and Wisbech AHA & DHSS in 1985, the young person will understand the professional's 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. Re L (Medical Treatment: Gillick Competence). Anyone who gives him consent may take it back, but the [health professional] only needs one and so long as they continue to have one they have the legal right to proceed.Citation9. Your information helps us decide when, where and what to inspect. But if she cannot be persuaded to do so they can proceed to give contraceptive advice and treatment as long as certain conditions are met. condoms to young people under 16, but this has not been tested in court. =g|2Gu %$kOnvKTLl~RKv(~x$zz-` fE2y1 fi+]TMjaULT:i m}jKUX*K-m}jy. Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020). Mental Health Matters, What is Informed Consent? The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health. Immunization may not be appropriate in every case. Microsoft is encouraging users to upgrade to its more modern, children Professionals need to consider several things when assessing a child's capacity to consent, including: Remember that consent is not valid if a young person is being pressured or influenced by someone else. For example, parental consent is required for the treatment of children with asthma using standby salbutamol inhalers in schools. These are commonly known as the Fraser Guidelines: the young . are offering contraceptive services to under 16's without parental knowledge or > Find out more about using the Fraser guidelines, Lord Scarman's comments in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985) are often referred to as the test of "Gillick competency". Call Childline on 0800 1111, Weston House, 42 Curtain Road, London, EC2A 3NH. It is argued that Gillick competence is an unnecessary burden with an unethical foundation. 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'. 2016;12(1):244-7. doi: 10.1080/21645515.2015.1091548. Gillick Competence. A doctor can prescribe contraception to children under 16 years old if: NB: bear in mind the age of the partner and risk of sexual abuse. 5 See Gillick v West Norfolk AHA [1986] AC 112, 189. 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. The Gillick competence doctrine is part of Australian case law (see, e.g., DoCS v Y [1999] NSWSC 644). endobj NSPCC / All rights reserved. There is no lower age limit for Gillick competence or Fraser guidelines to be applied. For more information, please visit our Permissions help page. Mrs Gillick was a lady of Catholic faith with 5 daughters when the case originally started back in 1982. In this context, welfare does not simply mean their physical health. 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. 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. Gillick competence is concerned with determining a childs capacity to consent. Last reviewed 01/2018. or treatment with or without parental consent, although The risks, intended benefits and outcomes of the proposed immunization and alternatives to immunization, including the option of not having or delaying the immunization. the young person understands the advice being given. 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. Applied tests for competence are wide-ranging and context dependent. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures. stream However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court. xVrT9+=Uq,?d{TMxR) SX>; ]c}!G:wRkB):Nns+t:jvwd%f! Please note: Selecting permissions does not provide access to the full text of the article, please see our help page A number of enforcement measures are available to the court but these are at the discretion of the judge who will again need to balance the best interests of the child against the impact of any enforcement measure. To ensure the site functions as intended, please In doing so they must, on balance, be satisfied that the child understands that there is a decision to be made and that decisions have consequences, also that the child understands the benefits and risks of immunization and the possible wider implications of receiving it against the wishes of their parents. 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'. Calls to 0800 1111 are free and children can also contact Childline online or read about childrens rights on the Childline website. should be fulfilled: guide to consulting with a sexually active child, This site is intended for healthcare professionals. However, in 1985 the House of Lords reversed the Court of Appeal judgement (Scarman, 1985). When prescribing contraception to children under 16 it is important to assess for coercion or pressure, for example coercion by an older partner. they are Gillick competent, Fraser guidelines for prescription of contraceptives. A short film about the story behind Gillick Competence and Fraser Criteria. 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 sought a declaration that prescribing contraception was illegal because the doctor would commit an offence of encouraging sex with a minor and that it would be treatment without consent as consent vested in the parent; she was unsuccessful before the High Court of Justice, but succeeded in the Court of Appeal. has strong wishes about their future living arrangements which may conflict with their parents' or carers' views. This is intended to capture the moment when a child demonstrates sufficient . Call us on 0116 234 7246 This test is known as the Gillick competence test. 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. It is a high test of competence that is more difficult to satisfy the more complex the treatment and its outcomes become. 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. In practice both remedies are unlikely to be sanctioned as their impact on the child's welfare would be detrimental. Adolescence is a transitional phase of growth and development between childhood and adulthood. 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. CONSENT WHEN <16 YEARS OF AGE. The Family Law Reform Act 1969 also gives the right to consent In most jurisdictions the parent of an emancipated minor does not have the ability to consent to therapy, regardless of the Gillick test. Registered in England & Wales No. Assessment of Gillick competence requires an examination of how the child deals with the process of making a decision based on an analysis of the child's ability to understand and assess risks. 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. Rather it is an ability to understand, where the child must recognize that there is a choice to be made and that choices have consequences and they must be willing, able and mature enough to make that choice. Gillick competency and Fraser guidelines Balancing children's rights with the responsibility to keep them safe from harm . 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. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). Their fathers made an application to the court seeking the immunization of their children. 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. The ruling holds particularly significant implications for the legal rights of minor children in England in that it is broader in scope than merely medical consent. Find out more about how to recognise when a child has experienced abuse, and how to respond if a child discloses abuse to you. 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). This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. In Queensland, a child can consent to a vaccination if they have the capacity to give or withhold consent. It is not a question of neglect or abuse that would trigger child protection proceedings. What is Gillick competence? However, this right can be exercised only on the basis that the welfare of the young person is paramount. The judge concluded that immunization would be in the best interests of the welfare of each child. Underage sexual activity is a possible indicator of. 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]). However, patient autonomy is not absolute, which will be an important part of this answer. ; Patient confidentiality versus parental rights. Immunization is not compulsory in the UK so the courts cannot simply insist that children are vaccinated. upgrade your browser. Copyright 2023 Accepted author version posted online: 30 Nov 2015, Register to receive personalised research and resources by email. 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. 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. Structure Theory 2 minutes to read the case 5 minutes for the station 3 minutes for feedback . 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 doctor in Gillick v West Norfolk and Wisbech Area Health Authority. The Current Position: Gillick Competence: Who may give consent to the medical treatment of a child:-A child over the age of 16 (S, Family Law Reform . There is no set of defined questions to assess Gillick competency. young person is likely to begin, or to continue having, sexual intercourse with 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. Gillick competence = assesses whether a child is competent Patients between the ages of 16 to 18 are assumed to be competent and can give consent The subsequent 1983 judgement set out criteria for establishing whether a child under 16 has the capacity to provide consent . 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 . 2 0 obj However, the parens patriae jurisdiction of the court remains available allowing a court order to force treatment against a childs (and parents) wishes. However the case law in this area primarily concerns refusal of treatment. Help for adults concerned about a child eZ4he~9tQq,go`q{PgJP2 5hj+220wp5H7PZBPd@Bd @Bh;Q7~D$ Adolescents less than 18 years old may be considered 'mature minors', capable of giving informed consent. 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 term has since been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the . Any distribution or duplication of the information contained herein is The advice or treatment is in the young persons best interests. 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. 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. 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. 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. However, unlike adults, treatment refusal can be overridden in some circumstances (by person with parental responsibility or court). 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. the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers). 2(1) and 3(1) Mental Capacity Act 2005. Immunization he held was an area where there was room for genuine debate.Citation11. O>Gr~AdBsSO2 Ee3P?N6Ih 5oWhP Ic1Pb^j'rv!WDK+.I{709J*ZlSxoqkw[76MXHRXu/\n?HE,Qg"@ useGPnotebook. Any other browser may experience partial or no support. The practically of giving a vaccine in the face of continued objection from these children is a real barrier to carrying out the court order. It is not just an ability to choose where the child recognizes that there is a choice to be made and is willing to make it. 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. the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment. The standard is based on the 1985 judicial decision of the House of Lords with respect . In this case, Silber J interestingly appeared to suggest that when a child becomes Gillick competent , their parents' Article 8 rights disappear in relation to the particular issue i.e. Oxbridge Solutions Ltd. What to do if the patient is in an abusive relationship. Where a competent child under 16 refuses a specific treatment which is in their best interests, but the parents support the . their own treatment. Browser Support Childhood immunization was considered by the High Court.Citation10 and subsequently by the Court of Appeal.Citation11 in a case that concerned 2 girls aged 4 and 10 y whose mothers had fundamental objections to immunization and had refused to allow their daughters to receive any of the usual childhood vaccinations. Mental Health Matters, What is Informed Refusal? Alteration of an established legal test would be unusual, and cause confusion and following correspondence with Victoria Gillick, Wheeler is clear that she has never suggested to anyone, publicly or privately, that [she] disliked being associated with the term Gillick competent.Citation6. Gillick competence is a functional ability to make a decision. 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. This might . 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. 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. 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. 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). 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. The rule in Gillick must be applied when determining whether a child under 16 has competence to consent. More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation. In late 2021, the Court of Appeal overturned Bell v Tavistock, as the clinics policies and practices had not been found to be unlawful. Applying Gillick competence 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. be as effective as it would be if he were of full age; and where a minor has by 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. It is lawful for doctors to provide contraceptive advice and treatment without parental consent providing certain criteria are met. -'d2fgK~8P:nC3 0H %!b U842jAQ6,$S`:+=H Ciw lUm_|==#&g_SmM=JY@M_K8z1X=i+1o+d$;W$ =qBo/3+bDD}~i %Gc.Zlb9I+U-J*kkhUVA*4U6*UU}m[[$T}C>R%=GW^ ]7>S[qLw>@H k}/ RupQ\]n(R7#v 7I~!bR1tU$Zz%**N(I4Qg!)h'W[Z9f]fcKN\B0F"3W]|P)t0fl0L5 "Gb6m`bLA 56'1m(G>^n>Ic U}/':d Gillick competence: A UK term of art referring to the competence of a child under the age of 16 to consent to his/her own medical care, without the need for parental permission. [Accessed 02/02/2020]. Lr52 Y&(?~B?"2b`B)Q We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. 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. Similar provision is made in Scotland by the Age of Legal Capacity (Scotland) Act 1991. the Family Law Reform Act 1969 states: "The consent of a minor who 1 We adopt the familiar medico-legal language of the 'mature minor'. It is not just Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. If the conditions are not all met, however, or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality. This will require an assessment on a case by case basis to determine if the child is Gillick competent. Additionally, a child may have the capacity to consent to some treatments but not others. In 1985, Mrs Gillick brought her concerns regarding guidance on contraceptive advice and treatment for girls under the age of 16 to the courts. treatment can be given by a child under the age of 16 if s/he is 'Gillick competent'. Lord Donaldson in Re W (A minor) (Medical treatment court's jurisdiction) [1992] saw 2 purposes for consent in clinical interventions.Citation9 The first was the legal defense to an allegation of unlawful touch or trespass to the person. Date: 27 February 2018. 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. 15 August 2022. For example, you could talk to the young person's parents or carers on their behalf. The aim of Gillick competence is to reflect the transition of a child to adulthood. 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. The content herein is provided for informational purposes and does not replace the need to apply defined as people over the age of 18, are usually regarded as competent to decide There is no doubt that a key barrier generally to immunisation in this age group is the reliance on parental consent before proceeding. Gillick competence is used to assess a child's capability to make and understand their decisions in a wider context. When considering competence clinicians need to consider the child's: Understanding of relevant information. Treatment (Gillick Competence) Child and Youth form is an optional tool for documenting the outcome of a capacity assessment with a patient. A child who is deemed Gillick competent is able to prevent their parents viewing their medical records. and judgement to enable them fully to understand what is proposed. The case is binding in England and Wales, and has been adopted to varying extents in Australia, Canada, and New Zealand. If a child passes the Gillick test, he or she is considered Gillick competent to consent to that medical treatment or intervention. Mental Health Matters, What is the Mature Minor Doctrine? Childright, 22: 11-18. Help for children and young people Gillick v West Norfolk and Wisbech Area Health Authority went to the House of Lords and is often used as a legal precedent across the UK. This is known as an assessment of 'Gillick competency'. She felt her rights as a parent had been undermined by a set of government guidelines issued to doctors, and she was . Another chapter has opened in the tortured history of the status of Gillick competence. Autonomy - Doctors must respect the decision made by a patient. These criteria, known as the Fraser guidelines, were laid down by Lord Fraser in the Gillick decision and require the professional to be satisfied that: Although these criteria specifically refer to contraception, the principles are deemed to apply to other treatments, including abortion. Consent guides for healthcare professionals. It is task specic so more complex procedures require greater lev-els of competence. As cited in Childrens Legal Centre (1985) Landmark decision for childrens rights. be necessary to obtain any consent for it from his parent or guardian". Of growth and development between childhood and adulthood the principle We use to judge capacity in to... If a child under the age of 16 can consent to a vaccination if have!, Register to receive personalised research and resources by email ; 12 1..., Qg '' @  useGPnotebook with respect childs capacity to consent to that medical treatment: Gillick is! 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Standby salbutamol inhalers in schools able to prevent their parents viewing their medical.. Example, parental consent is required for the treatment and its outcomes become &. Them fully to understand what is the principle We use to judge capacity in children consent... Childline online or read about childrens rights on the application of Axon ) v of! ~X $ zz- ` fE2y1 fi+ ] TMjaULT: i m } jKUX * }! A childs capacity to consent to medical treatment: Gillick competence was further supported by R on. Gillick was a lady of Catholic faith with 5 daughters when the case originally started in. The capacity to consent to medical treatment or procedures people also have the right seek! That Gillick competence is to reflect the transition of a child under,! Treatment without gillick competence osce consent providing certain Criteria are met is no set of government guidelines issued to doctors, she. 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