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. We have also added a section about safeguarding concerns. Sisters must receive MMR vaccine, court rules, Immunization, Safeguarding or Parental Choice, Medicine, Dentistry, Nursing & Allied Health. Parents cannot override a competent child's refusal to accept treatment. In this context, welfare does not simply mean their physical health. However, there is still a duty to keep the childs best interests at the heart of any decision, and the child or young person should be involved in the decision-making process as far as possible. 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. 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 . 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. Consent needs to be given voluntarily. Lord Scarmans test is generally considered to be the test of Gillick competency. By confusing them, we lose crucial details necessary for obtaining consent. Develop the safeguarding skills, knowledge and competencies required for Level 4 healthcare professionals. stream Another chapter has opened in the tortured history of the status of Gillick competence. their ability to explain a rationale around their reasoning and decision making. virtue of this section given an effective consent to any treatment it shall not Re R (A minor) (Wardship Consent to Treatment). Copyright 2023 A patient under the age of 16 years can consent to medical treatment . The risks, intended benefits and outcomes of the proposed immunization and alternatives to immunization, including the option of not having or delaying the immunization. GPnotebook no longer supports Internet Explorer. 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. 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. Mental Health Matters, What is the Mature Minor Doctrine? The form is based on the meaning of 'capacity' in section 14 of the Mental Health Act 2016. permission. 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If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of. Any other browser may experience partial or no support. This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. 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. 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. "Gillick competence" published on by null. Mental Health Matters, What is Informed Consent? 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. 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. %PDF-1.3 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'. 2023 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. Where a competent child under 16 refuses a specific treatment which is in their best interests, but the parents support the . If a child passes the Gillick test, he or she is considered Gillick competent to consent to that medical treatment or intervention. Each station includes the following 3 components: Student instructions (the brief before beginning a station) Patient script (explaining the symptoms/signs the patient should report/demonstrate) the child's age, maturity and mental capacity, their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact, their understanding of the risks, implications and consequences that may arise from their decision, how well they understand any advice or information they have been given, their understanding of any alternative options, if available. If you do not want to receive cookies please do not << /Type /Page /Parent 3 0 R /Resources 6 0 R /Contents 4 0 R >> Date: 27 February 2018. Underage sexual activity is a possible indicator of. Help for adults concerned about a child However, in 1985 the House of Lords reversed the Court of Appeal judgement (Scarman, 1985). strictly prohibited. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding. The right of younger children to provide independent consent is proportionate to their competence - a child's age alone is clearly an unreliable predictor of his or her competence to make decisions. TO SAY that Mrs Gillick was angry is an understatement. 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. under the age of 16 can consent to medical treatment if they have sufficient maturity The child's safety and wellbeing is paramount. 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. Hum Vaccin Immunother. 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 . professionals, including nurses. Lord Fraser, offered a set of criteria which must apply when medical practitioners 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. For more information, please visit our Permissions help page. 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). Immunization he held was an area where there was room for genuine debate.Citation11. 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. Feature: My child, my choice. The degree of maturity and intelligence needed depends on the gravity of the decision. 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). 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. Gillick competence is therefore the correct term, still used by judges and health professionals, to identify children aged under 16 who have the legal competence to consent to immunization, providing they can demonstrate sufficient maturity and intelligence to understand and appraise the nature and implications of the proposed treatment, including the risks and alternative courses of actions. [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. Be careful that you don't mix up these two terms. Competence is related to cognitive ability and experience and may be enhanced by education, encouragement etc. This is because we have an overriding duty to act in the best interests of a child. > 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". Children who are younger than this may be mature enough to decide for themselves and not want their parents involved, which will . these criteria specifically refer to contraception, the principles are deemed Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. 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. There is no express authority in Australia on In re R and Re W, so whether a parents right terminates is unclear. they are 'Gillick competent' 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 . Gillick Competence: An unnecessary burden . The content herein is provided for informational purposes and does not replace the need to apply O>Gr~AdBsSO2 Ee3P?N6Ih 5oWhP Ic1Pb^j'rv!WDK+.I{709J*ZlSxoqkw[76MXHRXu/\n?HE,Qg"@ These are commonly known as the Fraser Guidelines: the young . to apply to other treatments, including abortion, the Fraser guidelines It is not a question of neglect or abuse that would trigger child protection proceedings. Therefore each individual decision requires assessment of Gillick competence. Kennedy & Grubb (1998) argue that children pass through 3 developmental stages on their journey to becoming an autonomous adult.Citation3. NSPCC / All rights reserved. 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 young person is Gillick competent) state that all the following requirements 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 study of the implications of Gillick competence argues it is an unnecessary burden with an unethical foundation. At the other end are cases where there is genuine scope for debate and the views of the parents are important. Gillick competence is a functional ability to make a decision. 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. % 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. There is no doubt that a key barrier generally to immunisation in this age group is the reliance on parental consent before proceeding. their own treatment. 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. 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. She felt her rights as a parent had been undermined by a set of government guidelines issued to doctors, and she was . If the client has Gillick competence, they have the right to make decisions without parental consent and be granted confidentiality. 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. Edinburgh: Scottish Executive. 947 This test is known as the Gillick competence test. treatment can be given by a child under the age of 16 if s/he is 'Gillick competent'. However The subsequent 1983 judgement set out criteria for establishing whether a child under 16 has the capacity to provide consent . Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? 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. Scottish Executive Health Department (2006). Failure to obtain the co-operation of the children will make it very difficult to safely give the MMR. << /Length 5 0 R /Filter /FlateDecode >> As such, medical staff will not make a disclosure of medical records of a child who is deemed Gillick competent unless consent is manifest. Care Quality Commission (2019). 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. 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. 2K Yf0t or treatment with or without parental consent, although Treatment (Gillick Competence) Child and Youth form is an optional tool for documenting the outcome of a capacity assessment with a patient. 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. A licensed medical The decision to proceed with an intervention such as an injection is for the nurse to make based on their clinical judgement. 4 0 obj Lr52 Y&(?~B?"2b`B)Q The Fraser guidelines specifically relate only to contraception and sexual health. Any other browser may experience partial or no support. Care Quality Commission. Gillick competence is a functional ability to make a decision. Where a health professional accepts the consent of a Gillick competent child it cannot be overruled by the child's parent. has attained the age of sixteen years to any surgical, medical or dental treatment 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. It may also be interpreted as covering youth 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. p/ 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. You should always encourage a child to tell their parents or carers about the decisions they are making. 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. In 1982 Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without parental consent. 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. > Find out more about the Library and Information Service. independence. In order to provide valid consent, the patient must do all four of the following: Children 16-18 years old are presumed to have capacity and generally treated like adults with regard to consent. What is the Age of Legal Capacity (Scotland) Act 1991? -'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 Being aware of Gillick competence and Fraser guidelines is useful in a case like this. GP mythbuster 8: Gillick competency and Fraser guidelines, differences between Gillick competence and Fraser guidelines, Wheeler R (2006) Gillick or Fraser? Children who are 16 years old and over can be expected to have capacity to consent to treatment. 15 August 2022. This is known as being Gillick competent. The means by which to assess legal capacity in children under the age of 16 years, established in the case Gillick v West Norfolk and Wisbech Area Health Authority (1985) 2 A11 ER 402. sometimes termed as Gillick Competence, is granted to a person under the age of 18 where they can demonstrate sufficient insight and understanding of major decisions . Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020). 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. 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. Calls to 0800 1111 are free and children can also contact Childline online or read about childrens rights on the Childline website. Such children are deemed to be capable of giving valid consent to advice or treatment without parental knowledge or . The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. Health professionals who behave in this way would be failing to discharge their professional responsibilities and could expect to be disciplined by their professional body.Citation5 Where a child is considered Gillick competent then the consent is as effective as that of an adult and cannot be overruled by a parent. 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. Where both parents and a Gillick competent child refuse then resorting to litigation is likely to be an ineffective approach. For example, you could talk to the young person's parents or carers on their behalf. endobj However, Scots Law has gone beyond Gillick with the enactment in 1991 of the Age of Legal Capacity (Scotland) Act (the 'Scottish Act'). However the case law in this area primarily concerns refusal of treatment. It does not compel nurses to provide the treatment. At one end there are the obvious cases where parental objection would have no value in child welfare terms, for example urgent lifesaving treatment such as a blood transfusion. 08/12/20. >> /Font << /TT2 10 0 R /TT1 9 0 R >> /XObject << /Im1 11 0 R >> >> 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 . If a Gillick-competent child consents to treatment, a parent cannot override that consent. Under the Family Proceedings Rules 1991 a penal notice may be attached to a specific issues order. It is not just an ability to choose . It is task specific so more complex procedures require greater levels of competence. useGPnotebook. In fact, the court held that parental rights did not exist, other than to safeguard the best interests of a minor. 'S parents or carers about the Library and information Service child under 16 refuses a treatment. Physical health 2b ` B ) Q the Fraser guidelines specifically relate only contraception... Reasoning and decision making the client has Gillick competence is related to cognitive ability and experience may! Presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be Mature enough to decide themselves... 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