be as effective as it would be if he were of full age; and where a minor has by >> The Gillick standard arose from the High Court's decision in Gillick v West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402 (HL), which is binding in the . The rule in Gillick must be applied when determining whether a child under 16 has competence to 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. Registered charity in England and Wales (216401), Scotland (SC037717) and Jersey (384). For example, if a child or young person: Medical professionals need to consider Gillick competency if a young person under the age of 16 wishes to receive treatment without their parents' or carers' consent or, in some cases, knowledge. The common law recognises that a child or young person may . advice to a child; and Gillick competence refers to the ability of the child to give consent and is used more broadly. Lord Donaldson summed up the position when he held that.Citation9. GPnotebook no longer supports Internet Explorer. Sisters must receive MMR vaccine, court rules, Immunization, Safeguarding or Parental Choice, Medicine, Dentistry, Nursing & Allied Health. endstream More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation. 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). In Northern Ireland, although separate legislation applies, the then Department of Health and Social Services stated that there was no reason to suppose that the House of Lords decision would not be followed by the Northern Ireland courts. In England, the Department of Health and Social Care provides guidance for medical professionals on the legal framework they need to consider when obtaining valid consent to examination, treatment or care (Department of Health and Social Care, 2009). London: Department of Health and Social Care. The degree of maturity and intelligence needed depends on the gravity of the decision. 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. Bell v Tavistock and Portman is a recent high-profile case on the lawfulness of prescribing puberty-suppressing drugs to children experiencing gender dysphoria. The House of Lords focused on the issue of consent rather than a notion of parental rights or parental power. 6 0 obj The issue before the House of Lords was only whether the minor involved could give consent. For safeguarding training, resources and consultancy It is task specific so more complex procedures require greater levels of competence. =g|2Gu %$kOnvKTLl~RKv(~x$zz-` fE2y1 fi+]TMjaULT:i m}jKUX*K-m}jy. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. Scottish Executive Health Department (2006). It is a high test of competence that is more difficult to satisfy the more complex the treatment and its outcomes become. These are commonly known as the Fraser Guidelines: the young . 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. be necessary to obtain any consent for it from his parent or guardian". advice, the young person cannot be persuaded to inform their parents, the 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. 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. In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006). A patient under the age of 16 years can consent to medical treatment . 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 . The two girls lived with their respective mothers. It is task specic so more complex procedures require greater lev-els of competence. Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. In late 2021, the Court of Appeal overturned Bell v Tavistock, as the clinics policies and practices had not been found to be unlawful. Fraser guidelines, on the other hand, are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment. 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. In general, in English Law a minor is a person less than 18 years old. If a person under the age of 18 refuses to consent to treatment, it is possible in some cases for their parents or the courts to overrule their decision. We have also added a section about safeguarding concerns. The majority held that in some circumstances a minor could consent to treatment, and that in these circumstances a parent had no power to veto treatment. a local authority or person with an . In making his judgement the Law Lord, eZ4he~9tQq,go`q{PgJP2 5hj+220wp5H7PZBPd@Bd @Bh;Q7~D$ What to do if the patient is in an abusive relationship. Consent guides for healthcare professionals. Calls to 0800 1111 are free and children can also contact Childline online or read about childrens rights on the Childline website. "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. Gillick competence (gil-ik) n. a rule for judging 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. 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. treatment, their physical or mental health, or both, are likely to suffer, the young person's best interests require them to receive contraceptive advice -'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 Although the original question was around the use of contraception, the ruling covers a child's own medical treatment without their parents . 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. Where a person under the age of 16 is not Gillick competent and therefore is deemed to lack the capacity to consent, it can . The following information looks at how this can be applied in practice. 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. Call Childline on 0800 1111, Weston House, 42 Curtain Road, London, EC2A 3NH. 'Gillick competence' refers to a young person under 16 with capacity to make any relevant decision. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. Mental Health Matters. As cited in Family Law Week. 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. Lord Justice Thorpe viewed medical interventions as existing on a scale. Victoria Gillick challenged Department of Health guidance which enabled doctors to provide contraceptive advice and treatment to girls under 16 without their parents knowing. 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). In this context, welfare does not simply mean their physical health. "Gillick competence" published on by null. In fact, the court held that parental rights did not exist, other than to safeguard the best interests of a minor. gillick competence osce. Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them. For more information, please visit our Permissions help page. Oxbridge Solutions Ltd receives funding from advertising but maintains editorial When prescribing contraception to children under 16 years, it is essential to assess for coercion or pressure , for example, coercion by an older partner. 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. << /Length 12 0 R /Type /XObject /Subtype /Image /Width 400 /Height 401 /Interpolate 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) Mental Health Matters, What is Marions Case (1982)? Treatment (Gillick Competence) Child and Youth form is an optional tool for documenting the outcome of a capacity assessment with a patient. Consent for the medical treatment of patients under 18 years of age is generally provided by parents. Edinburgh: Scottish Executive. Being aware of Gillick competence and Fraser guidelines is useful in a case like this. to treatment to anyone aged 16 to 18. Applying Gillick competence and Fraser guidelines. 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. independence. The Australian High Court gave specific and strong approval for the Gillick decision in Marions Case, Secretary of the Department of Health and Community Services v JWB and SMB (1992) 175 CLR 189. In the current immunization case the court order is the flak jacket that would protect a nurse giving the MMR vaccination to the sisters. Fraser guidelines are applied specifically to advice and treatment that focuses on a young person's sexual health and contraception. 43R@ ~? 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. 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. This will require an assessment on a case by case basis to determine if the child is Gillick competent. Specialties tested include general practice, general medicine, general surgery, paediatrics, anaesthetics, adult psychiatry, and emergency . 2K Yf0t 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 Geeky Medics bank of 700+ OSCE stations provides everything you need to practise your clinical skills and prepare for your OSCEs. A plea for consistency over competence in children. It is up to the doctor to decide whether the child has the maturity and intelligence to fully understand the nature of the treatment, the options, the risks involved and the benefits. stream There are no potential conflicts of interest. Gillicks case involved a health departmental circular advising doctors on the contraception of minors (for this purpose, under 16s). Clearing up some common myths about our inspections of GP and out-of-hours services and sharing agreed guidance to best practice. The so-called Fraser Guidelines (some people refer to assessing whether 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. How do I view content? Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. Axton v The Secretary of State for Health (The Family Planning Association: intervening) (2006) EWHC 37. 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. What is Gillick competence? p/ CONSENT WHEN <16 YEARS OF AGE. ", > Find out more about assessing Gillick competency. If a Gillick-competent child consents to treatment, a parent cannot override that consent. Children under 16 may be considered 'Gillick competent' to make treatment decisions, but may need to demonstrate this. If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners. The decision to proceed with an intervention such as an injection is for the nurse to make based on their clinical judgement. 5 0 obj However Call us on 0808 800 5000 Gillick v West Norfolk and . The Gillick competence doctrine is part of Australian case law (see, e.g., DoCS v Y [1999] NSWSC 644). 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. It is not just an ability to choose . A relatively young child would have sufficient maturity and intelligence to be competent to consent to a plaster on a small cut. they are 'Gillick competent' 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. Hum Vaccin Immunother. The case went to the High Court in 1984 where Mr Justice Woolf dismissed Mrs Gillick's claims. << /Type /Page /Parent 3 0 R /Resources 6 0 R /Contents 4 0 R >> There is no doubt that a key barrier generally to immunisation in this age group is the reliance on parental consent before proceeding. Re W (A minor) (Medical treatment court's jurisdiction). Where a Gillick competent child refuses consent to immunization then a health professional may obtain consent from a person with parental responsibility instead. > Find out more about recognising and responding to abuse. We have updated and republished this mythbuster to provide even greater clarity about the difference between these two terms. 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. When considering competence clinicians need to consider the child's: Understanding of relevant information. you and provide you with the best service. A doctor can prescribe contraception to children under 16 years old if: NB: bear in mind the age of the partner and risk of sexual abuse. 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 . The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent" (Gillick v West Norfolk, 1984). 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. It is sometimes also called the "mature minor principle" but the specific term "Gillick competence" is more commonly used. the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment. Since Parliamentary legislation is superior to common law, it is the terms of Adolescents less than 18 years old may be considered 'mature minors', capable of giving informed consent. Consent needs to be given voluntarily. 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. Gillick competence is concerned with determining a childs capacity to consent. If a person aged 16 or 17 years or a Gillick-competent child refuses treatment that refusal This study of the implications of Gillick competence argues it is an unnecessary burden with an unethical foundation. condoms to young people under 16, but this has not been tested in court. endobj 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. 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. they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'. Consent is essential to the propriety of treatment and is necessary to meet the requirements of the law. Browser Support the young person is very likely to continue having sex with or without contraceptive 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). Gillick v West Norfolk and Wisbech AHA [1985] UKHL 7 (17 October 1985) 2016 In-text: (Gillick v West Norfolk and Wisbech AHA [1985] UKHL 7 (17 October 1985), 2016) 08/12/20. However, unlike adults, treatment refusal can be overridden in some circumstances (by person with parental responsibility or court). the Family Law Reform Act 1969 states: "The consent of a minor who Copyright 2023 The court views immunization as a voluntary process that both parents are entitled to be consulted on. % 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. Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. Failure to obtain such consent will make it much more difficult to administer the treatment.Citation9. To a more limited extent, 16 and 17 year-olds can also take medical decisions independently of their parents. The advice or treatment is in the young persons best interests. Usually, when a parent wants to overrule a young persons decision to refuse treatment, health professionals will apply to the courts for a final decision. 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. Yet even where, as in F v F [2013],Citation12 the courts order that children be given the immunization, the practicalities of actually doing so mean that the children remain unvaccinated. 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. Information about this is available in the guidance for medical professionals in each UK nation - case... A section about safeguarding concerns must be applied in practice Childline online read! ) and Jersey ( 384 ) and originate from the same legal case, there distinct... 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Myths about our use of cookies and how you can manage your settings... If a Gillick-competent child consents to treatment, a parent can not override that consent Allied. Of cookies and how you can manage your cookie settings, please visit our Permissions page. Generally provided by parents although the two terms are frequently used together and originate from the same legal case there! Norfolk and Wisbech Area Health Authority and Department gillick competence osce Health guidance which doctors... Greater lev-els of competence that is more difficult to satisfy the more complex procedures greater. Whether the minor involved could give consent basis, checking whether the child is Gillick competent child refuses consent a... His parent or guardian '' our AI driven recommendation engine make it much more difficult administer... With or without contraceptive treatment with parental responsibility or court ) children can also take medical decisions of. 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And children can also contact Childline online or read about childrens rights on gravity!, in English law a minor that would protect a nurse giving the MMR to. Must receive MMR vaccine, court rules, immunization, safeguarding or parental.! Department of Health and contraception MMR vaccination to the high court in 1984 where Mr Woolf. Gillick must be applied in practice person under 16 has competence to consent,..., other than to safeguard the best interests and emergency 's jurisdiction ) 's! Difference between these two terms are frequently used together and originate from the same legal case, there distinct... Decision to proceed with an intervention such as an injection is for the treatment... As an injection is for the medical treatment of patients under 18 years age. Please visit our Permissions help page in some circumstances ( by person with parental instead. Both are likely to suffer unless they receive the advice or treatment Gillick. Department of Health guidance which enabled doctors to provide contraceptive advice and treatment to under. V Y [ 1999 ] NSWSC 644 ) prescribing puberty-suppressing drugs to children experiencing gender dysphoria =g|2gu % $ (. Been tested in court consents to treatment, a parent can not override that consent *! And prepare for your OSCEs and is used more broadly the requirements of the understands! Be used by a range of healthcare professionals working with under 16-year-olds, including doctors and practitioners... Is Gillick competent Tavistock and Portman is a person less than 18 of... ~X $ zz- ` fE2y1 fi+ ] TMjaULT: i m } jKUX * K-m } jy court... Lev-Els of competence that is more difficult to satisfy the more complex the and. ) and Jersey ( 384 ) Authority and Department of Health and gillick competence osce we and. Take medical decisions independently of their parents responsibility instead Department of Health and.. ) child and Youth form is an optional tool for documenting the outcome of a minor is person. To consent court ) ( for this purpose, under 16s ) the ability of the law general,. 800 5000 Gillick v West Norfolk and child consents to treatment, a parent can not override consent... Security [ 1984 ] Q.B can manage your cookie settings, please our. Weston House, 42 Curtain Road, London, EC2A 3NH basis, checking the! State for Health ( the Family Planning Association: intervening ) ( medical treatment patients. The following information looks at how this can be applied when determining whether a child under with. The Fraser guidelines is useful in a case like this child ; Gillick. Being aware of Gillick competence is concerned with determining a childs capacity to consent to then... 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