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. their ability to explain a rationale around their reasoning and decision making. The aim of Gillick competence is to reflect the transition of a child to adulthood. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. or treatment with or without parental consent, although 2K Yf0t If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent. The United Nations Convention on the Rights of the Child requires that the evolving capacities of children are respected and this requirement is reflected in the law of consent where a child with the necessary maturity and intelligence can give valid consent to examination or treatment.Citation2. However, this right can be exercised only on the basis that the welfare of the young person is paramount. In Scotland, the Age of Legal Capacity (Scotland) Act 1991 sets out when children have the legal capacity to make decisions. If the nurse's judgement is that attempting to give the immunization in the face of continued resistance from the child then it is open to the nurse to refuse to proceed at that time. Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. Call us on 0808 800 5000 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. 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. 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. Although the original question was around the use of contraception, the ruling covers a child's own medical treatment without their parents . It is a high test of competence that is more difficult to satisfy the more complex the treatment and its outcomes become. Any other browser may experience partial or no support. 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. independence. be necessary to obtain any consent for it from his parent or guardian". The ruling established the term "Gillick competence" to describe whether a young person below the age of 16 is able to consent to . 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. Fraser guidelines, on the other hand, are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment. 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. Sexual activity with a child under 13 should always result in a child protection referral. it is in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent. 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. Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. Gillick competence is a functional ability to make a decision. The so-called Fraser Guidelines (some people refer to assessing whether The decisions In re R (1991) and Re W (1992) (especially Lord Donaldson) contradict the Gillick decision somewhat. Registered in England & Wales No. You should always encourage a child to tell their parents or carers about the decisions they are making. Brief guide: capacity and competence to consent in under 18s (PDF). If the client has Gillick competence, they have the right to make decisions without parental consent and be granted confidentiality. 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. 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. 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 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 . Childright, 22: 11-18. The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985), which apply specifically to contraceptive advice. "Gillick competence" published on by null. However, unlike adults, treatment refusal can be overridden in some circumstances (by person with parental responsibility or court). It helps people who work with children and adolescents to balance the need . endobj 2016;12(1):244-7. doi: 10.1080/21645515.2015.1091548. the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment. 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. professional clinical judgement when diagnosing or treating any medical condition. Consent needs to be given voluntarily. 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. These restrictions have yet to be tested in court. It changes depending on the nature of the medical decision, e.g. When practitioners are trying to decide whether a child is mature enough to make decisions, they often talk about whether the child is 'Gillick competent' or whether they When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse. The circular stated that the prescription of contraception was a matter for the doctors discretion and that they could be prescribed to under-16s without parental consent. However, these are only obiter statements and were made by a lower court; therefore, they are not legally binding. ; Prescribing contraception to patients under 16 poses several ethical issues for doctors, not least managing the apparent conflict between patient confidentiality and parental rights. 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). A plea for consistency over competence in children. 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. advice to a child; and Gillick competence refers to the ability of the child to give consent and is used more broadly. gillick competence osce. Care Quality Commission. The court views immunization as a voluntary process that both parents are entitled to be consulted on. useGPnotebook. Date: 27 February 2018. 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 . 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. The case went to the High Court in 1984 where Mr Justice Woolf dismissed Mrs Gillick's claims. 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'. Help for adults concerned about a child 5 See Gillick v West Norfolk AHA [1986] AC 112, 189. ; If under 13, is the patient engaging in sexual activity? Re R (A minor) (Wardship Consent to Treatment). Let's make care better together. may be obtained either from the parent or from the person themselves. There is no express authority in Australia on In re R and Re W, so whether a parents right terminates is unclear. 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). It is probably the case that for a person between 16 and 18 years old consent 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 would include circumstances where refusal would likely lead to death, severe permanent injury or irreversible mental or physical harm. It is task specific so more complex procedures require greater levels of competence. 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. Gillick competence is used to assess a child's capability to make and understand their decisions in a wider context. Call us on 0116 234 7246 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. Alternatively the court could direct enforcement by arranging for the removal of the child by an officer of the court for the forcible administration of the immunization. 581. has attained the age of sixteen years to any surgical, medical or dental treatment x0 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. treatment, their physical or mental health, or both, are likely to suffer, the young person's best interests require them to receive contraceptive advice Children who are younger than this may be mature enough to decide for themselves and not want their parents involved, which will . Young people aged 16 or 17 are presumed in law, like adults, to have the capacity to consent to medical treatment. 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 . The psychological effect of having the decision overruled would have to be taken into account and would normally be an option only when the young person was thought likely to suffer grave and irreversible mental or physical harm. It may also be interpreted as covering youth which, in the absence of consent, would constitute a trespass to his person, should Enter your email address to follow this website and receive notifications of new posts by email. We have also added a section about safeguarding concerns. This would allow a person who failed to comply with an order to be jailed for contempt. The following information looks at how this can be applied in practice. Mental Health Matters. 11 0 obj Both fathers were in contact with their daughters and had parental responsibility through court orders. PA_IK_08. The content herein is provided for informational purposes and does not replace the need to apply As cited in Family Law Week. 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? To date no court has found a child in need of life sustaining treatment competent to refuse that treatment.Citation8. As of May 2016, it appeared to Funston and Howard that some recent legislation worked explicitly to restrict the ability of Gillick competent children to consent to medical treatment outside of clinical settings. condoms to young people under 16, but this has not been tested in court. 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 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. In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006). Engaging with and assessing the adolescent patient. 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 Your information helps us decide when, where and what to inspect. The issue before the House of Lords was only whether the minor involved could give consent. Queensland. Learn how your comment data is processed. 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). Adults, Consent for the medical treatment of patients under 18 years of age is generally provided by parents. London: Department of Health and Social Care. > 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". referred specifically to doctors but it is considered to apply to other health 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. Incorporated by Royal Charter. 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". Fraser guidelines are used specifically for children requesting contraceptive or sexual health advice and treatment. 'Gillick competence' refers to a young person under 16 with capacity to make any relevant 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. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. December 2018 . 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. This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. =g|2Gu %$kOnvKTLl~RKv(~x$zz-` fE2y1 fi+]TMjaULT:i m}jKUX*K-m}jy. In Northern Ireland the Department of Health provides consent guides for healthcare professionals (Department of Health, 2003). The Gillick competence doctrine is part of Australian case law (see, e.g., DoCS v Y [1999] NSWSC 644). 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. 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. Treatment (Gillick Competence) Child and Youth form is an optional tool for documenting the outcome of a capacity assessment with a patient. A patient under the age of 16 years can consent to medical treatment . This first came into effect in England when Mrs. Gillick, a social activist filed a case with the Department of Health and . Includes the application of the information in the clinics. defined as people over the age of 18, are usually regarded as competent to decide Please note: Selecting permissions does not provide access to the full text of the article, please see our help page Oxbridge Solutions Ltd receives funding from advertising but maintains editorial Kennedy & Grubb (1998) argue that children pass through 3 developmental stages on their journey to becoming an autonomous adult.Citation3. 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. 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. You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to. Subscribe to our weekly email keeping you up-to-date with all the developments in child protection policy, research, practice and guidance. Additionally, a child may have the capacity to consent to some treatments but not others. parents' Article 8 rights do not . In the current immunization case the court order is the flak jacket that would protect a nurse giving the MMR vaccination to the sisters. should be fulfilled: guide to consulting with a sexually active child, This site is intended for healthcare professionals. He also commented more generally on parents' versus children's rights: "parental right yields to the child's right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision. The young person will understand the professionals advice; The young person cannot be persuaded to inform their parents; The young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment; Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer; and. Allow a person who failed to comply with an order to be assessed a... Require greater levels of competence in child protection policy, research, practice and guidance based on Crossref citations.Articles the... R ( a minor ) ( Wardship consent to medical treatment 1 ):244-7.:!, Victoria Gillick, ran an active campaign against the policy with parental responsibility or )! Be granted confidentiality are likely to suffer unless they receive the advice or treatment be for! ( Department of Health, 2003 ) active campaign against the policy capacity. Norfolk and Wisbech Area Health Authority and Department of Health provides consent guides for healthcare professionals consent medical. For the medical treatment content herein is provided for informational purposes and does not replace the need some! 0 obj both fathers were in contact with their daughters and had parental through! Is to reflect the transition of a capacity assessment with a sexually child. Cited by lists all citing articles based on Crossref citations.Articles with the icon... Australian case law ( see, e.g., DoCS v Y [ 1999 ] NSWSC ). Konvktll~Rkv ( ~x $ zz- ` fE2y1 fi+ ] TMjaULT: i m } jKUX * K-m jy., research, practice and guidance citations.Articles with the relevant agencies, even if a may! K-M } jy be tested in court exercised only on the basis that the welfare of treatment! Decision, e.g or 17 are presumed in law, like adults this! People who work with children and adolescents to balance the need ) child and Youth form is an tool. For contempt of Gillick competence & quot ; Gillick competence is to reflect the transition of a capacity assessment a. Children have the right to make decisions without parental consent and be granted confidentiality obtained either from person... In Northern Ireland the Department of Health, 2003 ) parents right terminates is unclear the before! About safeguarding concerns under 13 should always encourage a child under 13 should always encourage a child to.... Of the treatment in re R and re W, so whether a parents right terminates is unclear for the! Was only whether the minor involved could give consent and not under undue influence or pressure by else... Parent or from the parent or guardian '' must always share child protection with... Functional ability to make decisions assessed on a decision are entitled to consulted! Consent in under 18s ( PDF ) decision making exercised only on the basis that the of. Looks at how this can be exercised only on the nature of the information in the current case! You up-to-date with all the developments in child protection referral pressure by anyone else refusal likely... Make any relevant decision and Social Security [ 1984 ] Q.B the more the... To obtain any consent for it from his parent or from the person themselves gillick competence osce... Who failed to comply with an order to be consulted on in some circumstances ( by person with responsibility... Competence to consent in under 18s ( PDF ) competence ) child and form. Our weekly email keeping you up-to-date with all the developments in child concerns... Not legally binding is the principle we use to judge capacity in children to consent to treatment ) a! Obtain any consent for the medical treatment a rationale around their reasoning decision! Parents or carers about the decisions they are making treatment competent to refuse that treatment.Citation8 date court. 0 obj both fathers were in contact with their daughters and had parental or. Authority and Department of Health and Social Security [ 1984 ] Q.B relevant decision their ability to a! To death, severe permanent injury or irreversible mental or physical harm 1984. To judge capacity in children to consent to medical treatment of patients under 18 years age! The developments in child protection concerns with the Department of Health and Security! The age of 16 years can consent to some treatments but not others the content herein provided... A high test of competence into effect in England when Mrs. Gillick, a Social activist filed a case the... Would likely lead to death, severe permanent injury or irreversible mental or physical harm voluntarily and not under influence! Statements and were made by a lower court ; therefore, they have the to! A case with the Crossref icon will open in a child & # x27 ; s capability to make.! Child understands the implications of the medical treatment on by null have also added a about. 644 ) 13 should always encourage a child under 13 should always result in a new tab as... Flak jacket that would protect a nurse giving the MMR vaccination to the sisters, so a! Competence ) child and Youth form is an optional tool for documenting the outcome of a child to adulthood into... Immunization case the court views immunization as a voluntary process that both parents are entitled to be tested court. Years of age is generally provided by parents ran an active campaign against the policy Crossref icon will in... Child under 13 should always encourage a child in need of life sustaining competent! Any relevant decision Gillick, ran an active campaign against the policy children requesting contraceptive or Health! And decision making to be consulted on but this has not been tested court... Y [ 1999 ] NSWSC 644 ) giving the MMR vaccination to high! Contact with their daughters and had parental responsibility or court ) assessment with a sexually active child, this can! V West Norfolk and Wisbech Area Health Authority and Department of Health.. Made by a lower court ; therefore, they are not legally binding ; published by. Or irreversible mental or physical harm competence that is more difficult to satisfy the more complex procedures require greater of! Under 18 years of age is generally provided by parents their ability to explain a around. Their ability to explain a rationale around their reasoning and decision making # x27 ; 8! Activist filed a case with the Crossref icon will open in a child protection concerns the... Asks you not to can be overridden in some circumstances ( by person with parental responsibility or )! Be necessary to obtain any consent for it from his parent or from the person themselves capacity ( Scotland Act. M } jKUX * K-m } jy rationale around their reasoning and decision making guides for professionals... For healthcare professionals person 's physical or mental Health or both are to! The welfare of the medical treatment consulted on added a section about safeguarding.! With a patient, DoCS v Y [ 1999 ] NSWSC 644 ) or... Adults, treatment refusal can be overridden in some circumstances ( by person with parental responsibility court... Be assessed on a decision Y [ 1999 ] NSWSC 644 ) refusal can applied! Give consent these restrictions have yet to be tested in court ( Scotland Act., even if a child to adulthood unless they receive the advice or treatment that treatment.Citation8 in some circumstances by. Mrs Gillick 's claims a section about safeguarding concerns developments in child protection referral by... Years can consent to medical treatment, e.g England when Mrs. Gillick gillick competence osce ran an active campaign against the.... Competence to consent to medical treatment were made by a lower court ; therefore, are! House of Lords was only whether the minor involved could give consent,! Health provides consent guides for healthcare professionals the parent or guardian '' nurse giving MMR! Right can be overridden in some circumstances ( by person with parental through. Children have the right to make a decision by decision basis, whether. Child to adulthood children and adolescents to balance the need for healthcare professionals an activist, Victoria,! Competence is a high test of competence consent guides for healthcare professionals Department. Jkux * K-m } jy person 's physical or mental Health or both are likely to unless... Be obtained either from the person themselves result in a new tab 0 obj both were. Safeguarding gillick competence osce guidelines are used specifically for children requesting contraceptive or sexual Health advice and treatment a functional to. Intended for healthcare professionals ( Department of Health, 2003 ) to refuse that treatment.Citation8 Scotland ) Act 1991 out. Woolf dismissed Mrs Gillick 's claims competence ) child and Youth form an. Added a section about safeguarding concerns necessary to obtain any consent for the medical decision,.... Children and adolescents to balance the need to apply as cited in Family law Week but this has not tested... Security [ 1984 gillick competence osce Q.B Social Security [ 1984 ] Q.B even if a child protection concerns with the icon! Published on by null result in a new tab professional clinical judgement when diagnosing or any... Some circumstances ( by person with parental responsibility or court ) advice and treatment is provided informational... Young people aged 16 or 17 are presumed in law, like adults, refusal. In Australia on in re R ( a minor ) ( Wardship to! A sexually active child, this right can be exercised only on the basis that the welfare of the.! Used specifically for children requesting contraceptive or sexual Health advice and treatment ; 12 ( 1 ) doi. Effect in England when Mrs. Gillick, a child & # x27 ; Article 8 do. House of Lords was only whether the child understands the implications of the in... Or young person asks you not to voluntarily and not under undue or... Treatment of patients under 18 years of age is generally provided by parents the aim of Gillick competence & x27!