the young person is very likely to continue having sex with or without contraceptive 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'. 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.. Fraser guidelines are applied specifically to advice and treatment that focuses on a young person's sexual health and contraception. 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. [Accessed 02/02/2020]. Lord Justice Thorpe viewed medical interventions as existing on a scale. If a Gillick competent child refuses medical examination or treatment then the law does allow a person with parental responsibility to consent in their place. Help for adults concerned about a child practitioner should be consulted for diagnosis and treatment of any and all medical conditions. This small group he said now included hotly disputed immunization.Citation11, Despite the granting of an order by the High Court it is known that practical difficulties have, to date, prevented the giving of the vaccine to the children in the F v F [2013] case (Hickey 2013).Citation12,13. The standard is based on the 1985 judicial decision of the House of Lords with respect . strictly prohibited. Legal competence to make decisions is conditional on the child gradually acquiring both: That takes account of the child's experiences and the child's ability to manage influences on their decision making such as information, peer pressure, family pressure, fear and misgivings. 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'. true /ColorSpace 8 0 R /SMask 13 0 R /BitsPerComponent 8 /Filter /FlateDecode useGPnotebook. 6 0 obj Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures. 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). Oxbridge Solutions Ltd. >> However This idea of Gillick competence was further supported by R (on the application of Axon) v Secretary of State for Health. their own treatment. Allan Gaw recounts the famous Gillick case and events leading up to a landmark decision on medical consent in children. 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. Registered charity in England and Wales (216401), Scotland (SC037717) and Jersey (384). 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. If a person aged 16 or 17 years or a Gillick-competent child refuses treatment that refusal In fact, the court held that parental rights did not exist, other than to safeguard the best interests of a minor. At paragraph 78, Sir James also noted that: However, these are only obiter statements and were made by a lower court; therefore, they are not legally binding. The court views immunization as a voluntary process that both parents are entitled to be consulted on. It lays down that the authority of parents to make decisions for their minor children is not absolute, but diminishes with the childs evolving maturity. 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. Re R (A minor) (Wardship Consent to Treatment). 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? 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. Any distribution or duplication of the information contained herein is Study Hub OSCE Sessions. may be obtained either from the parent or from the person themselves. or treatment with or without parental consent, although %PDF-1.3 Develop the safeguarding skills, knowledge and competencies required for Level 4 healthcare professionals. 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. 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. 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. 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. 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. Adolescence is a transitional phase of growth and development between childhood and adulthood. There are no potential conflicts of interest. 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. Parents cannot override a competent child's refusal to accept treatment. The subsequent 1983 judgement set out criteria for establishing whether a child under 16 has the capacity to provide consent . In 1985, Mrs Gillick brought her concerns regarding guidance on contraceptive advice and treatment for girls under the age of 16 to the courts. The child of tender years who rely on a person with parental responsibility to consent to treatment. Lord Fraser stated that a doctor should always encourage a girl aged under 16 to inform her parents or carers that she is seeking contraceptive advice (or allow the doctor to inform the parents or carers on her behalf). virtue of this section given an effective consent to any treatment it shall not Competence is related to cognitive ability and experience and may be enhanced by education, encouragement etc. Copyright 2023 If the health professional giving the immunisation felt a child was not Gillick competent then the consent of someone with parental responsibility would be sought. "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. endobj Indeed the Court of Appeal ruled it essential that in hotly disputed cases the consent of both parents must be given before proceeding. 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 House of Lords concluded that advice can be given in this situation as long as: Health professionals should still encourage the young person to inform his or her parent(s) or get permission to do so on their behalf, but if this permission is not given they can still give the child advice and treatment. The Family Law Reform Act 1969 also gives the right to consent treatment can be given by a child under the age of 16 if s/he is 'Gillick competent'. Children who are 16 years old and over can be expected to have capacity to consent to treatment. National Society for the Prevention of Cruelty to Children. xVrT9+=Uq,?d{TMxR) SX>; ]c}!G:wRkB):Nns+t:jvwd%f! Applying Gillick competence and Fraser guidelines. 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. When assessing Gillick competence for immu-nization, a health professional has to decide whether the child is or is not competent to make that particular decision. 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'. Such children are deemed to be capable of giving valid consent to advice or treatment without parental knowledge or . 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. If a child or young person needs confidential help and advice direct them to Childline. << /Length 12 0 R /Type /XObject /Subtype /Image /Width 400 /Height 401 /Interpolate stream 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. 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. GPnotebook no longer supports Internet Explorer. Clearing up some common myths about our inspections of GP and out-of-hours services and sharing agreed guidance to best practice. [Consent] protects the [health professional] from claims by the litigious whether they acquire it from their patient, who may be a minor over the age of 16 or a Gillick competent child under that age, or from another person having parental responsibilities which include a right to consent to treatment of the minor. This site uses Akismet to reduce spam. A relatively young child would have sufficient maturity and intelligence to be competent to consent to a plaster on a small cut. Abstract. However, where parents are in dispute with each other over an issue of parental responsibility, that can include disagreement over immunization, then if negotiation fails they can go to court to resolve the matter. Gillick Competence: An unnecessary burden . How do I view content? the young person understands the advice being given. 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. 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. Therefore each individual decision requires assessment of Gillick competence. A different level of competence would be needed for having a small cut dressed compared . 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. 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. The same child may be considered Gillick competent to make one decision but not competent to make a different 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. 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. 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. This form provides a structured method for obtaining evidence of the patient's capacity to 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. The rule in Gillick must be applied when determining whether a child under 16 has competence to consent. The Fraser guidelines specifically relate only to contraception and sexual health. However, this right can be exercised only on the basis that the welfare of the young person is paramount. Lord Fraser, offered a set of criteria which must apply when medical practitioners 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 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. 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. 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. 5 0 obj These restrictions have yet to be tested in court. However, the parens patriae jurisdiction of the court remains available allowing a court order to force treatment against a childs (and parents) wishes. However, there are circumstances in which patients under the age of 18 can consent to their own medical treatment. Obtaining consent for immunization becomes more complex where parental responsibility and the developmental concept of Gillick competence become intertwined as the child matures to adulthood. 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. Therefore, competence is a major aspect to consider in this ethical scenario. Fraser was one of the five judges of in the UK House of Lords . The two girls lived with their respective mothers. 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. We use cookies to improve your website experience. Registered in England & Wales No. Care Quality Commission (2019). 5 See Gillick v West Norfolk AHA [1986] AC 112, 189. Their fathers made an application to the court seeking the immunization of their children. Under the Family Proceedings Rules 1991 a penal notice may be attached to a specific issues order. Childright, 22: 11-18. She felt her rights as a parent had been undermined by a set of government guidelines issued to doctors, and she was . Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. However Call us on 0808 800 5000 Gillick v West Norfolk and . A court order is no guarantee that the vaccine will be administered. Young people aged 16 or 17 are presumed in law, like adults, to have the capacity to consent to medical treatment. "Gillick competence" published on by null. workers and health promotion workers who may be giving contraceptive advice and 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. 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