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. useGPnotebook. 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 refers to the fact that some children under the age of 16 are able to give consent. When prescribing contraception to children under 16 years, it is essential to assess for coercion or pressure , for example, coercion by an older partner. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. People also read lists articles that other readers of this article have read. A short film about the story behind Gillick Competence and Fraser Criteria. 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 form is based on the meaning of 'capacity' in section 14 of the Mental Health Act 2016. Applying Gillick competence and Fraser guidelines. Gillick Competence: An unnecessary burden . 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. 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. Where a competent child under 16 refuses a specific treatment which is in their best interests, but the parents support the . The child's safety and wellbeing is paramount. The rule in Gillick must be applied when determining whether a child under 16 has competence to consent. This study of the implications of Gillick competence argues it is an unnecessary burden with an unethical foundation. Engaging with and assessing the adolescent patient. In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006). When prescribing contraception to children under 16 it is important to assess for coercion or pressure, for example coercion by an older partner. 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. 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. young person is likely to begin, or to continue having, sexual intercourse with Childright, 22: 11-18. TO SAY that Mrs Gillick was angry is an understatement. The nature of the standard remains uncertain. 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. 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'. This form provides a structured method for obtaining evidence of the patient's capacity to However, these are only obiter statements and were made by a lower court; therefore, they are not legally binding. the Family Law Reform Act 1969 states: "The consent of a minor who It is not just an ability to choose . Although people with parental responsibility were generally free to act alone when making decisions for their children this freedom was not unfettered. Immunization may not be appropriate in every case. The age at which a person becomes an 'adult' in Australia is 18. Due to the unique specifics of that treatment, the High Court concluded that in such cases the answer will almost always be no, a priori. You can also download or order Childline posters and wallet cards. 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. Otherwise, someone with parental responsibility can consent for them. Young person's 16 and 17 y old who are able to consent to treatment as if they were of full age.Citation4, The right of a child under 16 to consent to medical examination and treatment, including immunization was decided by the House of Lords in Gillick v West Norfolk and Wisbech AHA [1986] where a mother of girls under 16 objected to Department of Health advice that allowed doctors to give contraceptive advice and treatment to children without parental consent.Citation5 Their Lordships held that a child under 16 had the legal competence to consent to medical examination and treatment if they had sufficient maturity and intelligence to understand the nature and implications of that treatment.Citation5, Wheeler (2006) argues that something of an urban myth has emerged over the use of the term Gillick competence.Citation6 It suggests that Mrs Gillick wishes to disassociate her name from the assessment of children's capacity, thus carrying the implication that the objective test of a child's competence should be renamed the Fraser competence. Study Hub OSCE Sessions. 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. This key principle is reflected in consent law applied to children. At paragraph 78, Sir James also noted that: However the case law in this area primarily concerns refusal of treatment. Consent needs to be given voluntarily . The content herein is provided for informational purposes and does not replace the need to apply To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. This will require an assessment on a case by case basis to determine if the child is Gillick competent. 08/12/20. We use cookies to improve your website experience. 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. in England and Wales by the House of Lords in the case of Gillick vs West Norfolk 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. Subscribe to our weekly email keeping you up-to-date with all the developments in child protection policy, research, practice and guidance. 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. endobj There is specific guidance for medical professionals on using Gillick competence - see case history and legislation. A plea for consistency over competence in children. However, this right can be exercised only on the basis that the welfare of the young person is paramount. Tern enrolment procedure. Enter your email address to follow this website and receive notifications of new posts by email. Help for adults concerned about a child Mental Health Matters, What is Marions Case (1982)? It underpins the propriety of the treatment and furnishes a defense to the crime of battery and civil wrong of trespass.Citation1 It must be obtained before an immunization can proceed. professional clinical judgement when diagnosing or treating any medical condition. strictly prohibited. endobj 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. 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. This is known as being Gillick competent. Help for children and young people A relatively young child would have sufficient maturity and intelligence to be competent to consent to a plaster on a small cut. The Gillick competence doctrine is part of Australian case law (see, e.g., DoCS v Y [1999] NSWSC 644). Last reviewed 01/2018. If a Gillick-competent child consents to treatment, a parent cannot override that consent. practitioner should be consulted for diagnosis and treatment of any and all medical conditions. 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. 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. 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 . Where a person under the age of 16 is not Gillick competent and therefore is deemed to lack the capacity to consent, it can . The degree of maturity and intelligence needed depends on the gravity of the decision. referred specifically to doctors but it is considered to apply to other health 11 0 obj 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". The courts do not adopt an unquestioning recommendation of immunization but give careful consideration to each case on its facts. As Gillick was decided ultimately in the House of Lords 2, its authority extends to Scotland as well as to other parts of the UK. workers and health promotion workers who may be giving contraceptive advice and Gillick Competency 'Gillick competence' is a term originating in England and is used in medical law to decide whether a young person (under 16 years of age) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge. Edinburgh: Scottish Executive. In early September 2021, guidance circulated to NHS trusts stated that most 12- to 15-year-olds should be deemed Gillick competent to provide [their] own consent to be vaccinated against COVID-19, despite the JCVI fail[ing] to recommend Covid-19 vaccines for healthy 12- to 15-year-olds. Both fathers were in contact with their daughters and had parental responsibility through court orders. Any other browser may experience partial or no support. However Call us on 0808 800 5000 Gillick v West Norfolk and . "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. 2 0 obj 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. The fathers argued that the immunizations were in the children's best interests. Gillick competence is a functional ability to make a decision. Fast-forward 35 years and Gillick competence again comes to the fore - this time to assess whether under 16s can make their own decision whether to have the Covid-19 vaccination should their parents disagree and vice versa. Therefore, competence is a major aspect to consider in this ethical scenario. It is not a question of neglect or abuse that would trigger child protection proceedings. Allan Gaw recounts the famous Gillick case and events leading up to a landmark decision on medical consent in children. Re W (A minor) (Medical treatment court's jurisdiction). and Wisbech AHA & DHSS in 1985, the young person will understand the professional's Specialties tested include general practice, general medicine, general surgery, paediatrics, anaesthetics, adult psychiatry, and emergency . Date: 27 February 2018. 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