You can also download or order Childline posters and wallet cards. This is known as being 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. Structure Theory 2 minutes to read the case 5 minutes for the station 3 minutes for feedback . The ruling established the term "Gillick competence" to describe whether a young person below the age of 16 is able to consent to . Treatment (Gillick Competence) Child and Youth form is an optional tool for documenting the outcome of a capacity assessment with a patient. 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. 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 . The following information looks at how this can be applied in practice. By confusing them, we lose crucial details necessary for obtaining consent. 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. 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. Consent here was considered in the broad sense of consent to battery or assault: in the absence of patient consent to treatment, a doctor, even if well-intentioned, might be sued/charged. We use cookies to improve your website experience. It is not a question of neglect or abuse that would trigger child protection proceedings. These restrictions have yet to be tested in court. 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. Department of Health (2003). `ve-ej;U 73)_Qp6wS\Q3m&CTOg"!T LtPOh 5 Howick Place | London | SW1P 1WG. Consent is permission to touch and give the agreed treatment. Gillick competence is concerned with determining a childs capacity to consent. Fraser guidelines are applied specifically to advice and treatment that focuses on a young person's sexual health and contraception. Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. What to do if the patient is in an abusive relationship. Adolescents have the legal right to confidential health care. 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. A child who has such understanding is considered Gillick competent . Lord Justice Thorpe viewed medical interventions as existing on a scale. Calls to 0800 1111 are free and children can also contact Childline online or read about childrens rights on the Childline website. 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. xVrT9+=Uq,?d{TMxR) SX>; ]c}!G:wRkB):Nns+t:jvwd%f! -'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 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. Your information helps us decide when, where and what to inspect. Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. We have updated and republished this mythbuster to provide even greater clarity about the difference between these two terms. Abstract. Adolescence is a transitional phase of growth and development between childhood and adulthood. Any distribution or duplication of the information contained herein is If a Gillick-competent child consents to treatment, a parent cannot override that consent. 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. Re R (A minor) (Wardship Consent to Treatment). Gillick competency and Fraser guidelines Balancing children's rights with the responsibility to keep them safe from harm . Typical positions of emancipation arise when the minor is married (R v D [1984] AC 778, 791) or in the military. Under the Family Proceedings Rules 1991 a penal notice may be attached to a specific issues order. these criteria specifically refer to contraception, the principles are deemed Care Quality Commission. Subscribe to our weekly email keeping you up-to-date with all the developments in child protection policy, research, practice and guidance. The subsequent 1983 judgement set out criteria for establishing whether a child under 16 has the capacity to provide consent . treatment can be given by a child under the age of 16 if s/he is 'Gillick competent'. you and provide you with the best service. It is argued that Gillick competence is an unnecessary burden with an unethical foundation. 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]). independence. endobj 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. Copyright 2023 Later she had a total of 10 children. ; If under 13, is the patient engaging in sexual activity? 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. This is known as an assessment of 'Gillick competency'. In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006). 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 if she cannot be persuaded to do so they can proceed to give contraceptive advice and treatment as long as certain conditions are met. The so-called Fraser Guidelines (some people refer to assessing whether 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. Health professionals must be satisfied that the child understands: The necessity for immunization and the reasons for it; and. 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. 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. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? 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). However, Scots Law has gone beyond Gillick with the enactment in 1991 of the Age of Legal Capacity (Scotland) Act (the 'Scottish Act'). 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 . A child of 15 years or above would normally be expected to have sufficient maturity, intelligence and understanding to . They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners. strictly prohibited. the young person is Gillick competent) state that all the following requirements . Axton v The Secretary of State for Health (The Family Planning Association: intervening) (2006) EWHC 37. 'Gillick competence' refers to a young person under 16 with capacity to make any relevant decision. Mental Health Matters, What is Informed Refusal? 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. 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. 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. 6 0 obj 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. 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. Autonomy - Doctors must respect the decision made by a patient. 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. Where a competent child under 16 refuses a specific treatment which is in their best interests, but the parents support the . &Ed@ More recently the court has considered the immunization of older children. It is probably the case that for a person between 16 and 18 years old consent > 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". The Family Law Reform Act 1969 also gives the right to consent Gillick Competence was established in 1983, following a challenge to the Department of Health Guidance to allow girls under the age of 16 to access medical advice and treatment without parental consent. 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. 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. This site uses Akismet to reduce spam. =g|2Gu %$kOnvKTLl~RKv(~x$zz-` fE2y1 fi+]TMjaULT:i m}jKUX*K-m}jy. Applied tests for competence are wide-ranging and context dependent. This would include circumstances where refusal would likely lead to death, severe permanent injury or irreversible mental or physical harm. How do I view content? The courts do not adopt an unquestioning recommendation of immunization but give careful consideration to each case on its facts. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. Courts cannot treat the matter as a case of significant harm to a child that would warrant state intervention under the Children Act 1989. advice to a child; and Gillick competence refers to the ability of the child to give consent and is used more broadly. If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of. Where a health professional accepts the consent of a Gillick competent child it cannot be overruled by the child's parent. it is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent. 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. 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. This provides private law remedies to settle matters of parental responsibility concerning a child. This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. Consent guides for healthcare professionals. It changes depending on the nature of the medical decision, e.g. p/ There is no set of defined questions to assess Gillick competency. parents' Article 8 rights do not . Any other browser may experience partial or no support. Immunization may not be appropriate in every case. 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. >> /Font << /TT2 10 0 R /TT1 9 0 R >> /XObject << /Im1 11 0 R >> >> Although the original question was around the use of contraception, the ruling covers a child's own medical treatment without their parents . Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. Gillick competence refers to the fact that some children under the age of 16 are able to give consent. Introduction. Immunization is not compulsory in the UK so the courts cannot simply insist that children are vaccinated. At paragraph 78, Sir James also noted that: eZ4he~9tQq,go`q{PgJP2 5hj+220wp5H7PZBPd@Bd @Bh;Q7~D$ The young persons best interests require them to receive contraceptive advice or treatment with or without parental consent. You should always encourage a child to tell their parents or carers about the decisions they are making. Immunization he held was an area where there was room for genuine debate.Citation11. The case went to the High Court in 1984 where Mr Justice Woolf dismissed Mrs Gillick's claims. If a child passes the Gillick test, he or she is considered Gillick competent to consent to that medical treatment or intervention. Victoria Gillick challenged Department of Health guidance which enabled doctors to provide contraceptive advice and treatment to girls under 16 without their parents knowing. The degree of maturity and intelligence needed depends on the gravity of the decision. Mental Health Matters, What is the Mature Minor Doctrine? Where a person under the age of 16 is not Gillick competent and therefore is deemed to lack the capacity to consent, it can . This might . 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. 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. 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. Bell v Tavistock and Portman is a recent high-profile case on the lawfulness of prescribing puberty-suppressing drugs to children experiencing gender dysphoria. If you do not want to receive cookies please do not Health professionals must be confident in assessing a child's Gillick competence in order to ensure that the child's rights are respected, this requires the health professional to evaluate the child's maturity and intelligence when seeking consent to immunization. Failure to obtain the co-operation of the children will make it very difficult to safely give the MMR. ; there . Lr52 Y&(?~B?"2b`B)Q There is specific guidance for medical professionals on using Gillick competence - see case history and legislation. 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 case is binding in England and Wales, and has been adopted to varying extents in Australia, Canada, and New Zealand. Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020). A child who is deemed Gillick competent is able to prevent their parents viewing their medical records. Lord Scarmans test is generally considered to be the test of Gillick competency. If a person aged 16 or 17 years or a Gillick-competent child refuses treatment that refusal If a child or young person needs confidential help and advice direct them to Childline. Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. 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. Childright, 22: 11-18. Children under 16 may be considered 'Gillick competent' to make treatment decisions, but may need to demonstrate this. Call Childline on 0800 1111, Weston House, 42 Curtain Road, London, EC2A 3NH. There is no lower age limit for Gillick competence or Fraser guidelines to be applied. There are no potential conflicts of interest. 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'. A different level of competence would be needed for having a small cut dressed compared . It may also be interpreted as covering youth 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. However, there are circumstances in which patients under the age of 18 can consent to their own medical treatment. Consent is essential to the propriety of treatment and is necessary to meet the requirements of the law. 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. << /Length 12 0 R /Type /XObject /Subtype /Image /Width 400 /Height 401 /Interpolate It was determined that children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options. 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 . 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. {1XeJ v'cjt]aVfD9q$|rd[gNTM-P(Y"RUUbl{ U>CA%q\6h4; Parents cannot override a competent child's refusal to accept treatment. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). Once the child reaches the age of 16: (i) the issue of Gillick competence falls away, and (ii) the child is assumed to have legal capacity in accordance with s.8 Family Law Reform Act 1969, unless (iii) the child is shown to lack mental capacity as defined in ss. 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. virtue of this section given an effective consent to any treatment it shall not Engaging with and assessing the adolescent patient. Enter your email address to follow this website and receive notifications of new posts by email. The issue before the House of Lords was only whether the minor involved could give consent. Register a free Taylor & Francis Online account today to boost your research and gain these benefits: College of Human and Health Science; Swansea University; Swansea, Wales, UK, Convention on the rights of the child adopted under general assembly resolution 44/25, Section 8; mental capacity act 2005, section 1, Gillick or Fraser? Copyright Gillick Competence. In 1983 the judgement from this case laid out criteria for establishing whether a child under has the capacity to provide consent to treatment; the so-called Gillick test. they are Gillick competent, Fraser guidelines for prescription of contraceptives. the Family Law Reform Act 1969 states: "The consent of a minor who Hum Vaccin Immunother. Key Difference. 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. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. As the case concerned a fundamental issue of parental responsibility the High Court heard the case under the provisions of section 8 of the Children Act 1989. 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. In the UK so the courts can not simply gillick competence osce that children are vaccinated is able prevent... Of older children it shall not engaging with and assessing the adolescent patient email address to follow this website receive. 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