuse that treatment.Citation8. If a child passes the Gillick test, he or she is considered Gillick competent to consent to that medical treatment or intervention. Gillick Competence. 5 0 obj The Geeky Medics bank of 700+ OSCE stations provides everything you need to practise your clinical skills and prepare for your OSCEs. A different level of competence would be needed for having a small cut dressed compared . Consent guides for healthcare professionals. It may also be interpreted as covering youth workers and health promotion workers who may be giving contraceptive advice and condoms to young people under 16, but this has not been tested in court. The psychological effect of having the decision overruled would have to be taken into account and would normally be an option only when the young person was thought likely to suffer grave and irreversible mental or physical harm. Competence is related to cognitive ability and experience and may be enhanced by education, encouragement etc. The right to decide on competence must not be used as a license to disregard the wishes of parents whenever the health professional finds it convenient to do so. Develop the safeguarding skills, knowledge and competencies required for Level 4 healthcare professionals. The risks, intended benefits and outcomes of the proposed immunization and alternatives to immunization, including the option of not having or delaying the immunization. endstream In this context, welfare does not simply mean their physical health. upgrade your browser. 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